Abstract

In the first lesson, we will focus on the unique pregnancy care needs of minority groups, specifically the Roma population in Romania. The objective is to educate medical students and consultants about the challenges of providing care and effective communication with minority groups. Key issues will include accessibility to care, problems in pre-pregnancy counseling, and difficulties during and after pregnancy. Factors affecting accessibility may include language barriers, lack of information, financial constraints, and discrimination. By addressing these issues, the lesson aims to equip healthcare providers with tools to improve care for minority groups in the future.

Abstract

Migrants in western cities encounter significant barriers when accessing healthcare services. Common challenges include a lack of information about available resources and services, language barriers due to limited local language skills, and cultural differences that may make healthcare systems feel alien or threatening. These cultural norms and values often go unnoticed by healthcare providers, hindering effective communication and comfort. It's essential for healthcare institutions to recognize and address these challenges, fostering an inclusive environment that enhances the overall quality of care for migrant populations.

Abstract

Europe's population has historically been dynamic, with nation-states emerging from diverse populations through nationalism and assimilation in the 19th century. Today, globalization intensifies migration due to factors like communication, forced displacement from conflict zones, and climate change driving people from the global south to Europe. Despite negative political narratives, labor migration benefits the EU, addressing its aging population and labor shortages. This reliance on incoming migrants raises ethical concerns about exploiting skilled workers, echoing modern forms of colonization. Understanding these dynamics is crucial for addressing the complexities of migration in contemporary Europe.

Abstract

The Roma population consists of various communities with distinct linguistic, social, and cultural characteristics. Focusing on a specific subgroup, Roma women living in rural areas often face marginalization and low education levels, leading to poverty. These women typically seek a meaningful life, which they find through early motherhood. However, this choice can have long-term consequences, such as becoming single parents, remaining in poverty, and struggling to re-enter the job market. Additionally, their marginalized status contributes to various health issues throughout their lives, highlighting the need for targeted support and resources for these women.

Abstract

Globalization has significantly increased the diversity in Global Cities, bringing both challenges and benefits. While integration and inclusion of newcomers can be difficult, the advantages of diversity far outweigh these issues. People from various cultural backgrounds and with different knowledge come together, fostering innovation and the exchange of new ideas. This diversity enriches the societies in which these individuals arrive, making cities more dynamic and creative. In essence, the influx of people from diverse origins creates environments ripe for growth and development, contributing positively to the local community.

Abstract

This lecture explores infertility from an intercultural perspective, addressing both medical and patient viewpoints. Infertility, defined as no pregnancy after 12 months in women under 35, affects around 48 million couples globally. Causes vary and may include female conditions like endometriosis or male factors such as sperm quality. The second part focuses on patient experiences, emphasizing feelings like loss of control, anger, and anxiety, which medical staff must understand. Cultural, religious, and ethnic backgrounds influence how patients express these emotions and respond to treatment. The lecture aims to merge medical and patient perspectives to create culturally sensitive and effective treatment plans.

Abstract

In 2021, the Erasmus Plus Cooperation Partnership project, COCHRISE, was initiated to create an interdisciplinary curriculum on obstetrics and gynecology, focusing on human reproductive medicine in a changing Europe. The project addresses significant societal shifts, such as migration, which impacts population demographics, culture, and medical practices. The aim is to equip future doctors with the cultural competence needed to understand and meet diverse patient needs, particularly in areas like infertility and pain perception. With contributions from Hungary, Romania, and Austria, the curriculum integrates regional expertise to tackle different obstetric challenges. The materials will be freely accessible online, providing resources for both students and teachers across Europe.

Abstract

People struggling with infertility often endure years of emotional hardship, marked by uncertainty, failed attempts, and loss. Seeking medical help in such a personal matter can be challenging, but it brings relief and hope for many. However, couples often overestimate the success rates of IVF and underestimate its emotional toll. The process involves multiple hurdles, from injections to egg retrieval and fertilization, with no guarantee of pregnancy. The emotional strain is felt by both partners, leading to tension. Even when implantation occurs, the wait for results can be overwhelming, and a negative outcome is often experienced as profound grief.

Abstract

Telling patients struggling with infertility to "relax" or "take a vacation" can cause harm, leading to feelings of guilt without improving their chances of conception. Psychological factors, while not primary causes of infertility, can affect behavior that harms fertility, such as disordered eating, substance abuse, and improper timing of intercourse. However, common stress or emotional responses like sadness, anger, or envy are natural in those with unfulfilled desires for children. These emotions shouldn't be pathologized or blamed for infertility. Medical professionals should avoid advice that downplays patients' experiences or suggests relaxation as a cure, as it can exacerbate feelings of failure and stress.

