Knowledge and attitudes of female university students on menstrual cycle and contraception.

Socioeconomic changes, as well as the development of new contraceptive modalities may influence women's preferences in the selection of a method of contraception. The aim of this study was to evaluate the knowledge, opinions and attitudes of female university students regarding the menstrual cycle, sexual health and contraception. A questionnaire-based survey was conducted among 2572 female university students in Hungary, Romania and Serbia, between November 2009 and January 2011. A higher proportion of students of health sciences than students of other faculties had appropriate knowledge of the fertile period within a menstrual cycle: 86.0%, 71.5% (p = .02) and 61.1% vs. 71.9% (p < .001), 59.8% and 43.2% (p < .001) in Hungary, Romania and Serbia, respectively. Overall, more than 69% of the female university students believed in the need for monthly menstruation in order to be healthy; however, merely 30 to 40% of them wished to have monthly bleeding. In general, the respondents were aware of the importance of menstruation in relation to sexual health; however, they wished to suppress the menstruation-related symptoms. Differences in the knowledge and attitudes of female university students of the three assessed countries may be explained in part by cultural differences, and in part by the nature of their studies.

Fetal ultrasound scan--prerogatives for the basic level.

Adequate level of prenatal ultrasound scan is a prerequisite for a successful definition of high risk population that needs further investigations. "Basic", standardized fetal mid-trimester scan, with an informative report enables not only diagnosis of anomaly but also evaluation of state of pregnancy in general. This paper was aimed at reviewing the benefits of and requirements for a complete basic mid-trimester fetal ultrasound scan and the necessary documentation. Potential directions for development of organization of basic mid-trimester fetal ultrasound scans are standardization of the scan, with establishing the number and the level of examination, and continual education of both the doctors and the patients. In order to standardize the exam, a uniform check list is needed, so that the examination should always be done in the same manner and at the same level, no matter where it is done and by whom. International and national guidelines should be agreed upon and they should state clear standards on who should do the scan, how, what kind of ultrasound machine should be used and what documentation should be kept. This paper presents a possible standardization of basic level mid trimester fetal ultrasound scan. A routine complete second trimester ultrasound between 18 and 22 weeks and a complete ultrasound report will provide the best opportunity to diagnose fetal anomalies and to help in the management of prenatal care. It will also reduce the unnecessary number of ultrasound examinations done during the second trimester for completion of fetal anatomy survey, which would decrease the costs.

Variations of serum copper values in pregnancy.

INTRODUCTION: Copper is essential micronutrient and has an important role in the human body. The serum copper increases during pregnancy and is doubled at full term. Lower levels of serum copper in pregnancy are connected with some pathological conditions. OBJECTIVE: The aim of this study was to estimate the levels of serum copper in normal and pathological pregnancies, comparing them with values of serum copper in non-pregnant women, to determine if serum copper is lower in some pathological pregnancies and if this is of some importance. METHODS: A total of 2170 plasma samples for copper analyses were made in the following groups: healthy non-pregnant women; healthy pregnant women from the 5th-40th gestational week, during the first delivery stage and during the first three postpartum weeks, in pregnant women with habitual abortion, imminent abortion, abortion in progress, missed abortion (9th-24th weeks), missed labour and premature rupture of membranes (29th-40th weeks). Levels of serum copper were determined by colorimetric technique of bathocuproin with disulphate as a chromogen. RESULTS: Serum copper values in non-pregnant women range from 11.6-25.8 micromol/L. In healthy pregnant women, there is a constant trend of the increase of serum copper. The mean serum copper values revealed three significant peaks at the 22nd, 27th and 35th gestational week. Serum copper values in the patients with some pathological pregnancies in relation to the serum copper values of the healthy pregnant women were significantly lower. CONCLUSION: Serum copper values can be used as an indicator of some pathological pregnancies.

[Level of knowledge about sexually transmitted infections in the population of female students at the University of Novi Sad].

