Hypertensive disorders are among the most common complications in pregnancy and a major cause of perinatal morbidity and mortality. The aim of this study was to investigate the risk factors and adverse perinatal outcomes of pregnancies in mothers with hypertensive disorders, as well as the adequacy of prenatal care during the wartime and postwar period in South-Western region of Bosnia and Herzegovina. This study included a total of 542 pregnancies with hypertensive disorders during 5-year study period (1995-1999) and 1559 randomly selected controls. Data on risk factors, adverse perinatal outcomes (for singleton pregnancies only) and prenatal care on pregnant women were extracted from the medical records and compared with controls. Chi-square test and crude odds ratio (OR) with 95% confidence interval (95% CI) were used in statistical analysis. The average five-year incidence of hypertensive pregnancy disorders was 6.5% and it was significantly higher in 1995, the last year of the war, than in the postwar period (1996-1999) (p = 0.02). Factors significantly associated with hypertensive pregnancy disorders were maternal age > 34, nulliparity, multifetal gestation and male newborn (p < 0.001; except p = 0.002 for male newborn). Severe forms of hypertensive disorders were significantly associated with adverse perinatal outcomes: preterm birth (OR 2.6, 95% CI 1.08-6.3), cesarean delivery (OR 9.2, 95% CI 5.4-15.6), fetal growth restriction (OR 63.8, 95% CI 34.8-117.0), and stillbirth (OR 5.5, 95% CI 2.1-14.1). Women with hypertensive pregnancy disorders had significantly lower number of prenatal care visits than controls (p < 0.001). There was a high proportion of normally formed macerated stillbirths in the study (27 out of 30 or 90%) and in the control group (10 out of 12 or 83%). In conclusion, severity of the disorder and adequacy of prenatal care are strongly associated with adverse perinatal outcome related to hypertensive pregnancy disorders.

Early diagnosis and intervention intensity were suggested to be crucial factor in cerebral palsy (CP) treatment. Herein we observed 347 children diagnosed for CP in Clinical Hospital Mostar, Bosnia and Herzegovina, and studied the relationship between (a) intervention start point and the final motor outcome, (b) intensity of treatment and final outcome, and (c) relationship between documented risk factors and early diagnosis of the CP. Our study suggests that it is possible to relatively accurately diagnose the CP in the first trimester. Previous miscarriages, sepsis and intracerebral haemorrhage were significantly related to early diagnosis, while delivery outcome, RDS, premature birth, intracerebral haemorrhage, sepsis, meningitis, hydrocephalus and convulsions were found as significantly related to final motor CP outcome. We have found no significant influence of the intervention intensity and final diagnosis. Our results support the idea that the intervention start point has to be considered as one of the most important factors for the effective intervention program. In future studies dealing with the CP interventions and risk factors, special attention should be paid to homogeneity and size of the sample, as well as necessity of including the non-treated controls in the investigation.

UNLABELLED BASE: There are numerous studies that indicate the co-morbidity of a metabolic syndrome and mental disorders. Metabolic syndrome and mental disorders in pregnant women are rarely investigated, especially in pathological pregnancy. GOAL To determine a relationship between predisposed factors in pregnancy and the occurrence of metabolic syndrome as well as to determine the occurrence of psychological symptoms and disorders in pregnant women. SUBJECTS AND METHODS The tested sample consisted of 162 pregnant women (80 with normal and 82 with pathological pregnancy). For the examination, 3 questionnaires were used: clinical, laboratory, ultrasound and radiological scanning. Metabolic syndrome was diagnosed according to WHO criteria, and psychological symptoms by using the SCL 90-R questionnaire. RESULTS Metabolic syndrome was confirmed in 19 (23.2%) women with pathological pregnancy. These women had a greater prevalence of psychological symptoms (p<0.001). CONCLUSION Women with pathological pregnancy who are diagnosed with metabolic syndrome showed significantly more psychological symptoms.

UNLABELLED Women who delay childbearing are at increased risk for complications in pregnancy and delivery. AIM The aim of this study was to determine whether primiparas > or = 35 have worse perinatal outcome compared to primiparas aged 20-27. PATIENTS AND METHODS The perinatal outcome of 240 primiparas who gave singleton birth at Mostar Clinical Hospital between January 1, 2002 and December 31, 2004 was analyzed. Observed group was formed by 120 primiparas aged > or = 35. The control group was formed in the manner that each primipara from the observed group was assigned the first primipara younger than 35 with a singleton gestation who was subsequently entered in the delivery room record book. The data were collected from the maternal and newborn medical records at Mostar Clinical Hospital within the observed period. RESULTS Significantly higher occurrence of cesarean section (p < 0.001; OR = 2.6; 95% CI 2.32-2.90), preterm delivery (p < 0.001; OR = 4.8; 95% CI 4.51-5.09), newborn of low birth weight < 2500 g (p < 0.034; OR = 2.6; 95% CI 2.34-2.92) and neonatal intensive care unit admission (OR = 2.7; 95% CI 2.47-3.05) were observed in primiparas aged > or = 35. The perinatal mortality was also significantly higher in the group of the older primiparas (p = 0.020; OR = 7.8; 95% CI 7.55-8.13). CONCLUSION The overall results and a significantly higher number of perinatal deaths in particular present a significant concern because of growing number of older primiparas over the last decades.