Abstract

This lecture examines the relationship between reproductive technologies and social transformations. Social needs drive technological innovations, while new technologies influence social norms and behaviors. Advances in reproductive medicine have reshaped concepts of family planning and reproductive lifespan, raising ethical questions such as the legal status of frozen embryos and genetic selection. By considering biological, social, and biotechnological temporalities, we encourage students to explore the ethical and psychological aspects of these issues. Ultimately, the goal is to stimulate critical thinking and discussion about the implications of reproductive technologies on individual and family life.

Abstract

As a psychologist, I want to emphasize that IVF or fertility treatments involving donor gametes are not simply linear extensions of conventional treatment. They introduce new complexities, involving third parties—sometimes even fourth or fifth parties—into the couple's dyadic relationship. While these significant others may only play a medical role at the start, their psychological influence can extend throughout the child's life. Third-party reproduction includes egg, sperm, and embryo donation, as well as surrogacy. Regulatory frameworks differ widely across Europe and globally, posing both challenges and opportunities in modern reproductive medicine, including in Austria.

Abstract

Gynecologists must understand the unique psychological challenges of gamete donation, as it introduces third parties into the family dynamic. This involvement persists even after the child's birth, influencing their identity. It’s essential to create a family narrative addressing the role of donors before conception, considering implications such as the child's appearance and emotional fantasies about the donor. Professional psychological counseling is crucial to help couples explore these issues thoroughly. Open discussions can prevent taboos, which can negatively impact a child's development. Thus, psychological support is vital for couples considering sperm donation or other reproductive options.

Abstract

Regulations governing assisted reproductive technologies (ART) vary significantly across Europe, despite the underlying technology being the same. While some countries have restrictive policies, others are more permissive, leading to a diverse landscape in access and accepted practices. Initially, ART was primarily accessible to heterosexual couples, but over time, access has expanded to include same-sex couples and, in some cases, single women. Furthermore, specific interventions like egg and embryo donation and social freezing are permitted in some countries but prohibited in others. Overall, there is a growing trend towards permissiveness regarding ART regulations across Europe.

Abstract

Differences in the regulation of assisted reproductive technologies (ART) across Europe stem from various factors. Public attitudes toward ART vary widely, influenced by cultural and religious beliefs, particularly among those who oppose it based on the notion of not intervening in nature. Mindsets range from viewing ART as a medical solution for infertility to seeing it as a means to enhance genetic outcomes. Additionally, the discussions surrounding ART are often value-laden and can lead to heated debates, as seen in issues like abortion. Stakeholders such as religious organizations, industries, and patient advocacy groups also play a crucial role in shaping regulations. Finally, the timing and opportunities for lawmaking can impact how quickly regulations adapt to advancements in ART technologies.

Abstract

Austria's approach to assisted reproductive technologies (ART) has shifted over 40 years through four mindsets: initial resistance to intervention in reproduction, viewing ART as a medical necessity, expanding access for same-sex couples, and leveraging ART for genetic enhancement. The change was gradual, influenced by the intense debates over abortion in the 1970s that led to cautious regulation. Increased societal acceptance of same-sex couples and active advocacy by citizens demanding access to ART played crucial roles in transforming the legal landscape. This evolution reflects the dynamic interplay between public attitudes, legal action, and changing social norms in reproductive rights.

Abstract

Endometriosis is a prevalent gynecological disorder affecting 5-10% of women in their reproductive years, impacting approximately 175 million globally. Common symptoms include pelvic pain, often linked to menstruation (dysmenorrhea), inflammation, and infertility. Diagnosing endometriosis can be challenging, often taking 4 to 11 years, which significantly reduces women's chances of childbearing as reproductive age is limited. The condition can manifest in various locations, including the pelvis, ovaries, and diaphragm. Diagnosis typically involves clinical assessment, ultrasound, and MRI. Treatment varies based on symptoms, with pain management through conservative methods or interdisciplinary approaches with reproductive specialists for infertility.

Abstract

My story highlights the complexity of endometriosis and emphasizes the importance of interdisciplinary collaboration among specialists. It began in 2015 when I experienced severe pain around my navel, which led to multiple misdiagnoses. Eventually, during surgery, I was diagnosed with endometriosis, necessitating the complete removal and surgical reconstruction of my navel. Prior to this, I had endured unexplained stomach pains and fever as a child. In 2020, my journey to conceive started, involving numerous treatments and significant waiting periods. Ultimately, a skilled surgeon identified extensive endometriosis using a DaVinci robot, paving the way for our dream of having children.

Abstract

Taking teratogenic medications, such as Mycophenolate, Leflunomide, Cyclophosphamide, or Methotrexate, before or during pregnancy poses significant risks. These drugs, commonly used in rheumatic therapy, can lead to congenital malformations and a higher chance of spontaneous miscarriages. For instance, Mycophenolate is associated with a 36% risk of congenital malformations and nearly 50% risk of miscarriage. Methotrexate carries a 6% risk of congenital malformations. During counseling, it’s crucial to communicate the baseline risk of congenital malformations (3-5%) and miscarriage (15-20%) to patients. This should be done in a participatory manner, considering the patient's circumstances. If a pregnancy continues, more frequent ultrasounds and screenings are recommended.

