Galectin-13 and Laeverin Levels Interfere with Human Fetoplacental Growth.

Galectin-13 (Gal-13) is predominantly produced by the syncytiotrophoblast, while laeverin is expressed on the outgrowing extravillous trophoblast, and both are thought to be biomarkers of preeclampsia. The aim of this study was to assess the correlation between concentrations of Gal-13 and laeverin measured in maternal serum and amniotic fluid at 16-22 weeks of gestation and the sonographic assessment of the fetoplacental measurements. Fetal biometric data and placental volume and perfusion indices were measured in 62 singleton pregnancies. Serum and amniotic levels of Gal-13 and laeverin levels were measured using a sandwich ELISA. Both amniotic fluid and serum Gal-13 levels expressed a negative correlation to the plasma laeverin level in mid-pregnancy. Serum laeverin level correlated positively with the gestational length at delivery (ß = 0.39, p < 0.05), while the amniotic laeverin level correlated well with the abdominal circumference of the fetus (ß = 0.44, p < 0.05). Furthermore, laeverin level in the amnion correlated positively with the estimated fetal weight (ß = 0.48, p < 0.05) and with the placental volume (ß = 0.32, p < 0.05). Logistic regression analyses revealed that a higher circulating Gal-13 level represents a slightly significant risk factor (OR: 1.01) for hypertension-related diseases during pregnancy. It is a novelty that laeverin can be detected in the amniotic fluid, and amnion laeverin concentration represents a potential biomarker of fetoplacental growth.

How the Soluble Human Leukocyte Antigen-G levels in Amniotic Fluid and Maternal Serum Correlate with the Feto-Placental Growth in Uncomplicated Pregnancies.

Introduction: Trophoblast-derived angiogenic factors are considered to play an important role in the pathophysiology of various complications of pregnancy. Human Leukocyte Antigen-G (HLA-G) belongs to the non-classical human major histocompatibility complex (MHC-I) molecule and has membrane-bound and soluble forms. HLA-G is primarily expressed by extravillous cytotrophoblasts located in the placenta between the maternal and fetal compartments and plays a pivotal role in providing immune tolerance. The aim of this study was to establish a relationship between concentrations of soluble HLA-G (sHLA-G) in maternal serum and amniotic fluid at 16-22 weeks of gestation and the sonographic measurements of fetal and placental growth. Materials and methods: sHLA-G in serum and amniotic fluid, as well as fetal biometric data and placental volume and perfusion indices, were determined in 41 singleton pregnancies with no complications. The level of sHLA-G (U/mL) was tested with a sandwich enzyme-linked immunosorbent assay (ELISA) kit. Results: The sHLA-G levels were unchanged both in amniotic fluid and serum during mid-pregnancy. The sHLA-G level in serum correlated positively with amniotic sHLA-G level (ß = 0.63, p < 0.01). Serum sHLA-G level was significantly correlated with abdominal measurements (ß = 0.41, p < 0.05) and estimated fetal weight (ß = 0.41, p < 0.05). Conversely, amniotic sHLA-G level and placental perfusion (VI: ß = -0.34, p < 0.01 and VFI: ß = -0.44, p < 0.01, respectively) were negatively correlated. A low amniotic sHLA-G level was significantly associated with nuchal translucency (r = -0.102, p < 0.05). Conclusions: sHLA-G assayed in amniotic fluid might be a potential indicator of placental function, whereas the sHLA-G level in serum can be a prognostic factor for feto-placental insufficiency.

Predictive Capabilities of Human Leukocyte Antigen-G and Galectin-13 Levels in the Amniotic Fluid and Maternal Blood for the Pregnancy Outcome.

