Therapy-resistant hypertension in pregnancy after live donor kidney transplantation

Összefoglaló. A veseátültetés a legnagyobb reményt nyújtja a végstádiumú vesebetegségben szenvedő nők számára, akik teherbe kívánnak esni. A veseátültetett beteg terhessége továbbra is kihívást jelent az immunszuppresszív gyógyszerek mellékhatásai, az allograftfunkció romlásának kockázata, a praeeclampsia és a magas vérnyomás káros anyai szövődményeinek rizikója, valamint a koraszülés, az alacsony születési súly kockázata miatt. A terhesség alatt nagy a magas vérnyomás kialakulásának kockázata, a szérum-kretaininszint emelkedik, és a terhesség végére proteinuria is kialakulhat. Az ajánlott fenntartó immunszuppresszió terhes nőknél a kalcineurininhibitorok (takrolimusz/ciklosporin) és alacsony dózisú szteroid adása, melyek biztonságosnak tekinthetők. Fontos, hogy a gyermekvállalási tanácsadás már a vesetranszplantáció előtt megkezdődjön, és a transzplantációt követően minden klinikai kontroll megtörténjen. Orv Hetil. 2021; 162(23): 924-926. Summary. Kidney transplantation offers the best hope to women with end-stage renal disease who wish to become pregnant. Pregnancy in a kidney transplant recipient continues to remain challenging due to side effects of immunosuppressive medication, risk of deterioration of allograft function, risk of adverse maternal complications of preeclampsia and hypertension, and risk of adverse fetal outcomes of premature birth, low birth weight, and small for gestational age infants. The factors associated with poor pregnancy outcomes include the presence of hypertension, serum creatinine greater than normal range and proteinuria. The recommended maintenance immunosuppression in pregnant women is calcineurin inhibitors (tacrolimus/cyclosporine) and low-dose steroid which are considered safe. It is important that counseling for childbearing should start as early as prior to getting a kidney transplant and should be done at every clinic visit after transplant. Orv Hetil. 2021; 162(23): 924-926.

Application of discontinuity factors and group constants generated by SERPENT in the KIKO3 DMG code

Discontinuity factors and node-wise group constants were generated by the SERPENT Monte Carlo code and applied in the KIKO3 DMG nodal code. The methodology was tested by calculating a typical VVER-440 calculation benchmark. A reference solution of the benchmark was calculated by using also the SERPENT code and the accuracy of the different approaches was checked against this latter solution.

Hot channel calculation methodologies in case of VVER-1000/1200 reactors

In VVER-1000/1200 type reactors much higher and geometrically more complex assemblies are applied compared to the VVER-440 design. Additionally, assembly shrouds are not used in the improved reactor types. This implies that the existing sub-channel wise models and hot channel calculation methodologies used in the safety assessment of VVER-440 reactors have to be improved. For this purpose a full core thermal hydraulic model was developed. In the first part of the paper the new model and its connections with the reactor physics of KARATE-1200 code system are demonstrated with results regarding the sub-channel outlet temperature and DNBR. In the second part of the paper the hot channel calculation methodologies to be used in the transient safety analyses of VVER-1200 type reactors are discussed. The appropriate frame parameter concept concerning the limitation of the heating up of the coolant and the single closed sub-channel approach vs. the multi-channel approach are studied, as well.

A methodology for the estimation of the radiological consequences of a Loss of Coolant Accident

For calculation of the radiological consequences of Large Break Loss of Coolant (LBLOCA) events, a set of various computer codes modeling the corresponding physical processes, disciplines and their appropriate subsequent data exchange are necessary. For demonstrating the methodology applied in MTA EK, a LBLOCA event at shut down reactor state – when only limited configuration of the Emergency Core Cooling System (ECCS) is available – was selected. In this special case, fission gas release from a number of fuel pins is obtained from the analyses. This paper describes the initiating event and the corresponding thermal hydraulic calculations and the further physical processes, the necessary models and computer codes and their connections. Additionally the applied conservative assumptions and the Best Estimate Plus Uncertainty (B+U) evaluation applied for characterizing the pin power and burnup distribution in the core are presented. Also, the fuel behavior processes. Finally, the newly developed methodology to predict whether the fuel pins are getting in-hermetic or not is described and the the results of the activity transport and dose calculations are shown.

