Background: The aim of this study was to determine type and frequency of complications during multiple pregnancies, mode of delivery and perinatal outcome in three groups of pregnant women, categorized by gestational age of pregnancy.Methods: In cross-sectional epidemiological study data were collected and processed from the medical database of University Clinical Hospital in Mostar in the period between 2015. and 2019. A total of 149 pregnant women and their neonates were included and divided into three groups according to gestational age: moderately preterm birth (from 22 to 33 + 6 weeks - MPTB), late preterm birth (from 34 to 36 + 6 weeks - LPTB ), term birth (from 37 weeks). SPSS for Windows software (version 23.0, SPSS Inc, Chicago, Illinois, USA) was used for statistical analysis.Main findings: Of the total 149 pregnancies, 64.86% were completed by C-section and it was the dominant mode of delivery in all gestational groups. Hypertension, PPROM and gestational diabetes pregnancy were the most common complications in the group of term birth, PPROM and preeclampsia in the LPTB group, multiple maternal complications in the group MPTB (p <0.001). In both twins, respiratory distress syndrome (RDS) was the most common complication in MPTB group, and neonatal jaundice and perinatal infection and sepsis in the LPTB and term birth group.Principal conclusions: Caesarian section was dominant mode of delivery in all groups. RDS and multiple complications were significantly more common in MPTP group, and neonatal jaundice, perinatal infections and sepsis in LPTP and term birth group.Key words: multiple pregnancy, PPROM, preeclampsia, hypertension, perinatal complications, caesarian section.

Abstract Background To examine correlation between elevated levels of thyrotropin with the frequency of miscarriages. Methods A cross-sectional study was conducted on the 380 respondents and it investigated TSH (thyrotropin), thyroid peroxidase antibody(anti-TPO) and free thyroxine (FT4) in pregnant women who had a miscarriage (N = 179) and pregnant women with normal pregnancies (N = 201). Results The incidence of subclinical hypothyroidism in the miscarriages group was higher than in control group (61.4% vrs 15.79% (p < 0.001). In the miscarriages group with hypothyroidism (first trimester) mean value of TSH was significantly higher 4.31 ± 2.55 mIU/L compared to the control group 1.95 ± 0.86mIU/L (p < 0.001). Logistic multivariate regression revealed that TSH and body mass index (BMI) have a significant influence on the miscarriage; TSH level has a higher odds ratio (OR) 1.47 CI (95% 1.22–1.78) than BMI (OR) 1.14 CI (95% 1.06–1.23)) (p < 0.001). The combination of thyroid autoimmunity and TSH > 2.5mIU/L increase the risk of miscarriage (65.75%) compared to positive anti-TPO antibodies and TSH < 2.5mIU/L(14.15%)(p < 0.001). Conclusions Higher TSH levels correspond with obesity during early pregnancy and may be a sign of maternal thyroid dysfunction. Physiological thyroid function in the first trimester of pregnancy is important for perinatal outcome.

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries.

Background : This study conducted at the Clinic for Children’s Diseases of the University Clinical Hospital Mostar, aims to highlight the characteristics, frequency, course, most common complications and treatment outcomes of pregnant women and their late preterm infants according to gestational age. Methods : This study is a retrospective epidemiologic study for the period from 1/1/2018 to 31/12/2021. The study included all the preterm infants who were born at a gestational age from 34 +0/7 to 36 +6/7 weeks and their mothers. Results : In the period under study, a total of 7178 infants were born, of which 253 (3.52%) were late preterm infants. The results show that most mothers were between 30 and 39 years of age, pregnant for the first time with a single pregnancy, delivered by caesarean section, with complications in 53.1% of the pregnancies. All the analyzed pathological conditions were more common in the pregnancies which ended at 34 weeks. Our results indicate that the late preterm babies had a good birth weight (53.8%) and high vitality scores (93%) at birth, but these scores were not confirmed on the first day of life. A significant number of late preterm infants had some pathological condition which was treated in the intensive care units (ICU) ( p < 0.001). Conclusions : The study concludes that half of the pregnant women had risk factors which were the basis for the preterm births and the development of complications in the late preterm infants. Furthermore, despite good birth weight and vitality scores at birth, only one fifth of the late preterm infants were not treated with medications or developed pathological conditions, whereas only one third required no intensive care treatment. It is, therefore, necessary to improve the monitoring and understanding of such pregnancies, implement antenatal corticosteroid therapy, and increase parental awareness to ensure long-term and frequent monitoring of late preterm infants by pediatricians.

