Attila Keresztúri

Effect of Female Body Weight on Efficiency of Donor AI

A total of 1144 infertile women were treated by artificial donor insemination. Unsuccessful ovulation induction was found in 96 of these cases. The obese women (BMI: 28-36) had a relative risk of unsuccessful ovulation induction of 2.7 (95% confidence interval (CI)=2.1-3.4) compared with women lower or normal body weight (BMI: 20-24). The effect was smaller in women with a BMI 25-27 or <19 (relative risk (RR)=1.4, 95% CI=0.9-2.1 and 1.5, 95% CI=0.8-2.5), respectively. During the AID treatment 412 pregnancies occurred. Pregnancy rate achieved by insemination was 28% (50 pregnancies per 178 cases, BMI 16-19), 42% (251/599, BMI 20-24), 33% (92/286, BMI 25-27), and 21% (19/81, BMI 28-36), respectively, in the different BMI groups.

Four years experience of first-trimester nuchal translucency screening for fetal aneuploidies with increasing regional availability

Background. A prospective screening study was carried out at the regional genetic and perinatal center in South Hungary in order to determine the efficiency of first‐trimester nuchal translucency screening for fetal aneuploidies, following augmentation of the availability of nuchal translucency screening in the region by the inclusion of newly‐trained hospital sono‐graphers.

The Edinburgh Postnatal Depression Scale: Translation and antepartum validation for a Hungarian sample

OBJECTIVE the Edinburgh Postnatal Depression Scale (EPDS) is an important screening instrument routinely used during the peripartum period for the identification of depression. The purpose of the study was to assess the validity of the 10-item EPDS in screening for antepartum depression (APD) in Hungary. DESIGN validation study carried out between July and December 2010. SETTING Department of Obstetrics and Gynecology, University of Szeged, Hungary. PARTICIPANTS 219 women attending a routine check-up at 12 weeks antepartum. INTERVENTIONS participants completed the newly translated Hungarian version of the EPDS and underwent a clinical assessment with the Structured Clinical Interview for DSM-IV disorders (SCID-I). MEASUREMENT AND FINDINGS seven (3.2%) of the mothers were diagnosed with major antepartum depression and 15 persons (6.85%) with minor depression on the basis of the SCID. Internal consistency of the EPDS was satisfactory (Cronbach α coefficients ≥0.728). The best cut-off on the Hungarian version of the EPDS for major depression was 8/9, with a sensitivity of 71.4%, and a specificity of 91.5%. The area under the ROC curve was found significant for combined depression as well and at a cut-off of 6/7 indicated a sensitivity of 81.8% and a specificity of 83.2%. KEY CONCLUSIONS the EPDS showed acceptable validity despite a considerable scatter in the total scores in our sample. IMPLICATION FOR PRACTICE the EPDS is a reliable instrument for the screening of depressive disorders, especially major depressive disorder in early pregnancy among Hungarian women.

Identification of Causes of Stillbirth Through Autopsy and Placental Examination Reports

The autopsy and placental histopathological examination results following fetal deaths were analyzed retrospectively in an attempt to explain the stillbirths that occurred from 1996 to 2010 at the Department of Obstetrics and Gynecology, University of Szeged. One hundred and forty fetal deaths were recorded in that period, i.e. a rate of 4.69 stillbirths per 1000 deliveries. The postmortem examination provided the exact cause of the fetal death in 57.9% of the cases. The most common causes were a placental insufficiency (46.9%) and an umbilical cord complication (25.9%). In the first half of the third trimester, a placental insufficiency predominated as the cause of stillbirth, whereas mainly umbilical cord complications occurred around term. In spite of the availability of the autopsy and histopathological examination results, the proportion of unexplained stillbirths in our sample was relatively high. A considerable proportion of stillbirth cases could probably be prevented by more effective screening of a placental insufficiency.