Transabdominal amnioinfusion in the correction of oligohydramnios following twin-to-singleton reduction – A report of two cases

Background:

On rare occasions, elective iatrogenic reduction of a dichorionic twin is performed due to maternal request and in order to improve the perinatal outcome.

Materials and methods:

Nine twin-to-singleton reductions were identified retrospectively at the Feto-maternal Unit, University of Szeged, Hungary, between December 1997 and June 2015. A post-procedure, routine weekly sonographic scan revealed severe oligohydramnios in two out of the nine cases (22.2%) and amnioinfusion was performed in the mid-trimester to prolong gestation. The fetus survived in one case (11.1%) and the pregnancy continued until preterm birth.

Conclusion:

A repeated sonographic follow-up for an early diagnosis of oligohydramnios is feasible to avoid miscarriage after artificial embryo reduction.

Knowledge of Emergency Contraceptive Pills among Hungarian Women Presenting for Induced Abortion or Seeking Emergency Contraception

Aim: To compare the differences in contraceptive characteristics and the knowledge of emergency contraception (ECP) among women who used ECP after unprotected intercourse and those who sought an abortion. Methods: A questionnaire survey was conducted in a Hungarian university hospital among women for whom ECP was prescribed after unprotected intercourse (n = 940) as well as women who presented for the termination of pregnancy (n = 1592) between January 1, 2005 and November 20, 2006. Their knowledge of ECP and their experience with and attitudes toward ECP use were targeted. Results: The availability of ECP was well known (87.9 %), but it was still greatly underutilized: applied by only 13 of the 1592 women who resorted to abortion. Primarily, the ECP group consisted of those who experienced a condom failure significantly more often (odds ratio [OR] = 4.1), followed by those cases where ECP applications was a consequence of not using any kind of contraception (OR = 3.8). Fewer than one third (32 %) of the abortion seekers had previously used ECP, and only one fifth knew how to obtain it. Appropriate awareness of ECP was influenced by information obtained from health-care providers (adjusted odds ratio [AOR] = 3.93) or school education (AOR = 1.82). Conclusions: More thorough education is needed to provide a deeper knowledge of ECP use during contraceptive counseling for women seeking abortion, including those contraceptive mishaps where unintended pregnancy can be prevented by ECP.

Uncertainties of the KIKO3D-ATHLET calculations using the Kalinin-3 benchmark (Phase II) data

The best estimate simulation of three-dimensional phenomena in nuclear reactor cores requires the use of coupled neutron physics and thermal-hydraulics calculations. However these analyses should be supplemented by the survey of the corresponding uncertainties. In this paper the uncertainties of the coupled KIKO3D-ATHLET calculations are presented for a VVER-1000 type core using the OECD NEA Kalinin-3 (Phase II) benchmark data, although only the neutronic uncertainties are considered and further simplifications are applied and discussed. Additionally, this study has been performed in the conjunction with the OECD NEA UAM benchmark, as well. In the first part of the paper, the uncertainties of the effective multiplication factor, the assembly-wise radial power distribution, the axial power distribution, the rod worth, etc. are presented at steady-state. After that some uncertainties of the transient calculations are discussed for the considered switch-off of one Main Circulation Pump (MCP) type transient.

Prevalences and pregnancy outcome of vanishing twin pregnancies achieved by in vitro fertilization versus natural conception

OBJECTIVE

To evaluate whether vanishing twin (VT) pregnancies achieved by in vitro fertilization and intracytoplasmic sperm injection (IVF-ICSI) had a more adverse perinatal outcome than those after natural conception.

DESIGN

Longitudinal, retrospective cohort study.

SETTING

Tertiary university hospital.

