BACKGROUND The student population is at higher risk of acquiring sexual transmitted diseases (STDs) and accounts for a higher incidence of unplanned pregnancies due to a combination of lifestyle and environmental reasons. AIM To determine the attitudes of medical students towards contraception. METHODS A total of 190 students of the School of Medicine of University of Mostar attending four different-academic years participated in this cross-sectional study. Attitudes of participants towards contraception were examined using an anonymous questionnaire. RESULTS Sexually active students accounted for 61.1% of participants, of which 52.6% regularly used contraception. The most common method of contraception was male condom (90.3%). The main reason for contraception was to avoid pregnancy (64.1%). Students with higher medical education (p<0.001) and students with non-religious views (p=0.004) had positive attitudes towards contraception. There were no gender differences on contraception views. CONCLUSION Students with higher medical education and those with non-religious views had positive attitudes towards contraception. Therefore, education on contraception assumes its wider use, which is an important measure to reduce the incidence of STDs and unwanted pregnancies in high-risk population.

Preterm delivery before 37 gestational weeks is a major challenge in perinatal health care. Over the past 30, the incidence of preterm delivery in most developed countries has been about 7–10% of live births. Some evidence shows that this incidence has increased slightly in the past few years, but the rate of birth before 32 weeks' gestation is almost unchanged, at 1-2%. Several factors have contributed to the overall rise in the incidence of preterm delivery. These factors include increased use of assisted reproduction techniques, increasing rates of multiple births, and more obstetric intervention. Progesterone is the key hormone maintaining pregnancy. Numerous progesterone effects can be demonstrated by laboratory studies involving every tissue of the reproductive tract, the myometrium, decidua, cervix, and fetal membranes. In particular, progesterone can alter the response to cytokines, inhibit prostaglandin and nitric oxide synthesis, reduce corticotrophin-releasing hormone (CRH) synthesis, block cervical stromal degradation, and induce cervical stromal matrix protein secretion. By altering both the mechanical and physiologic functions of the cervix, cervical performance may be substantially enhanced by these agents. Presumably, progesterone may alter the rate of cervical stromal degradation via altering secretion of matrix metalloproteases by diminishing prostaglandin and nitric oxide synthesis and minimizing neutrophil recruitment. The diverse aetiology of preterm delivery makes its prediction difficult. A substantial part of unexplained preterm deliveries might be attributable to a deleterious immune response of the mother toward the foetus. A growing body of evidence suggests that progesterone might play a significant role in establishing an adequate immune environment during the early stages of pregnancy. In the presence of progesterone, lymphocytes of pregnant women release a protein named the progesterone induced blocking factor (PIBF)7 which mediates the immunomodulatory and antiabortive effects of progesterone. Immunologic recognition of pregnancy and subsequent activation of maternal immune system result in an upregulation of progesterone receptors on activated lymphocytes among placental cells and CD8+ cells. In the presence of sufficient progesterone levels, these cells synthesize PIBF. Patients at risk of preterm delivery presented increased proinflammatory cytokines, low PIBF, and reduced IL-10 expressions on lymphocytes. PIBF alters the profile of cytokine secretion of activated lymphocytes shifting the balance toward Th2 dominance. During a normal uneventful pregnancy, the concentration of PIBF continuously increases from the 7th to the 37th gestational weeks. After the 41st week of pregnancy, PIBF concentrations dramatically decrease. In patients with a diagnosis of threatened premature labour, studies have shown that PIBF levels failed to increase during pregnancy. Identification of women with risk for preterm delivery would be a key for its prevention. No sufficiently specific marker, however, has so far been found. The diverse aetiology of preterm birth makes its prediction difficult. This special issue will give as some useful information but also questions which are important for our understanding of pathophysiology, prevention, diagnosis, and treatment of preterm birth. Igor  Hudic Babill  Stray-Pedersen Vajdana  Tomic

Pregnancy is followed by many physiologic, organic and psychological changes and disorders, which can become more serious in pregnancy followed by complications, especially in women with pathological conditions during pregnancy. The purpose of this study was to find out and analyze the prevalence and intensity of psychological disorders in women with pathological conditions during pregnancy and compare it with conditions in pregnant women who had normal development of pregnancy. The research is approved by the Ethical committee of the Mostar University Hospital Center, and it was made in accordance with Helsinki declaration and good clinical practices. The research conducted section for pathology of pregnancy of Department for gynecology and obstetrics of the Mostar University Hospital Center. It included 82 pregnant women with disorders in pregnancy developement and control group consisted of pregnant women who had normal development of pregnancy. The research work was conducted from September 2007 to August 2008 in Mostar University Hospital Center. Pregnant women had Standard and laboratory tests, Ultrasound. CTG examinations were done for all pregnant women and additional tests for those women with complications during pregnancy. Pregnant women completed sociobiographical, obstetrical-clinical and psychological SCL 90-R questionnaire. Pregnant women with pathological pregnancy exibited significantly more psychological symptoms in comparison to pregnant women with normal pregnancy (p < 0.001 to p = 0.004). Frequency and intensity of psychical symptoms and disorders statisticly are more characteristic in pathological pregnancy (61%/40.6%). The statistical data indicate a significantly higher score of psychological disorders in those pregnant women with primary school education (p = 0.050), those who take more than 60% carbohydrates (p = 0.001), those with pathological CTG records (p < 0.001), those with pathological ultrasound results (p < 0.001 to 0.216) and those pregnant women with medium obesity and obesity (p = 0.046). Body mass index (BMI) during normal pregnancy development is lower (p = 0.002) but the levels of glucose, triglycerides, cholesterol, HDL and LDL in blood are higher Blood pressure in pregnant women with pathological pregnancy was statistically significantly higher (p < 0.001). Diagnostic criteria for the metabolic syndrome were found in 19 pregnant women with the pathological pregnancy. Statistically, in those women, a significantly higher appearance of psychological symptoms and disorders was observed in comparison to the pregnant women without metabolic syndrome (p < 0.001). The research has shown that 87.8% from all pregnant women included in this study have been hospitalized due to premature birth, hypertensive disorders, and diabetes in pregnancy, and also due to bleeding in the second and third trimester of pregnancy.

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.

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.

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.

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.