Acute abdomen in pregnancy is one of the biggest diagnostic and therapeutic challenges today. Despite advances in medical technology, the preoperative diagnosis of acute abdominal conditions is still inaccurate. Torsion of the adnexa, which refers to complete or partial rotation of the adnexa, resulting in obstruction of venous and lymphatic reflux in the ovary, is a common gynecological emergency. Torn adnexa affect both the ovary and the fallopian tube, and rarely affect only one of them. Adnexal torsion occurs more frequently in the first and early second trimester than in the third trimester. It is difficult to diagnose in advanced pregnancy because of nonspecific symptoms and signs of acute abdomen as well as ultrasound limitations due to uterine enlargement complicate diagnosis. Late diagnosis and delayed surgical treatment result in ovarian loss and fetal endangerment. It is important to thoroughly evaluate the adnexa at the 1st ultrasound examination in pregnancy and to monitor the observed formations.

Abstract Objective: To determine the frequency of subclinical hypothyroidism in women with pathological pregnancies and the association between elevated thyroid-stimulating hormone (TSH) and pregnancy outcome. Subjects and methods: A cross-sectional prospective study investigated value of TSH and free thyroxine (FT4) in (1) pregnant women with hypertension (HTA) (N = 62) or preeclampsia (PE) (N = 50), (2) women with gestational diabetes mellitus (GDM) (N = 92) in pregnancy, and (3) women with normal pregnancies (control) (N = 201). The level of statistical significance was set at p < .05. Results: Of the total 404 respondents, the highest incidence of subclinical hypothyroidism was in the group with preeclampsia 22%, followed HTA group 9.6%; GDM group 10.9% and in the control group 9% (p < .001). Higher levels of TSH were in the preeclampsia (2.5 ± 1.54 mIU/L) and in the HTA (2.03 ± 0.97 mIU/L) compared with the control group (1.95 ± 0.86 mIU/L); (p < .001). Weight gain in pregnancy was significantly higher in women with TSH >3 mIU/L (p = .003). There were no differences in the average TSH value between GDM (1.93 ± 1.03 mIU/L) and control group (p = .962). Conclusions: Early detection and optimal treatment of thyroid dysfunction before and in the first trimester of pregnancy reduces the risk of adverse pregnancy outcomes.

BACKGROUND The objective of this study was assasment of women's knowledge and awareness on medication and herbal remedies use during pregnancy. SUBJECTS AND METHODS Cross-sectional study was conducted in Department of Obstetrics and Gynaecology University Clinical Hospital Mostar. The study included 230 parturients (primipara) and 20 pharmacists who work in pharmacies of Mostar. Collected and analyzed data was based on a questionnaire of 25 questions. RESULTS Out of total number of respondents (N =230), 159 of them (69.1%) used some vitamin or mineral product, 44.8% of respondents had problems with morning sickness and vomiting, but they did not use any medication in pregnancy. Higher educated respondents used folic acid more often (p=0.005), they knew the benefits of using folic acid (p<0.001) and magnesium during pregnancy (p=0.002) and they were familiar with harmful effect of alcohol and cigarettes consumption during pregnancy (p=0.005) so as with harmful effect of excessive quantity of vitamin A (p=0.037), they were more familiar with harmful effect of herbal remedies and at least one harmful herb compared to less educated respondents (p<0.001). CONCLUSION There is lack of knowledge and unawareness on harmful effect of medication use and herbal remedies during pregnancy.