INTRODUCTION: The reason for extremely high incidence of sexually transmitted inflections is the lack of necessary knowledge about the mode of transmission and protection measures. The aim of this study was to determine the level of knowledge about sexually transmitted infections in the population of female students of the University of Novi Sad. MATERIAL AND METHODS: The study included 397 female students at the University of Novi Sad from different faculties. A questionnaire was designed for the purpose of this research. RESULTS AND DISCUSSION: Students from all faculties (55.7-66.7%), with the exception of the medical students, believe that the use of condoms is the safest way of protection from sexually transmitted infections. The medical students showed a different attitude and opinion on the use of condoms and avoidance of multiple sexual partners, which are important measures in the prevention of these diseases (38.8%). The fact that some sexually transmitted infections caused by viruses are associated with the malignancy of the cervix was recognized by 74.81% of students. The fact that the main therapeutic approach for treatment of sexually transmitted diseases is the simultaneous treatment of both partners was known by 81.86% of female students. As it is known, sexually transmitted infections may not always be symptomatic, which is an opinion held by 73.55% of students. CONCLUSION: Results obtained in this study indicate the need for implementation of educational activities about sexually transmitted infections, which would enable the preservation and promotion of reproductive health of young people.

[Investigation of risk factors for acute stress reaction following induced abortion].

INTRODUCTION: Termination of pregnancy-induced abortion is inevitable in family planning as the final solution in resolving unwanted pregnancies. It can be the cause of major physical and phychological consequences on women's health. Diverse opinions on psychological consequences of induced abortion can be found in literature. MATERIAL AND METHODS: A prospective study was performed in order to predict acute stress disorder (ASD) after the induced abortion and the possibility of post-traumatic stress disorder (PTSD). Seven days after the induced abortion, 40 women had to fill in: (1) a special questionnaire made for this investigation, with questions linked to some risk factors inducing stress, (2) Likert's emotional scale and 3. Bryant's acute stress reaction scale. RESULTS: After an induced abortion 52.5% women had ASD and 32.5% women had PTSD. Women with ASD after the abortion developed more sense of guilt, irritability, shame, self-judgement, fear from God and self-hatred. They were less educated, had lower income, they were more religious, did not approve of abortion and had worse relationship with their partners after the abortion in comparison to women without ASD. Age, number of previous abortions and decision to abort did not differ between the two groups. DISCUSSION: and conclusion Induced abortion represents a predisposing factor for ASD and PTSD in women. Some psycho-social factors contribute to the development of stress after abortion. Serbia has a task to reduce the number of abortions which is very high, in order, to preserve reproductive and phychological health of women.

[Medical abortion--modern method for termination of pregnancy].

INTRODUCTION: Modern methods of medically induced abortions are being used in many countries all over the world. These methods are safe and effective when used in an appropriate way. DRUGS USED FOR MEDICAL ABORTION: The most widely used regimens for drug induced abortions include antiprogestogen mifepriston followed by administration of a synthetic prostaglandin analogue--gemeprost vaginally or misoprostol orally or vaginally. When used for abortions up to 9 and 7 weeks of pregnancy, this method has efficacy up to 98%. The regimen between 9 and 12 completed weeks is still under investigation. Methods for medical abortion after 12 completed weeks since last menstrual period include several regimens and medications--combination of mifepriston and repeated doses of misoprostol, misoprostol or gemeprost alone, methotrexate, synthetic prostaglandin analogues, oxytocin and some others. MEDICAL ABORTIONS AT OUR DEPARTMENT OF OBSTETRICS AND GYNECOLOGY, NOVI SAD, CLINICAL CENTER VOJVODINE, SERBIA: Medical abortions in the second trimester were introduced at our Department of Obstetrics and Gynecology Novi Sad, Serbia, in early 1980s using prostaglandin analogues. This method was improved in year 2000 introducing two dinoprostone gels intracervically/extraaminally instead of just one, for cervical preparation before intramuscular application of carboprost thrometamine, which led to significantly shorter abortion interval. During the years 2003/2004 we took part successfully in one of the multicentric WHO projects for investigating new regimens on early medical abortions with mifepriston and misoprostol. CONCLUSIONS: Modern methods of medical abortions are safe and effective for termination of unwanted pregnancies in the first and second trimester.