Background and Objectives: Increasing evidence points to the significant role of the angiogenic factor levels in screening for pregnancy outcome. To examine the potential relationship between concentrations of placental protein 13 (PP13) and soluble human leukocyte antigen-G (sHLA-G) in maternal serum and amniotic fluid at 16-23 weeks of gestation and the sonographic features of pregnancy as well as pregnancy outcome. Materials and Methods: PP13 and sHLA-G in serum and amniotic fluid, fetal biometrical data, and placental volume and perfusion indices were determined in 71 euploid, singleton pregnancies. Results: The serum sHLA-G level exhibits a negative correlation with the serum PP13 level (r = -0.186, p < 0.001) and a positive correlation with the sHLA-G level in amniotic fluid (r = 0.662, p < 0.001). A significant correlation was found between serum sHLA-G level and placental volume (r = 0.142, p < 0.05) and between amniotic sHLA-G level and placental perfusion (r = -0.450, p < 0.001). A low amniotic PP13 level significantly predicted the birth weight (r = -0.102, p < 0.05), the duration of pregnancy (r = -0.155, p < 0.05), and the fetal abdominal circumference (r = -0.098, p < 0.05). Conclusions: PP13 assayed in amniotic fluid might be a potential marker of fetal growth, and sHLA-G can be an adjunct modality reflecting placental sonographic parameters.

Angiogenic factors measured in aspirated placental tissue between the 10 + 6 and 18 + 3 weeks of gestation.

This study was designed to determine the level of vascular endothelial growth factor-A (VEGF-A), basic fibroblast growth factor (bFGF) and endothelial nitric oxide synthase (eNOS) in chorionic villi during in first and second trimester, and their association with nuchal translucency (NT) measured by ultrasound. Seventy-five singleton healthy pregnancies with no detected congenital malformation were collected for NT measurements and chorionic villus sampling (CVS). Concentrations of angiogenic factors were assayed in chorionic villi sampled between 10 + 6 and 18 + 3 weeks of gestation. ENOS level was steady during this gestational period, while the concentrations of VEGF-A and bFGF significantly decreased. Placental concentrations of VEGF-A and bFGF correlated positively with each other (semi-partial correlation in multivariable linear regression (r): 0.90) and both correlated negatively with the eNOS level (r: -0.64 and r: -0.83, respectively). NT was positively correlated with eNOS concentration and negatively correlated with bFGF levels (r: 0.85 and r: -0.78, respectively). Inverse correlation was found between gestational age and VEGF-A and bFGF concentrations (r: -0.57 and r: 0.73, respectively). Alterations of angiogenic factors in chorionic villi might be an adjunct modality to NT and foetal growth as sonographic markers.

Evaluation of the relation between placental weight and placental weight to foetal weight ratio and the causes of stillbirth: a retrospective comparative study.

The aim of the present study was to evaluate the clinical importance of placental weight (PW) and placental weight to foetal weight (PW/FW) ratio according to maternal characteristics, pathological conditions in obstetrics and the causes of foetal death by category in stillbirths. The results of autopsies and placental histopathological examinations for 145 singleton stillbirths were reviewed retrospectively. Pathological features of the placenta were significantly associated with lower PW compared to the group with no pathological placental parameters (230 grams versus 295 grams, p = .045). Foetal growth restriction (FGR) with pre-eclampsia (PE) was accompanied by significantly lower FW, PW and PW/FW compared to FGR cases without PE (1045 grams versus 1405 grams, p = .026, 200 grams versus 390 grams, p = .006 and .19 versus .24, p = .037, respectively), whereas a similar trend was not observed in the non-FGR pregnancies complicated by PE. Oligohydramnios was accompanied by lower foetal weight compared to those who had normal amount of amniotic fluid (650 grams versus 1400 grams, p = .006). Among the clinical factors, only PE and oligohydramnios contributed to disproportionate fetoplacental growth in stillbirth, while none of the categories of stillbirth was related to unequal fetoplacental growth. Impact statement What is already known on this subject: In 27% of stillbirths, pathological features of the placenta or placental vascular bed are recorded. Underlying placental pathology contributes to foetal growth restriction (FGR) in approximately 50%. Although placental weight relative to foetal weight (PW/FW ratio) is an indicator of foetal as well as placental growth, data on PW/FW in stillbirth has not yet been published. What the results of this study add: Causes of death do not show any correlation with PW/FW ratio. Placentas derived from pregnancies complicated by pre-eclampsia (PE) and concomitant FGR are smaller and PW/FW is also diminished. Oligohydramnios is associated with an enhanced risk of restricted placental growth. FGR is not correlated with any categories of causes of death. What the implications are of these findings for clinical practice and/or further research: Sonographic follow-up of placental volume and FW can predict the stillbirth in PE complicated by FGR and oligohydramnios.

