[Fetal pain and intrauterine analgesia/anesthesia--long-term pathologic effects, causes and alleviation of intrauterine pain]. / Magzati fájdalom es intrauterin fájdalomcsillapítás--az intrauterin fájdalom hosszú távú káros hatásai, okai es csillapítása.

The human fetus can suffer several presumably painful interventions perinatally and even before, during its intrauterine life. In the past years, scientific dispute concerning the existence of fetal pain and the need for its relief has expanded, and a heated social, political, religious, moral and philosophical debate has arisen, focusing mainly on the suffering experienced by the fetus during artificial abortion. In our two connected papers, medical scientific knowledge regarding fetal pain in the literature is reviewed. In the first article published in Orvosi Hetilap volume 150, issue 11, we defined pain and the neuroanatomical structures participating in subjective pain perception, as well as the development of these structures. Then, the objective indicators of intrauterine stress response (such as fetal neuroendocrine, cardiovascular, reflex and behavioral reactions) evoked by noxious stimuli were discussed. The present second article gathers the evidence of long-term pathologic effects caused by early-experienced pain and stress in animal models and humans. Finally, the potentially pain-evoking pre- and perinatal interventions are evaluated, as well as the analgetic/anesthetic methods that can be applied to intrauterine fetuses in everyday obstetrical practice.

[Fetal pain and intrauterine analgesia/anesthesia: neuroanatomy, ontogenesis and physiology of pain perception]. / A magzati fájdalom és intrauterin fájdalomcsillapítás - a fájdalom neuroanatómiája, ontogenezise és fiziológiája.

The human fetus can suffer several presumably painful interventions perinatally and even before, during its intrauterine life. In recent years, a scientific dispute has expanded, concerning the existence of fetal pain and the need for its relief, and a heated social, political, religious, moral and philosophical debate has arisen, focusing mainly on the suffering experienced by the fetus during artificial abortion. We review the medical scientific knowledge regarding fetal pain in the literature. The definition of pain and the neuroanatomical structures participating in subjective pain perception, followed by the development of the latter in the course of ontogeny is presented. The objective indicators of intrauterine stress response (such as fetal neuroendocrine, cardiovascular, reflex and behavioral reactions) evoked by noxious stimuli are discussed.

[The relationship between hysterectomy and sexual life according to the latest research]. / A méheltávolítás és a nemi élet kapcsolata az újabb kutatási eredmények tükrében.

Hysterectomy is one of the most frequent surgical interventions. Both specialists and lay people are interested in the following question: what kind of late psychosexual consequences does hysterectomy have? In the past years many publications showed a new aspect of the effects of hysterectomy on sexual life. The results of these prospective, randomized studies show that the late psychosexual changes do not primarily depend on the surgical method (vaginal, abdominal total or subtotal hysterectomy). The most significant predictive factor is the quality of sexual relationship before the operation. In the light of the evidence of the latest research, women can be reassured about the fact that hysterectomy, performed due to a benign disease, usually ameliorates the function of the organs in the small pelvis, i.e. positive change in sexual life can be expected. On the basis of the observations, this statement is valid for 2 years after the intervention. To analyze the effects after this period, further long-term studies are required. In this literature review the authors present the most significant study results published in the recent past.

Interpretation in reproductive genetic counseling: a methodological framework.

In case of genetic risk, parents are often faced with reproductive decisions affecting their life essentially, so it is advisable to pursue careful deliberation. For this reason, the genetic counselor is expected to help the counselee make well-informed and well-considered decisions, which requires the understanding of the patient as an individual. To reach emphatic understanding, physicians can use the results of the Gadamerian theory of interpretation that contains the idea -- as it has been summarized by V. Arnason -- that four aspects of openness are necessary to fully understand the other, such as openness to oneself, to the other, to the subject matter and to tradition. In our paper, we are applying the four-openness model of interpretation to genetic consultation, and we argue that during counseling double interpretation takes place: the physician interprets the patient, and the patient interprets the physician. Double interpretation leads to the clarification of those factors which influence the patient's decision-making: the counselor's attitude and prejudices, the counselee's values and needs, the medical, social, and moral implications of the genetic disease, and the social expectations. By adopting the theory of interpretation, counselors can also advance the provision of emotional support patients need in hard situations.

[Opinions about postpartum care: expectations of the population]. / Vélemények egy gyermekágyas osztály múködéséról: a lakosság elvárásai.

INTRODUCTION: During the last few years family centred obstetric practice became more widespread in Hungary as well. The opinion of the population, however, is hardly known. OBJECTIVES: The authors attempted to acquire a better knowledge of the expectations of the various population segments towards postpartum care. METHODS: The opinion of 485 person was analyzed with a questionnaire survey. The questions asked about ideal visiting time at the postpartum ward, postpartum organisational structures and appropriate time for discharge. RESULTS: The average age of the examined sample was 25.2 years; 32.4% were still students, 52.6% were state employees. A very early discharge (within 6-8 hours) was suggested only by 1.2% of the sample. The ratio of those who wanted to leave the hospital at less than 24 hours postpartum was only 7.8% as well. At the same time, only one third (35.9%) of the participants would like to be discharged after 4 days after delivery. 57.7% of the whole sample would prefer discharge between day 2 and 4 after delivery. The opinions about the time of discharge are independent from the size of the family, martial status, sex, education and monthly income of the interviewees. The patients' preferences concerning the appropriate time for discharge following an uncomplicated pregnancy and normal vaginal delivery is mainly influenced by the number of children (chi 2 = 62.260; df = 20; p = 0.000) and previous deliveries (chi 2 = 57.803; df = 20; p = 0.000). Early discharge was most commonly voted for by those who had no children or by those who had many. CONCLUSIONS: When organising postpartum care, the opinion and expectations of the population should be taken into account as well. Almost 62% of the sample had no children at the time of the interview. They will be in need of obstetric care in the future as well. Because of this, their opinion is especially important.