Validation of the Edinburgh Postnatal Depression Scale as a screening tool for postpartum depression in a clinical sample in Hungary

BACKGROUND the purpose of the study was to assess the validity of the 10-item Edinburgh Postnatal Depression Scale (EPDS) in screening for postnatal depression (PND) in Hungary. METHODS between July 2010 and March 2011, a sample of 266 women attending a routine check-up at six weeks post partum completed the newly translated Hungarian version of the EPDS at the Department of Obstetrics and Gynecology, University of Szeged, Hungary, and underwent clinical assessments based on the Structured Clinical Interview for DSM-IV disorders (SCID-I). FINDINGS eight (3.0%) of the mothers were diagnosed with major postnatal depression, and 36 (13.5%) with minor depression on the basis of the SCID. Internal consistency of the Hungarian version of the EPDS was satisfactory (Cronbach α coefficients ≥0.727). The best cut-off for major depression was 12/13, with a sensitivity of 100.0%, and a specificity of 97.7%. The area under the ROC curve was found significant for combined (major+minor) depression as well and at a cut-off of 7/8 indicated a sensitivity of 72.7% and a specificity of 86.0%. A factor analysis suggested multidimensionality with two factors (anxiety and depression). CONCLUSIONS the EPDS showed good validity in the postnatal period in a clinical sample in Hungary.

Non‐medical determinants of cesarean section in a medically dominated maternity system

To assess the contribution of non‐medical factors to actual mode of delivery in a setting with high cesarean rates.

Pregnancy Rate after Controlled Ovarian Hyperstimulation and Intrauterine Insemination for the Treatment of Endometriosis following Surgery

Objective. To compare pregnancy rate after controlled ovarian hyperstimulation and intrauterine insemination (COH-IUI) with no treatment in patients with endometriosis-associated infertility treated with laparoscopy. Design. A clinical cohort study. Setting. University-level tertiary care center. Patients. 238 women with various stages of endometriosis after laparoscopic treatment. Interventions. Either COH-IUI or follow-up for 12 months. Main Outcome Measures. The primary outcome measures were clinical pregnancy and live birth rate. Predictive factors evaluated were female age, maternal BMI, and duration of infertility. Results. The pregnancy rate attained after the integrated laparoscopy–COH-IUI approach was 53.4%, while it was significantly lower (38.5%) in the control group. Similarly, a significant difference was observed in live births (48.3% versus 34.2%). Patients with severe endometriosis were less likely to achieve pregnancy (38%) and live birth (35%) than their counterparts with milder forms (57% and 53%). Conclusions. In patients with endometriosis-based infertility, surgery followed by COH-IUI is more effective than surgery alone.

Magnetic resonance vs. sonographic imaging: diagnostics of a large congenital pulmonary airway malformation.

Sonographic scan revealed a homogenously hyperechogenic lesion in the right fetal lung with microcystic pattern by a primigravid women at 22nd weeks of gestation. A large congenital pulmonary airway malformation (CPAM) was suspected with a lesion-to-lung ratio over 90%. The microcystic image of this thoracic anomaly was moderately visible on magnetic resonance imaging (MRI) at that early stage of the pregnancy. Fetopsy confirmed the diagnosis as a pure microcystic CPAM following termination of pregnancy. A controlled prospective study could be performed to compare ultrasound as a diagnostic modality to the MRI, focusing on volumetry, signal characteristics, and follow-up/regression of fetal pulmonary malformations.

Effects of aromatase inhibitor on menopausal hyperplasia in a case of obesity

The aromatase inhibitor anastrazole proved effective in the treatment of endometrial hyperplasia and postmenopausal bleeding in an obese 65-year-old woman with high operative risk. During anastrazole administration for 12 months, the endometrial thickness decreased from 9.8 mm to 2.4 mm and the control endometrial histology showed an atrophic endometrium. Uterine bleeding did not occur in the post-treatment, 3-year follow-up period. The endometrial thicknesses measured yearly by ultrasonography were 2.9, 3.5 and 3.3 mm. The plasma estradiol levels increased from < 73 pmol/l post-treatment to 112, 98 and 103 pmol/l. This case demonstrates that long-term aromatase inhibitor treatment can result in a refractory status of the endometrium and the estradiol produced in the adipose tissue does not exert a proliferative effect.

Results of insemination (AIH) following GnRH treatment of endometriosis.

Endometriosis is one of the most frequent benign diseases in gynecology. It is the cause of the pelvic pain and infertility in more than 35% of women of reproductive age. The most appropriate treatment for endometriosis is the combination of surgery and adjuvant medical therapy with GnRH agonists. The authors demonstrate the results of 33 artificial intrauterine homolog inseminations after a 6-month GnRH analog therapy.