[Clinical aspects of congenital maxillofacial deformities]. / A veleszületett maxillofacialis deformitások klinikai aspektusai.

The cleft lip and palate deformity is one of the most common type of congenital abnormalities. The aim of this paper is to summarise the literature knowledge about cleft lip and/or palate. The authors review and discuss international literature data on the prevention, genetic and environmental predisposing factors, anatomical and embryological features, as well as pre- and post-natal diagnosis and treatment of these deformities. The aetiology is multifactorial, driven by both genetic and environmental factors which lead to multifaceted phenotypes and clinical features of these malformations. The lack of the multidisciplinary knowledge about prenatal diagnosis, prevention, genetic aspects and treatment strategy could result in serious diagnostic errors, hence clinical teamwork is critically important to solve the problems of this pathology. Only the professional teamwork and multidisciplinary cooperation can guarantee the optimal level of health care and better quality of life for these patients and their families.

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.

Nasal bone length: prenasal thickness ratio: a strong 2D ultrasound marker for Down syndrome.

OBJECTIVES: To evaluate the feasibility of incorporating two-dimensional ultrasound measurements of nasal bone length (NBL) and prenasal thickness (PT) into the second-trimester anomaly scan and to determine whether the NBL : PT ratio could help in differentiating euploid and Down syndrome fetuses. METHOD: Two-dimensional measurements of NBL and PT were obtained from the midsagittal plane of the fetal head at 14-28 weeks of gestation in a Caucasian population at risk for aneuploidy. The screening performances of NBL, PT, and the ratios NBL : PT and PT : NBL were analyzed in euploid (n = 1330) and Down syndrome (n = 33) fetuses. RESULTS: Nasal bone length and PT alone showed strong correlations with Down syndrome (sensitivity: 76% at 1.88% and 2.35% false positive rate, respectively). However, the NBL : PT ratio showed an even stronger correlation with Down syndrome (false positive rate: 0.9%, sensitivity: 97%). The mean NBL : PT ratio showed a gradual increase from 1.48 to 1.79 (a 21.2% increase) between 14 and 28 weeks of gestation. CONCLUSION: Two-dimensional ultrasound measurements of NBL and PT, particularly the NBL : PT ratio, are highly sensitive markers for Down syndrome fetuses.

Severe midtrimester oligohydramnios: treatment strategies.

PURPOSE OF REVIEW: Nearly 1% of pregnancies are affected by some type of midtrimester oligohydramnios. Evidence is currently accumulating that suggests the better efficacy of the new therapeutic procedures relative to conventional management. This review summarizes the available evidence. RECENT FINDINGS: The prolongation of the period between the diagnosis of oligohydramnios and delivery following amnioinfusion and amniopatch techniques appears to be strongly associated with the gestational age and whether the situation was based on rupture of the membranes or not. Case series reveal that amnioinfusion significantly improves the perinatal outcome and prolongs the pregnancy in severe second-trimester oligohydramnios in both idiopathic cases and those involving rupture of the amniotic membranes [preterm prelabor rupture of the membranes (PPROM)]. There is clear evidence of a lower frequency of perinatal complications and successfully prolonged gestation in iatrogenic PPROM after the amniopatch technique relative to population controls. SUMMARY: Identification of potentially modifiable risk factors for the successful prolongation of pregnancy complicated with midtrimester oligohydramnios, and previable PPROM is needed for the improvement of treatment strategies and prognosis. Randomized trials are needed to determine whether amniotic fluid-replenishing strategies can improve pregnancy outcomes.