The aim of this research was to determine the incidence, risk factors and perinatal outcome of the macrosomic infants (birth weight > or = 4000 g). The retrospective research was performed using a case-control study conducted at Mostar Clinical Hospital. Total of 379 women gave singleton term births to macrosomic newborn in the period from January 1st, 2004 to December 31st, 2005 (observed group). Another 379 singleton normal birthweight term newborns (birth weight < 4000 g, but not small for gestational age), of the same maternal parity and age, who were delivered in the same period, formed the control group. The incidence of macrosomic births was 13, 1%. In the study group, significantly higher number of cases of postdatism (> 42 weeks of gestation) (P<0,001), maternal obesity (prepregnancy BMI> 26 kg/m2) (P<0,001), gestational diabetes mellitus (P=0,033), hypertension (P=0,025) and male infant (P<0,001) were observed. Cesarean delivery (P<0,001), intrapartal complications (cephalopelvic disproportion P<0.001, perineal trauma P=0,042) and newborn birth trauma (clavicular fracture P=0,038, brachial palsy P=0,021) occurred significantly more often in the macrosomic group. There was only one fetal death in the macrosomic group. In the control group there were no cases of perinatal deaths. To conclude, it is important to emphasize the significance of proper diagnosis of fetal macrosomia and management of macrosomic birth, since we have seen a growing number of macrosomic births during the last decades, and have faced a problem of increased risks of adverse perinatal outcome.

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.

AIM Research frequency of puerperal disorders in nulliparous women who had cesarean section in University Hospital Mostar in year 2004 and given results compared with nulliparus women who had vaginal mode of delivery. PATIENTS AND METHODS Research included 119 nulliparous women who had C-section in year 2004 (Tested group) and 119 nulliparous women who had vaginal mode of delivery (control group) taking in count time of delivery (first next one in delivery room protocol) and age (+/- 2 years). We analyzed type of puerperal disorders and their frequency in these groups and made comparison among them. RESULTS Frequency of puerperal disorders in nulliparous women delivered by cesarean section is higher increased compared with nulliparous women who had vaginal mode of delivery (chi2=15,015; p<0,001). In tested group was found significantly higher frequency of anemia (chi2=8,895; p=0,003) and puerperal fever (chi2=8,333; p=0,004). Higher risk of puerperal disorders in nulliparous women who had cesarean section was confirmed by odds ratio which was 4,183. CONCLUSION Higher incidence of puerperal disorders in nulliparous women who had cesarean section is confirmation of higher risks for women with operative mode of delivery which is concerning due to increased trend of cesarean sections in our country and in the world.

AIM The aim of this study was to present the trend of the rates of perinatal mortality at the University hospital Mostar in the period from 1999 to 2003 and to determine risk factors of perinatal mortality. PATIENTS AND METHODS Observed group was formed by 110 pregnant women whose infants died in perinatal period at University hospital Mostar in the period from 1999 to 2003 and control group by 107 pregnant women, the same parity and age, whose infants didn't die in perinatal period. The groups were compared acccording to available parameters which determine perinatal outcome. We determined risk factors of perinatal mortality by using case-control study. RESULTS Mean of perinatal mortality at University hospital Mostar in the observed five year period was 14,71%, range 8,88-19,1%o. A significantly higher number of premature labor (ten times higher), twin pregnancy (p=0.005; chi2 = 7.76), placental abruption (p<0.001; chi2 = 13.84), preeclampsia (p=0.027; chi2 = 4.891), placental insufficiency (p= 0.002; chi2 =9.395), metrorrhagia (p=0.007; chi2 = 7.237), fetal growth restriction (p=0.007; chi2 = 7.237), fetal asphyxia (p=0.017; chi2 = 5.683), true knots in the umbilical cord (p=0.024; chi2 = 5.12) and congenital malformations of fetus (p=0.024; chi2 = 5.12) were in the observed group than in control. 68,04% of all infants which died in perinatal period were premature babies. CONCLUSION Rate of perinatal mortality at the University hospital Mostar is unacceptable high and doesn't show clear tendency of decreasing in observed period. In order to decrease perinatal mortality rate it is necessary to improve the organization and quality of perinatal care and start with regionalisation and establishing tertiary centers on state level.

We performed a retrospective, descriptive study in order to analyze characteristics of the cesarean sections at the University Hospital Mostar in year 2002. We analyzed cesarean sections incidence, general characteristics of the parturients and neonates, major indications for the cesarean section and postoperative course. During year 2002, there were 247 cesarean sections out of total of the 1510 deliveries. Total of 255 neonates were born by this operative procedure and 16 of them were twins. We used the operational, labour, neonate and parturients records in order to collect data. The incidence of cesarean sections in University Hospital Mostar in year 2002 was 16.4%. There were 5.3% elective procedures. Most of the parturients were in age group 25-35. More than half of the parturients gave birth for the first time. The major diagnoses for cesarean section were previous cesarean section, fetal distress, breech presentation, cephalo-pelvine dysproportion and dystocia. Most of the pregnancies terminated by cesarean section (87.3%) were in term. The majority of neonates had weight > or = 2500 g (93.7%) and first minute Apgar score > or = 7 (96.4%). Parturients stayed for a week in the hospital and were given antibiotic prophylaxis postoperatively. Each second parturient suffered from pyrexia of unknown origin postoperatively. Comparing to literature data, we found high incidence of cesarean sections considering total number of deliveries and pregnancy pathology. We think that proper measures of decreasing this incidence should take place in University Hospital Mostar.