Bleeding pattern, tolerance and patient satisfaction with a drospirenone-containing oral contraceptive evaluated in 3488 women in Europe, the Middle East and Canada.

BACKGROUND: This study was conducted to assess the bleeding pattern, tolerance and patient satisfaction associated with an oral contraceptive (OC) containing 3 mg of drospirenone and 30 mcg of ethinyl estradiol under real-life conditions. STUDY DESIGN: A multicenter, prospective and observational six-cycle study was conducted in 12 countries in Europe, the Middle East and Canada. The efficacy variables included an assessment of bleeding patterns, premenstrual symptoms of water retention and patient satisfaction as determined by a visual analog scale. RESULTS: A total of 3488 women was enrolled in the study. The percentage of women with intermenstrual bleeding decreased from 27.9% at baseline to 5.4% at the end of Cycle 6, while dysmenorrhea decreased from 67% to 17.7%. Also, amenorrhea decreased from 21.3% to 7.5%. The decreases in all three parameters were statistically significant (p<.0001). Approximately 70% of the women reported abdominal bloating and/or breast tenderness at baseline and less than 38% did so at the end of Cycle 6 (p<.0001). Patient satisfaction increased for all investigated items. Upon completion of the study, 86.2% of the women answered "yes" to continuing treatment with this OC. CONCLUSION: The OC containing 3 mg of drospirenone and 30 mcg of ethinyl estradiol has beneficial effects on bleeding pattern, symptoms of water retention and patient satisfaction.

[Department of Obstetrics and Gynecology, Clinical Center of Vojvodina--department for the 21st century].

DEPARTMENT OF OBSTETRICS AND GYNECOLOGY: Department of Obstetrics and Gynecology of the Clinical Center of Vojvodina, as a tertiary care center, is going through constant innovation and improvement which are results of constant development of medical sciences, as well as of the increasing demands and needs of patients. New methods are being introduced, conditions of stay and treatment are improved, medical staff are required to participate in continuing medical education. Through the mutual efforts and achievements of the medical staff of the Department of the Clinical Center of Vojvodina and Provincial Secretary of Health and Social Welfare, the Department of Obstetrics and Gynecology of the Clinical Center of Vojvodina has become a department for the 21st century.

[Course and outcome of adolescent deliveries--a comparative analysis for 1992 and 2002].

INTRODUCTION: Adolescent pregnancy is considered to be risky, with potential psychosocial and health risks. From a medical point of view, adolescent pregnancy and delivery are risky and mortality of mothers and newborns is higher than in women aged 20-30. MATERIAL AND METHODS: The analysis included all adolescent deliveries at the Department of Gynecology and Obstetrics in Novi Sad in 1992 and 2002. These data were compared with those observed in women aged 19 and older, for the same years. RESULTS: In respect to the number of adolescent deliveries, a decreasing tendency is observed. Also, there is an increasing trend in the number of cesarean sections in adolescents, which follows the trend of higher rates of cesarean deliveries in general. Episiotomy is more often performed in adolescents than in older women, but a decreasing trend is also observed in this population, which was also the case in women over 19. Vacuum extraction is less frequent in cases of adolescent deliveries. A very small percentage of malformed and stillborn newborns is registered in adolescents, whereas the percentage of premature births is similar in both groups. CONCLUSION: Although adolescent pregnancy and delivery are risky, good obstetrical care and efficient control during delivery provide optimal conditions for successful deliveries among adolescents.

[Emergency contraception--current trends, possibilities and limitations]. / Urgentna kontracepcija--savremene tendencije, mogucnosti I ogranicenja.