PATIENT(S)

Three hundred and six (78 after IVF-ICSI and 228 after natural conception) VT pregnancies over a 22-year period, with VT cases matched to primarily singleton controls.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Obstetric and neonatal outcome data.

RESULT(S)

The incidence of VT was statistically significantly higher after natural conception (18.2% of twins) than after IVF-ICSI (12.6% of twins). The odds of VT in pregnancies complicated with pregestational or gestational diabetes were disproportionally higher in IVF-ICSI cases than in spontaneously conceived VT pregnancies (adjusted odds ratio [AOR]: 0.80 vs. 3.10 and 1.00 vs. 1.07, respectively). Previous induced abortion (AOR 1.34) or second-trimester fetal loss (AOR 3.3) increased the risk of VT pregnancies after spontaneous conception. Gestational diabetes mellitus in both the previous (AOR 5.41) and the present (AOR 2.3) pregnancy as well as chronic maternal diseases (AOR 3.5) and placentation anomalies all represented independent risk factors for VT after IVF-ICSI.

CONCLUSION(S)

Vanishing twin pregnancies had a lower prevalence and a worse perinatal outcome after IVF-ICSI as compared with those of their spontaneously conceived counterparts.

Assessment of the uncertainties of MULTICELL calculations by the OECD NEA UAM PWR pin cell burnup benchmark

Defining precisely the burnup of the nuclear fuel is important from the point of view of core design calculations, safety analyses, criticality calculations (e. g. burnup credit calculations), etc. This paper deals with the uncertainties of MULTICELL calculations obtained by the solution of the OECD NEA UAM PWR pin cell burnup benchmark. In this assessment Monte-Carlo type statistical analyses are applied and the energy dependent covariance matrices of the cross-sections are taken into account. Additionally, the impact of the uncertainties of the fission yields is also considered. The target quantities are the burnup dependent uncertainties of the infinite multiplication factor, the two-group cross-sections, the reaction rates and the number densities of some isotopes up to the burnup of 60 MWd/kgU. In the paper the burnup dependent tendencies of the corresponding uncertainties and their sources are analyzed.

Analyses of Beyond Design Basis Accident Homogeneous Boron Dilution Scenarios

Homogeneous boron dilution scenarios in a VVER-440 reactor were analyzed using the coupled KIKO3D-ATHLET code. The scenarios are named “homogeneous” because of the very slow dilution caused by a rupture in the heat exchanger of the makeup system. In the case of the presented Beyond Design Basis Accident (BDBA) scenarios, it was supposed that after 30 min the operator doesn't stop the dilution, violating the prescriptions of the Limits and Conditions document. Without the presented analyses, a significant contribution of the homogeneous boron dilution to the Core Damage Frequency (CDF) had to be assumed in the Probabilistic Safety Analyses (PSA). According to the combined results of the presented deterministic and probabilistic analyses, the final conclusion is that boron dilution transients don't give significant contribution to the CDF for the investigated VVER-440 NPP.

Development and verification of new nodal methods in the KIKO3DMG code

The paper reports about the development and verification of the new nodal methods to be used in the KIKO3DMG code. Two classes of the new methods are presented. The first class makes the treatment of the heterogeneities possible inside the assemblies while the extent of the crucial approximations applied on the node boundaries is more considerable in comparison to those in case of the second type. The nodal methods were validated by two VVER reference problems found in the AER benchmark book (aerbench.kfki.hu/aerbench). The AER-2 and FCM-101 benchmarks correspond to the VVER-440 and VVER-1000 geometry, respectively. It was found that the differences between the converged and the reference solutions are negligible from the practical point of view. The performance characteristics concerning the accuracy and the necessary CPU time – both depending on the mesh refinement – were also compared.