Abstract

Congenital heart block, particularly AV block, can occur when pathogenic antibodies like anti-Ro and anti-La cross the placenta from mothers, often linked to conditions like Sjögren's syndrome and systemic lupus erythematosus. Healthy women can also have these antibodies. Treatment discussions with patients may include hydroxychloroquine to mitigate risks. Prenatal screening is vital, with fetal heart echoes performed weekly from weeks 16 to 24. For AV blocks, therapies include Dexamethasone for blocks 1 and 2, while block 3 may not benefit from treatment. Experimental options include Prevagen, Evig, apheresis, and TGF-beta inhibition.

Abstract

I am a lupus patient. My illness was discovered in 2016, but I was not affected until 2018, when my health declined by 40 percent. I had thrombosis three times—in my legs, shoulder, and even my eye—requiring Marcumar. Since 2018, I have undergone frequent check-ups to monitor my INR levels. By 2020, my condition stabilized, and my husband and I decided to plan for a child. Initial doctors didn’t recommend it, but we adjusted my therapy to include medications safe for pregnancy. A planned pregnancy is vital to avoid risks for the child, and consistent therapy helps maintain my health.

Abstract

If a woman has taken a teratogenic drug before or during pregnancy, it can be frightening, especially for those with serious conditions like autoimmune diseases. Common medications like mycophenolate mofetil, cyclophosphamide, and methotrexate pose risks. It's crucial to consider contraception and potential desires for children when treating women of reproductive age. If an unplanned pregnancy occurs, a detailed, participatory discussion about risks is essential. For example, mycophenolate carries a 36-40% risk of birth defects and a high miscarriage rate. Women should be informed of baseline risks and closely monitored with ultrasounds and gynecological care if they choose to continue the pregnancy.

Abstract

Good day, my name is Antonia Mazzucato-Puchner, a specialist in Internal Medicine and Rheumatology. Today, I will discuss immunosuppressive therapy during pregnancy, particularly relevant as autoimmune diseases are more common in women. Notably, systemic lupus erythematosus is eight times more prevalent in women. Key guidelines indicate that only cyclophosphamide, mycophenolate mofetil, and methotrexate are proven teratogenic. Methotrexate should be discontinued 3-1 months before pregnancy; others 3 months prior. During pregnancy, Salazopyrin, hydroxychloroquine, chloroquine, and TNF inhibitors are generally safe. While biologics can cross the placenta, current data suggests they are not teratogenic, making careful management essential.

Abstract

In this lesson, we will discuss the special challenges of twin pregnancies, particularly with the rise in artificial reproductive techniques. We will examine predisposing factors, including reproductive methods, advanced maternal age, ethnic backgrounds, and genetic influences. Additionally, we will determine obstetric risks based on chorionicity and provide guidelines for pregnancy monitoring and delivery methods for different twin types. The second part will focus on adverse maternal and fetal outcomes, specifically related to monochorionic twin pregnancies, including conditions like twin reverse arterial perfusion, twin-twin transfusion syndrome, and twin anemia-polycythemia sequence, all linked to placental vascular anastomosis.

Abstract

Today, I will discuss two syndromes that can occur in monochorionic twins: the more common fetofetal transfusion syndrome (FFTS) and the rarer Twin Anemia Polycythemia Sequence (TAPS). FFTS occurs in about 15% of monochorionic twins, caused by imbalanced blood flow through vascular anastomoses, leading to amniotic fluid discordance. Diagnosis relies on the difference in amniotic fluid levels, with therapy involving laser coagulation of vessels. TAPS, occurring in about 3% of cases, results from continuous small vessel blood transfer, causing polycythemia in one twin and anemia in the other, diagnosed via middle cerebral artery velocity measurements.

Abstract

In this lesson, we will discuss ultrasound screening in pregnancy, covering technical aspects and advances in ultrasound techniques over recent decades. We will differentiate between screening ultrasounds and diagnostic examinations, highlighting their limitations. The lesson will address the first ultrasound, early pregnancy detection, and screenings between the 18th and 22nd weeks and between the 28th and 32nd weeks. In the second part, we will explore the Doppler ultrasound technique's role in detecting fetal growth restriction and stillbirth risk, emphasizing how timing influences fetal outcomes. Lastly, we will examine the advantages and limitations of 3D and 4D ultrasound techniques.

Abstract

In an ultrasound examination, if something unusual is observed, it’s vital for the doctor to communicate this effectively. The doctor should acknowledge the woman’s concerns, stating, “I’ve seen something, and I’d like to take a closer look,” while ensuring reassurance. Afterward, simple explanations and visual aids should be provided. It’s crucial to check for a companion's presence and offer contact information for further questions. Emotional reactions are common, so the doctor should maintain eye contact, speak slowly, and signal support. Always have tissues on hand and ensure the woman remains seated for better communication.