Aim: The aims of this study were to compare ultrasound fetoplacental parameters and to calculate Hepato-Cephalic Index (HCI) as a new predictor of IUGR. Methods and material: A clinical prospective study was conducted and included 120 pregnant women divided in two groups: non IUGR group included healthy pregnant women (n=60) and IUGR group included pregnant women with preeclampsia and IUGR (n=60). Outcome measures were following ultrasound fetoplacental parameters in fetuses with IUGR and non IUGR: Fetal Liver Length (FLL), Femur Length (FL), Biparietal Diameter (BPD), Placental Maturation by Grannum, Amniotic Fluid Index (AFI) and Hepato-Cephalic Index (HCI). Sonography was carried out by probe 3.5 Mhz type MINDRAY DC 7. Results: The mean of maternal age was 30.0±6.1 years in women with preeclampsia and IUGR and 28.1±5.1 years in healthy pregnant women, p > 0.05. There was a statistically significant difference in values of: FLL (p < 0.001), FL (p = 0.004), BPD (p < 0.001), AFI (p < 0.001), HCI (p < 0.001) between IUGR and non IUGR groups. The most of women with preeclampsia and IUGR had grade III of placental maturation (48.3%). There is a significant association between the placental maturation and the diagnosis, p < 0.001. There was a statistically significant difference in body mass of newborns between IUGR and non IUGR groups, p < 0.001. Conclusion: In a fetus with IUGR in preeclampsia there is a reduction in FLL, FL, BPD, AFI and HCI and there is a early maturation of the placenta. By measurement of fetoplacental ultrasonic parameters of liver, pregnant women will experience prediction of risk pregnancy (preeclampsia with IUGR) due to hypoxia.

Aim: The aim of this study was to evaluate biochemical parameters in serum of women with preeclampsia and IUGR. Material and methods: A clinical prospective study was conducted and included 120 pregnant women divided in two groups: non IUGR group included healthy pregnant women (n=60) and IUGR group included pregnant women with preeclampsia and IUGR (n=60). Outcome measures were following values of biochemical parameters in serum of mother and fetuses: aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), bilirubin (indirect and direct) and cholesterol. A blood for analysis was drawn from the cubital vein of mothers and the umbilical vein of the fetuses during delivery period. Results: The mean of maternal age was 30.0±6.1 years in women with preeclampsia and IUGR and 28.1±5.1 years in healthy pregnant women, p > 0.05. The most of women with preeclampsia and IUGR had grade III of placental maturation (48.3%). There is a significant association between the placental maturation and the diagnosis, p < 0.001. There was a statistically significant difference in body mass of newborns between IUGR and non IUGR groups, p < 0.001. There was a significant statistically difference in serum value of AST, ALT, LDH and total cholesterol between women with preeclampsia and IUGR and healthy pregnant women (all p < 0.001). Conclusion: Measurement of AST, ALT, LDH, and total cholesterol in serum of pregnant women and newborns with IUGR allows the differentiation and threatening risk of perinatal complications due to hypoxia.

Introduction: The goal of this article is to present that innovating in health care begins to become an imperative in present time. Innovating will enable the achievement of the highest quality health care results and the patients' satisfaction with the least amount of financial resources.Methods: The thorough literature review of multifaceted sources was conducted including: studies, books, monographies and peer – reviewed journals with the goal of achieving the clearer picture of today's modern challenges in the complex fi eld of health care innovation.Discussion: Theoretical and empirical studies clearly indicate that the innovation is one of the key factors in the competitiveness of the organization and its survival in the market. Developed countries of the world today are making significant efforts in order for innovation to become a national priority, with special emphasis placed on measuring innovation performance. Results of theoretical and practical studies show that in the future, treatment of the most diffi cult and complex diseases of our time, through the entirely new discoveries and results, derived from the process of innovation, will project entirely new positive forms and outcomes in the health care.Conclusion: There is no doubt that the humanity and medical science will through innovation succeed to win the battles against the majority of the most complex contemporary diseases. Malignant neoplasm of tomorrow, through the application of a new, innovative approaches to research, processes and treatments will become a chronic diseases. Among many, the particular problem in the process of innovation will represent the cost of research and development (R&D), production and the safety of prescription drugs.