Investigation of the hot-channel calculation methodology in case of shroud-less assemblies

The fulfillment of the safety analysis acceptance criteria and the normal operation safety related limitations are usually evaluated by using separate hot-channel or/and hot-assembly thermal hydraulic calculations, especially for the closed VVER-440 assemblies. However, the shroud-less assemblies of the expected new NPP units in Hungary or even those of some recently foreseen VVER-440 are raising several questions; like what is the role of the coolant mixing between the neighboring assemblies and can the closed assembly approximation be regarded as conservative for DBA analyses. Focusing an anticipated transient without scram (ATWS) event, the paper evaluates the thermal hydraulic calculation methodology of the shroud-less assemblies by supplementing the computational domain step by step with the closest pins and subchannels of the neighboring assemblies. We concluded that assembly-wise coolant cross-flows and significant changes in the hot-channel DNBR can appear in case of shroud-less assemblies.

Assessment of the uncertainties of COBRA sub-channel calculations by using a PWR type rod bundle and the OECD NEA UAM and the PSBT benchmarks data

The assessment of the uncertainties of COBRA-IIIC thermal-hydraulic analyses of rod bundles is performed for a 5-by-5 bundle representing a PWR fuel assembly. In the first part of the paper the modeling uncertainties are evaluated in the term of the uncertainty of the turbulent mixing factor using the OECD NEA/NRC PSBT benchmark data. After that the uncertainties of the COBRA calculations are discussed performing Monte-Carlo type statistical analyses taking into account the modeling uncertainties and other uncertainties prescribed in the OECD NEA UAM benchmark specification. Both steady-state and transient cases are investigated. The target quantities are the uncertainties of the void distribution, the moderator density, the moderator temperature and the DNBR. We will see that – beyond the uncertainties of the geometry and the boundary conditions – it is very important to take into account the modeling uncertainties in case of bundle or sub-channel thermo-hydraulic calculations.

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.

Uncertainties of the neutronic calculations at core level determined by the KARATE code system and the KIKO3D code

In this paper the uncertainties of the neutronic calculations at core level – originating from the uncertainties of the basic nuclear data – are presented. The investigations have been made for a VVER-1000 core (Kozloduy-6) defined in the frame of the OECD NEA UAM benchmark. In the first part of the paper, the uncertainties of the effective multiplication factor, the assembly-wise radial power distribution, the axial power distribution and the rod worth are shown. After that the preliminary evaluation of the uncertainties of the neutron kinetic calculations are presented for a rod movement transient at HZP (Hot Zero Power) state, where the uncertainties of the time dependent core and assembly powers and the dynamic reactivity were evaluated. In both cases, we will see that the most important quantities –at core level and at HZP state – have a considerable uncertainty which is originating from the uncertainties of the basic cross section library in these investigations.

Qualification of the APOLLO2 lattice physics code of the NURISP platform for VVER hexagonal lattices

The experiments performed at the ZR-6 zero power critical reactor by the Temporary International Collective (TIC) and a burnup benchmark specified for depletion calculation of a VVER-440 assembly containing Gd burnable poison were used to qualify the APOLLO2.8-3.E (APOLLO2) code as a part of its ongoing validation activity. The work is part of the NURISP project, where KFKI AEKI undertook to develop and qualify some calculation schemes for hexagonal problems. Concerning the ZR-6 measurements, single cell, macro-cell and 2D calculations of selected regular and perturbed experiments are used for the validation. In the 2D cases, the radial leakage is also taken into account by the axial leakage represented by the measured axial buckling. Criticality parameter and reaction rate comparisons are presented. Although various sets of the experiments have been selected for the validation, good agreement of the measured and calculated parameters could be found by using the various options offered by APOLLO2. An additional mathematical benchmark – presented in the paper – also attests for the reliability of APOLLO2. All the test results prove the reliability of APOLLO2 for VVER core calculations.

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.

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.

[What does fetal renal echogenicity mean in intrauterine growth retardation?]

AIMS

The object of this study was to investigate the fetal renal and middle cerebral arterial blood flows in patients with normal and hyperechogenic kidneys during the fetal period.

MATERIAL AND METHODS

Study group consisted of 82 pregnancies with intrauterine growth retardation. Group included pregnant women from the third trimester. Hyperechogenic medullae were detected in 17 out of 82 pregnancies with intrauterine growth retardation.