INTRODUCTION: Emergency contraception has been used for over three decades. Indications for emergency contraception are intercourse without contraceptive protection or inadequate application of other contraceptive means. Also, this method is the only way out in situations when sexual intercourse has proceeded not only without protection, but also without voluntary agreement of both partners. CONTRACEPTION MEANS: Despite of their proven efficiency, it is thought that application of contraception means, even in countries with highly developed systems of health care, is far below optimal. Contemporary studies have pointed out some new posibilities and novel, modified methods of emergency contraception have been proposed. Basic methods of emergency contraception include use of hormonal preparations and postcoital insertion of intrauterine copper devices. Hormonal preparations that are used in emergency contraception are: combined hormonal contraceptive pills, levonorrgestrel and antiprogestin mifepristone. In 1998, the method with levonogestrel only, was indicated by World Health Organization as a "golden standard" in hormonal emergency contraception. The article gives a survey of new trends, possibilities and limitations of modern emergency contraception, with the aim of popularization of this form of contraception in our country.

[Persistent hyperemesis gravidarum as a psychosomatic dysfunction--case report]. / Dugotrajno graviditetno povracanje kao psihosomatska disfunkcija--prikaz slucaja.

INTRODUCTION: Persistent severe vomiting in pregnancy is called hyperemesis gravidarum. The etiology of this disorder is still unknown. However, endocrinological disorders and psychological factors are mentioned as possible causes. Vomiting usually stops after the end of the first trimester of pregnancy. CASE REPORT: A case of persistent, severe vomiting during pregnancy is reported. The patient was admitted to the Department of Gynecology and Obstetrics in Novi Sad in the 29th week gestation due to persistent vomiting from the beginning of pregnancy. A psychological evaluation including current psychological status was performed. The obtained results showed that hyperemesis gravidarum was a consequence of associated psychosocial factors, and conflicts causing somatic disorders. CONCLUSION: Such cases point to the importance of psychotherapy in pregnancy either with or without drug therapy. In addition, we underline the importance of psychological preparation before pregnancy and better information about pregnancy and motherhood.

[Sex hormones and female sexuality]. / Hormonska osnova feminine seksualnosti.

INTRODUCTION: In contrast to animal species in which linear relationships exist between hormonal status and sexual behaviour sexuality in human population is not determined so simply by the level of sexual steroids. The article analyses female sexuality in the light of hormonal status. ADMINISTRATION OF SEXUAL STEROIDS DURING PREGNANCY AND SEXUAL DIFFERENTIATION: High doses of gestagens, especially those with high androgen activity, widely used against miscarriages may lead to tomboys, but without differences in sexual orientation. However, it has been observed that the frequency of bisexual and lesbian women is higher in women with congenital adrenogenital syndrome. HORMONES SEXUAL DESIRE AND SEXUALITY DURING MENSTRUAL CYCLE: It has been established that sexual desire, autoeroticism and sexual fantasies in women depend on androgen levels. There are a lot of reports claiming that sexual desire varies during the menstrual cycle. HORMONAL CONTRACEPTION AND SEXUALITY: Most patients using birth control pills present with decreased libido. But, there are reports that progestagens with antiandrogenic effect in contraceptive pills do not affect sexual desire. HORMONAL CHANGES IN PERI- AND POSTMENOPAUSAL PERIOD AND SEXUALITY: Decreased levels of estrogen and testosterone in older women are associated with decreased libido, sensitivity and erotic stimuli. SEXUALITY AND HORMONE REPLACEMENT THERAPY: Hormonal therapy with estrogen is efficient in reference to genital atrophy, but not to sexual desire. Really increased libido is achieved using androgens. Also, therapy with dehydroepiandrosterone (DHEA) and tibolone have positive effects on female libido. CONCLUSION: Effect of sexual steroids on sexual sphere of women is very complex. The association between hormones and sexuality is multidimensional, as several hormones are important in regulation of sexual behaviour. Still, it should be pointed out that sexuality is in the domain of hormonal, emotional-motivational and social factors.