Introduction: Obesity is one of the greatest health problems in the world. The World Health Organization (WHO) defined obesity as a disease in which the excess of adipose tissue accumulates in such a degree that is endangers health. Obesity is a very complex multifactor disease that is developed under the influence of genetic and metabolic factors, environment, social and cultural environment as well as bad habits. The causes of obesity can be numerous. The most common source of obesity is the development of energetic imbalance. Material and methods: A retrospective study of medical records in the Department of Obstetrics and Gynecology, University Clinical Hospital in Mostar was conducted. It included 1300 pregnant women and their children that were delivered in the time period from January 1st 2015 to December 31st 2015. It was conducted a retrospective study which involved 1300 pregnant women who gave births in the Department of Obstetrics and Gynecology of University Clinical Hospital in Mostar in the period from January 1st 2015 to December 31st 2015 and their newborns. Results: The difference in age of pregnant women with different body mass index was not statistically relevant. The average age of pregnant women with normal body mass was 29.52 ± 5.48, overweight pregnant women 30.30 ± 5.138, and obese pregnant women 30.00 ± 5.103 (F = 2.730; p = 0.066). The youngest was 24, and the oldest was 49 years old. The average gestational age at delivery was 39.23 ± 1.556 (min 28; max. 42 weeks of gestation). The majority of pregnant women; 660 of them (50.8 %), were overweight in the early stages of their pregnancy, there were 322 (24.8 %) obese women, and there were 318 (24.5 %) normal weight women. At the end of the pregnancy, the highest number was that of obese pregnant women 925 (71.2 %), while 328 (25.2 %) pregnant women were overweight, and only 47 (3.6 %) pregnant women had normal weight. Conclusion: Nutritive status and weight gain of a mother during pregnancy are an important indication of her health and of the foetus growth. Overweightness and obesity of a mother before pregnancy and during pregnancy has a negative influence on the health of the mother and infant. Moreover, it is linked with risk and a negative pregnancy outcome. BMI was associated with an increased risk of adverse perinatal outcome.

Abstract Aim: To evaluate the perinatal outcomes of newborns after premature rupture of membranes (PROM) at the term according to the timing of initial antibiotic administration. Material and methods: This is a retrospective, cohort study investigating perinatal outcomes of newborns in pregnant women with PROM at the term who were treated with ampicillin within or after 6 h from the PROM. Statistical analysis was performed using Student’s t-test for continuous variables test and chi-square or for categorical data. Results: The study involved 144 pregnant women with PROM and their newborns, a lower number received antibiotics after birth were in the group who received antibiotics within 6 h of PROM (26.4% versus 73.6%), the mediane values of C-reactive protein were lower (3.0 ± 2.9 mg/l versus 6.1 ± 7.3 mg/l; p < 0.001), their newborns remained shorter in hospital after birth (4.13 versus 4.94; p =0.023) and time between PROM and delivery was shorter (p < 0.001). In group who received prophylactic antibiotics after 6 h of the PROM had significantly higher frequency of infection in newborns (45.3% versus 15.4%), and higher number of chorioamnionitis (9.72% versus 3,47%) compared to group who received antibiotics within 6h. Conclusion: Timely usage of antibiotic prophylaxis and shorter time between PROM and delivery improve perinatal outcomes.

Goal: To analyze the appearance of neurodevelopmental disorders in children delivered post-term and to find out whether prolonged pregnancy may be a cause of such disorders in a selected group participants. Patients and methods: This study included a cohort of 34 children born post-term suffering from neurodevelopmental disorders who were treated at the Service for psycho-physiological and speaking disorders in Mostar, Bosnia and Herzegovina during an 18-year period. Results: There were 59.4% of male and 40.6% female patients (P=0.002). The most common neurodevelopmental disorder in the sample was intellectual disability (38.2%), followed by epilepsy (26.4%), delayed psychomotor development (14.7%), and cerebral palsy (11.7%) (P<0.001). The correlation between mothers’ parity and post-term delivery was found (P=0.016). Conclusion: Post-term delivery may be the cause of neurodevelopmental disorders. The most common disorder among them were intellectual difficulties.

Vaginalni porod nakon prethodnog carskog reza predstavlja jednu od zna~ajnijih promjena i izazova u porodni{tvu zadnjih desetlje}a. Posljedica je to visoke u~estalosti carskih rezova u svijetu (u SAD oko 25%) i u nas (u KB Mostar oko 16%). 1,2 Rezultati brojnih studija potvr|uju povi{en pobol majki i novoro|en~adi te naro~ito rizik rupture uterusa u porodu nakon prethodnog carskog reza, 3,4 zbog ~ega je Ameri~ko dru{tvo opstetri~ara i ginekologa (ACOG) dalo smjernice za vo|enje vaginalnog poroda nakon prethodnog carskog reza (VBAC-vaginal birth after cesarean). 5,6 Rizik za komplikacije nakon prethodnog carskog reza je manji, ukoliko je rodilja prethodno rodila i vaginalno. Rezultati istra`ivanja Cahill-a i sur. 7 potvr|uju da je sigurniji vaginalni porod nakon prethodnog carskog reza i vaginalnog poroda, nego ponovljeni elektivni carski rez.