RESULTS

Fetal renal hyperechogenicity appears to be an indicator of fetal arterial circulatory depression, correlated with pathological changes in the pulsatility index for the fetal renal arteries. The fetal renal arterial blood flow pulsatility index was significantly lower in hyperechogenic cases, while in the middle cerebral artery flow was in the normal range. This may also be an indication of subsequent intrauterine and neonatal complications, such as cesarean section because of fetal distress (47%), treatment in a neonatal intensive care unit (71%) or increased perinatal mortality (12%) in our cases.

CONCLUSIONS

Detailed ultrasound of renal parenchyma and Doppler examination of renal and middle cerebral arteries appear to be an useful method in the prenatal diagnosis of reduced renal perfusion and of intrauterine hypoxia so as to detect possible pathological fetal conditions in utero.

[Biparietal diameter/kidney length ratio in cases with chronic hypoxic state]

AIMS

The object of this study was to investigate the fetal biparietal diameter/kidney length ratio in normal and hyperechogenic kidneys during the third trimester of gestation.

MATERIAL AND METHODS

The selected cases were characterized by pregnancy-associated hypertension and/or proteinuria, which was associated with fetal hypoxia due to the depression of placental blood flow. Depending on the renal manifestation of intrauterine chronic hypoxia, cases were divided into two study groups. Group I was composed of 21 fetuses with pregnancy-associated hypertension and/or proteinuria and hyperechogenic renal medullae. Group II consisted of 162 fetuses with pregnancy-associated hypertension and/or proteinuria and normal echoic kidney. Both study groups included pregnant women from the third trimester.

RESULTS

Fetal renal hyperechogenicity correlated with the pathological growth of fetal kidney. The fetal biparietal diameter/kidney length ratio was significantly lower in cases of hyperechogenicity.

CONCLUSIONS

The fetal renal hyperechogenicity is a relevant indicator of diminution of fetal renal perfusion. This can lead to abnormal development of the affected kidney and can result in a pathological reduction of biparietal diameter/kidney length ratio, which may also be an in utero indicator of subsequent intrauterine and neonatal complications. Detailed ultrasound examinations of renal parenchyma and kidney length seem to be a useful method in the prenatal diagnosis of decreased renal perfusion and of intrauterine hypoxia and serve to detect pathological conditions in utero.

Pressure vessel calculations for VVER-440 reactors

For the determination of the fast neutron load of the reactor pressure vessel a mixed calculational procedure was developed. The procedure was applied to the Unit II of Paks NPP, Hungary. The neutron source on the outer surfaces of the reactor was determined by a core design code, and the neutron transport calculations outside the core were performed by the Monte Carlo code MCNP. The reaction rate in the activation detectors at surveillance positions and at the cavity were calculated and compared with measurements. In most cases, fairly good agreement was found.

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.

[Comparative study of the efficiency of gonadotrope releasing hormone (GnRH) analogs for the treatment of endometriosis]

INTRODUCTION

Endometriosis is one of the most common gynaecological conditions in women of reproductive age. The aim of the authors' study was to compare the relative safety, efficacy and side effects of nafarelin and triptorelin.

PATIENTS AND METHODS

They treated 133 patients for six months and followed up for at least an additional 6 months. In the diagnosis of the endometriosis they use the gold standard, the laparoscopy.

RESULTS

During the 6-month therapy with analogues, there was a noticeable decline in the symptoms of the disease, there was no significant change in the efficacy and was no difference in main side effects of the two drugs.

CONCLUSION

These treatments represent favourable approaches in the management of endometriosis.

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 sonographers.

METHODS

Nuchal translucency thickness was measured by transvaginal sonography in 7,044 women with singleton or multiple pregnancies at weeks 10-12. Fetal karyotyping was performed when the nuchal translucency was . or = 2.5 mm, and in women with fetuses at high cytogenetic risk.