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.

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.

Management of severe idiopathic oligohydramnios: is antepartum transabdominal amnioinfusion really a treatment option?

OBJECTIVE: The aim of this study was an evaluation of the role of antepartum transabdominal amnioinfusion (APTA) in the management of severe idiopathic oligohydramnios with a view to improving the pregnancy outcome. METHODS: The study comprised an analysis of 20 pregnant women with severe oligohydramnios who were treated with APTA in 2009 and 2012. The pregnancy outcomes and the complications of the procedure were analysed. RESULTS: The mean gestational age at first treatment was 22 weeks 3 days. The preprocedure amniotic fluid index of <5 cm was restored by the treatment to 8 cm. More than a half of the pregnancies (66.7%, 8/12) treated with APTA finished with spontaneous abortion in the second trimester, mostly due to rupture of the membranes (as a consequence of retroamniotic filling with saline in four cases). The later the oligohydramnios developed, the higher the probability of a significant prolongation of the gestation. CONCLUSIONS: Although APTA is a useful procedure in the management of severe oligohydramnios, it may be followed by a relatively high rate of rupture of the membranes, particularly in the second trimester. Paradoxically, a higher volume of infused saline into the amniotic cavity is associated with a significantly lower risk of rupture.

Predictors of oral contraceptive use among teenaged girls in southeastern Hungary.

OBJECTIVE: To assess the main determinants of oral contraceptive (OC) use among teenaged girls in southeastern Hungary. METHODS: A questionnaire was self-administered by 332 participants aged 14 to 19 years seen at the Contraception Outpatient Clinic for Teenagers located in the Department of the Obstetrics and Gynecology of the University of Szeged from May 1, 2005, to March 31, 2006. RESULTS: Approximately half of the respondents (48.2%) used OCs, and only 21.9% of the OC users considered OC cost unimportant (vs 59% of the non-OC users). A considerable proportion in each group knew little about the fertile period of a menstrual cycle (43.1% vs 46.5%) and had an insufficient knowledge of the recommendations regarding pill use (66.6% vs 77.9%). Most (76.2%) of the participants intended to use OCs in the future. Intending to use OCs was strongly associated with the prevention of menstrual disorders (adjusted odds ratio [AOR], 4.73; 95% confidence interval [CI], 2.4-10.5) and the opinion that OCs did not interfere with sex life (AOR, 2.55; 95% CI, 1.3-5.1). CONCLUSION: The results demonstrate that the knowledge of teenaged girls concerning the correct use of OCs and the differences in fertility during the menstrual cycle is often inadequate and should be improved.

Determinants of emergency contraceptive use after unprotected intercourse: who seeks emergency contraception and who seeks abortion?

OBJECTIVE: To compare differences in contraceptive characteristics and the knowledge of emergency contraception (EC) between women who used EC after unprotected intercourse and those who sought abortion. DESIGN: A questionnaire survey. SETTING: A Hungarian university hospital. SAMPLE: Two large clinical groups were enrolled: women who were prescribed EC after unprotected intercourse (n= 952) (EC group) and women who presented for termination of pregnancy who had not taken EC after a contraceptive failure despite being suitable candidates to take EC (n= 577) (control group). METHODS: Questionnaire evaluation. MAIN OUTCOME MEASURES: Knowledge concerning, previous use of, and other factors related to EC use. RESULTS: The EC group experienced a condom failure significantly more often (odds ratio (OR) = 3.07), while the control group reported more failures with the contraceptive pill (OR = 0.69) and with periodic abstinence (OR = 0.09). Use of EC depended on age, education level, place of residence, accurate knowledge of EC (OR = 3.87) and previous EC use (OR = 1.16). Awareness of EC was influenced by information obtained from healthcare providers (OR = 3.63) or by school education (OR = 1.28). CONCLUSIONS: Women who use less reliable contraceptive methods should be targeted for health education that stresses the importance of reliable contraception and provides more detailed knowledge on EC and when it should be used.