ABSTRACT Introduction: Postmenopausal uterine bleeding is a „cancer until proven otherwise”. Endometrial cancer is a typical disease among postmenopause woman, because every bleeding in this age etiology associated with endometrial cancer (10-30%). The lifespan of women today has been extended and post menopause today last one third of a woman’s life. Early diagnosis of endometrial cancer has a very high cure rate. Screening for this cancer has limits in practice and is necessary given the definition of high-risk groups would be subject to primary and secondary prevention. Goal: Primary to evaluate the leading causes of postmenopausal uterine bleeding among patients at risk for endometrial cancer (diabetes, obesity, nulliparity, late menopause (after 55 years) and compared them with the causes of postmenopausal uterine bleeding patients without this risk. Material and methods: A retrospective, descriptive study with a targeted sample of 50 consecutive patients who had registered postmenopausal uterine bleeding in high-risk groups (cohorts) and the same number of patients with postmenopausal uterine bleeding that does not belong to the risk group (control group). Each patient underwent clinical examination, then fractionated curettements and its histopathological verification and assessment of treated clinical stage of disease with PH analysis of the resected specimens. Results: The patients of the studied risk group were significantly affected by endometrial cancer compared with the control group (RR=2.45, 95% CI 1.2 4.6, p=0.005). Endocervical pathology did not differ between groups. Clinical forms of bleeding: for those that are profuse bleeding cancer was present in 54.6% of cases. With intermittent bleeding cancer is verified in the 33.3% of patients. Risk patient groups with cancer frequently suffer from clinically more advanced stages of histologically aggressive endometrial cancer (serous adenocarcinoma–type II, low differentiated cancer).

Introduction: Having in mind the significance of its function, umbilical cord represents one of the predictors of pregnancy outcome, delivery and vitality of the newborn . Umbilical cord is the only connection between fetus and source of oxygen and nutritional components, and ultrasound (especially color Doppler, pulsating Doppler and 3D) provide us with an insight into organic and functional changes in umbilical cord. Material and methods: We have analyzed medical histories of women who delivered in 2007, as well as their CTG records typical for complications with umbilical cord, ways of delivery and vitality of newborns. Results: Out of 3550 deliveries, in 801 changes which indicated complications with umbilical cord on CTG record were evident . Most commonly, we were dealing with short term compression of the convolute of cord loop(s) around neck, shoulder or body of the fetus or extension of short umbilical cord in the phase of expulsion . There were 27 urgent Cesarean sections which were performed due to acute and prolonged asphyxia which was caused by strangulation of the neck with umbilical cord and 2 cases of fetus mortus in utero – one case of term pregnancy with 5 loops around the neck and one case of 28 weeks pregnancy with 4 loops around fetal neck .Conclusion: Most commonly , strangulation with umbilical cord does not represent a significant obstetrical problem, but in some cases ( intensive fetal activity , beginning of contractions ) can lead to acute catastrophic conditions . According to the available literature, percentage of cases of strangulation with umbilical cord is around 24,6% in newborns , out of which 21% is with a single loop, 3,5% with 2 or three loops and 0,1 % with four or more loops . The maximum reported number of loops is nine. Frequency of loops depends on the length of the cord – with short cords (35cm) the incidence is 14%, with normal length cords–2,3% and with cords longer than 89cm -53%. Cord loops around fetal neck can easily be presented with B mode and color Doppler.

Elective repeat cesarean section continues to remain the standard to care at GYK and OBST. Department in Sarajevo. This paper is a study of 216 patients with previous cesarean section who requested and were allowed a trial of labor. One hundred fifty-six (72%) achieved successful vaginal delivery with no maternal or fetal mortality or significant morbidity. Review of the USA literature indicates similar results in other independent studies. Continued accumulation of cases showing the efficacy of post-cesarean section trial of labor should encourage a reassessment of the continuing practice of elective repeat cesarean section.