RESULTS

Follow-up was performed in 6,841 of the 7,044 screened women. An abnormal karyotype was found in 33 cases (0.48%). The level of increased nuchal translucency was 4.5% at a cutoff of > or = 2.5 mm, and 2.8% at a cutoff of > or = 3 mm. Seventeen cases of trisomy 21, eight of trisomy 18, four of trisomy 13, one of 45,X, one of triploidy and two cases with other chromosomal abnormalities were detected. In the 33 fetuses with a chromosomal abnormality, the nuchal translucency thickness was <2.5 mm in a case of trisomy 18, > or = 2.5 mm in 32 cases and > or = 3 mm in 28 cases. With cutoffs of 2.5 mm and 3 mm, the sensitivity was 96.97% and 84.85%, respectively.

CONCLUSIONS

Application of a nuchal translucency thickness cutoff of 2.5 mm is highly efficient for the screening of fetal aneuploidies at 10-12 weeks. This efficiency can be maintained by increasing the regional availability of nuchal translucency screening through the inclusion of newly-trained hospital sonographers.

[Treatment of hyperprolactinemic anovulation with the dopamin-agonist quinagolide]

Quinagolide has a strong dopaminerg activity, suppresses prolactin secretion and restores gonadal function in women with hyperprolactinemic anovulation. The aim of our study was to investigate the effectiveness of quinagolide in the treatment of 16 hyperprolactinemic patients. The clinical diagnosis was functional hyperprolactinemia in 13 patients, microprolactinoma in 2 and empty sella syndrome in 1. The drug was administered orally and initially daily dose was 0.025 mg for the first three days, 0.050 mg for the next three days and 0.075 mg for the following 6 months. The serum prolactin level was measured monthly before pregnancy, three monthly during the pregnancy and six weeks after delivery. Serum prolactin levels decreased in most of the patients during the first month and only in one case remained in the pathological range after six months quinagolide++ treatment. Prolactin secretion changed (mean and range) from 3120 (780-5790) mU/l to 370 (84-1076) mU/l. Out of 16 hyperprolactinemic patients nine women were infertile. During quinagolide treatment 5 pregnancies occurred. In conclusion, our results show that quinagolide has a good efficacy on regulation of prolactin secretion and it is a well tolerated dopamin-agonist drug.

[Genetic counseling and prenatal care after medications during the first trimester]

Analysis of the outcome of 127 pregnancies with first trimester medication (8.4% of the total number of the patients seeking genetic advice in 1997 at the Institute of Medical Genetics in Szeged) was carried out. The gestational age at the time of the medication and genetic counselling, the indications of the treatment, the drugs, the estimated fetal risk, and results of genetic ultrasound examinations and pregnancy outcome were evaluated. The majority of pregnant woman (78%) asked for genetic counselling before the 12. gestational week. The main indications the treatment were: infections, psychiatric-neurologic (depression, anxiety, epilepsy), endocrine (diabetes, hyperthyreoidism), and cardiovascular diseases and gastrointestinal problems. The main groups of the drugs were: antibiotics, antipyretic-, antidepressive-, antidiabetic- and antihypertensive drugs. When the multiple medication was conducted by simultaneous administration of two or more drugs, a complex risk calculation was performed. The fetal risk was higher than 10% in 31 cases (24%). The ultrasound examinations performed by qualified sonographer contributed to a correct evaluation and to reliable follow-up of pregnancies. No suspicious ultrasound finding was reported in the first trimester. However, a severe fatal brain malformation was found in a second trimester pregnancy, which was terminated by the couple's request in the 18th gestational week. A complete follow-up was obtained in 70.9% (90) of the cases. Out of 64 pregnancies intended to continue to term 4 fetal malformations were found. Of them three malformations (patent ductus arteriosus, Robin sequence and a ventricular septal defect) were explored at birth or in the newborn period. The actual 6.3% of fetal malformations was higher compared to the rate expected at birth, but almost equal to the rate of congenital malformation found up to the end of the first year of age in Hungary.