Can a brief antepartum preventive group intervention help reduce postpartum depressive symptomatology?

BACKGROUND: Psychosocial and psychological interventions are generally effective in reducing depressive symptomatology in the postpartum period. Our aim was to evaluate the effectiveness of a brief preventive group intervention for postpartum depression (PPD) in a naturalistic setting, and study the effect of this on social and psychological risk factors. METHODS: We conducted a randomized controlled trial (n = 1,719) in south-eastern Hungary in 62 antepartum centers. Pregnant women (n = 710) underwent a 4-session preventive group intervention whereas a control group (n = 1,009) attended 4 sessions providing the same information given in usual care. RESULTS: Our intervention appeared to significantly reduce the risk of PPD, as defined by Leverton Questionnaire total scores (OR = 0.69). It resulted in an absolute risk reduction of about 18% in those with antepartum depression and 0.5% in those with no depression at recruitment. A multiple logistic regression analysis revealed a much reduced risk in those with a perceived lack of partner support (OR = 0.4) in the treatment group. Unplanned pregnancy, an irreversible risk factor affecting every fifth woman, also seemed to have a reduced effect on PPD after our group intervention (OR = 0.81). CONCLUSIONS: A brief preventive antepartum group intervention focusing on psychoeducation, stress management, improving coping mechanisms, and the development of social support can be effective in reducing postpartum depressive symptomatology.

Social dynamics of postpartum depression: a population-based screening in South-Eastern Hungary.

PURPOSE: To determine contributing psychosocial factors to postnatal depression (PND) in Hungary in 1996 and in 2006. METHODS: In 1996 and 2006, a total of 2,333 and 1,619 women, respectively, were screened for PND in South-Eastern Hungary, based on a Leverton questionnaire (LQ) score of ≥ 12 at 6-10 weeks after delivery. RESULTS: The LQ scores indicated an increase in PND from 15.0% in 1996 to 17.4% in 2006. The best predictors for PND in a multiple regression analysis were living in an urban environment [adjusted odds ratio (AOR) = 11.26], unstable relationship (AOR = 3.1) and a perceived lack of social support from partner (AOR = 3.65) in 1996, and recent major life events (AOR = 3.38), unstable relationship (AOR = 3.84), self-reported low income (AOR = 1.82), and intention to return to work soon after delivery (AOR = 0.47) in 2006. CONCLUSIONS: A self-defined low socioeconomic status and an intention to return to work have become significant factors in the development of PND. Besides the family factors recognized as salient variables in 1996, economic features came into prominence as newly identified main predictive factors for PND in 2006.

Role of the vascular endothelial growth factor in the inverse relationship between increased nuchal translucency thickness and fetomaternal transfusion.

OBJECTIVE: To elucidate the possible etiological role of the vascular endothelial growth factor (VEGF) in the inverse correlation between nuchal translucency (NT) thickness and fetomaternal transfusion (FMT). METHODS: The level of FMT was determined prospectively in 80 viable, singleton pregnancies in which 10-14-week ultrasonographic scanning, NT thickness measurement; chorionic villus sampling (CVS) for fetal karyotyping and VEGF concentration determination were performed. The grouping procedures were based either on NT thickness (<2 MoM in Group I, and ≥2 MoM in Group II), or on karyotype (euploid in Group A, and aneuploid in Group B). The level of FMT was determined via maternal serum α-fetoprotein levels before and after CVS. The FMT and the VEGF concentration of the chorionic tissue were analysed in comparisons between Groups I and II, and between Groups "A" and "B". RESULTS: The mean level of FMT after CVS was 72.5±21.3 µL and 19.28±5.4 µL in Groups I (n=44) and II (n=36), respectively (P<0.02). The VEGF concentration of the chorionic tissue in Groups I and II was 40.6±16.7 pg/mg protein and 21.1±6.3 pg/mg protein, respectively (P=0.28). The mean level of FMT was 57.9±15.0 µL and 8.1±3.9 µL in Groups A and B, respectively (P<0.003). The VEGF concentration of the chorionic tissue in Groups A and B was 25.9±10.7 pg/mg protein and 21.3±11.3 pg/mg protein, respectively (P=0.77). CONCLUSION: No difference exists in the VEGF concentration in the aspirated chorionic tissue between Groups I and II and between Groups A and B. A higher level of FMT was observed among the aneuploid pregnancies after CVS than among the euploid cases. Chorionic VEGF does not influence the inverse relationship between the pre-CVS NT thickness and FMT.

Cystic Dilation of the Aqueductus Sylvii in Case of Trisomy 17p11.2-pter with the Deletion of the Terminal Portion of the Chromosome 6.

Since the 1970s, about 30 cases of partial or complete trisomy 17p have been presented in the literature. Partial trisomies of the short arm of chromosome 17 are somewhat more common, but complete trisomy is quite rare. Most of these cases were described in infants and newborns; and to our knowledge only 3 cases of trisomy 17p have been detected intrauterine. Phenotypic features of trisomy 17p in fetuses are intrauterine growth retardation, ventriculomegaly, cleft lip and cleft palate, micrognathia, horseshoe kidneys, single umbilical artery, and congenital heart defects. The sonographic and foetopathologic findings of a pregnancy trisomy 17p11.2-pter with the deletion of the terminal portion of the chromosome 6 due to paternal balanced translocation are described in this case report.

Validation of the Leverton Questionnaire as a screening tool for postnatal depression in Hungary.

OBJECTIVE: To assess the validity of the 24-item Leverton Questionnaire (LQ) in screening for postnatal depression (PND). METHOD: A two-phase, cross-sectional study was designed. Between January and October 2006, a sample of 1552 women attending a routine postnatal check-up at 6 weeks postpartum completed the LQ in southeast Hungary. On the basis of the LQ total score, the participants were stratified and randomly selected within each stratum for clinical evaluation (Structured Clinical Interview for DSM-IV). Receiver operating characteristic (ROC) analyses were used to examine the sensitivity and specificity of the LQ to detect PND. RESULTS: The best cut-off on the Hungarian version of the LQ for PND was 11/12, with a sensitivity of 88.0%, and a specificity of 94.4%, and a positive predictive value of 53.1%. Internal consistency was satisfactory (Cronbach alpha coefficients > or = 0.753). The sensitivity of the modified Beck Depression Inventory (BDI) in detecting PND was 86.2% and the specificity 90.4%. Although the BDI performed slightly better than the LQ in distinguishing between minor and major depression, both psychometric scales showed satisfactory screening performance. CONCLUSIONS: Our data confirm the validity of the Hungarian version of the LQ reliably to identify PND. We propose a cut-off of 11/12 for screening purposes for PND, the range of 11-14 for detecting minor depression and regarding a total score of 15 points or above as indicative of major depression.

Leiden mutation, bed rest and infection: simultaneous triggers for maternal deep-vein thrombosis and neonatal intracranial hemorrhage?

The possible etiologic roles of infection and bed rest are discussed in connection with a case of maternal homozygous Leiden mutation leading to prematurity, maternal deep-vein thrombosis and neonatal intracranial hemorrhage in a heterozygous premature baby. Maternal bacterial infection and bed rest may trigger deep-vein femoral thrombosis in women with a homozygous Leiden mutation on tocolytic therapy for the treatment of premature labor. The neonate carrying at least one mutated allele of factor V Leiden might be at risk for the development of intracranial hemorrhage.