Background: The aim of this study is to compare the antenatal care, body weight, and weight gain in pregnancy between the adolescent and adult pregnancies and, thus, examine the impact of adolescence on the studied parameters. Methods: This prospective study includes 300 pregnant women who were the patients of University Clinical Center Tuzla, Clinic for Gynecology and Obstetrics from January 2011 to December 2014. The women were divided into two groups: an experimental group consisted of 150 adolescent pregnant women aged 13–19 years and a control group consisted of 150 adult pregnant women aged 20–35 years. The following parameters were analyzed: age of pregnant women, number of antenatal controls in pregnancy, prepregnancy body weight, weight gain in pregnancy, parity, and obstetric history data. Results: A significantly higher number of adolescent pregnant women belongs to a subgroup from one to two examinations during pregnancy (P < 0.000013) and to subgroups from three to five examinations (P < 0.000001). A significantly smaller number of adolescent pregnant women performed their first antenatal control in the first 2 lunar months (P < 0.01). A subgroup with optimal body weight (from 51 to 69 kg) are the most prevalent among adolescent pregnant women (P < 0.000001). A significantly larger number of adolescent pregnant women had an optimal weight gain of 7.8 to 12.99 kg (P < 0.001). Conclusions: The adolescent pregnant women have suboptimal antenatal care, which could lead to adverse maternal and birth outcomes, but have optimal body weight and weight gain during pregnancy.

Aim To investigate clinical and obstetrical characteristics, an outcome and a prognosis for pregnant women with diagnosed and treated genital or extragenital cancer and their newborns. Methods This retrospective cohort study included pregnant and childbearing women with a history of cancer diagnosed before pregnancy during the period between 1 January 2014 and 31 December 2018. Data related to the course of pregnancy and childbirth were collected from medical records (mothers' disease history and partogram). The analysis covered clinical and histopathological characteristics of cancers, type of the treatment (surgery, chemotherapy, radiotherapy), demographic data, obstetric characteristics, comorbidities of women, and outcome of the newborns. Results The study recorded 18 414 deliveries, of which 30 (0.16%) were pregnancies in women who had been diagnosed and treated earlier for genital or extragenital cancer. The average age of the women at the time of delivery was 29.43±5.97 years. There were six (20%) women with genital and 24 (80%) with extragenital cancer. The most frequent extra genital cancer was Hodgkin lymphoma, in eight (26.6%) cases; ovarian cancer was the most frequent genital cancer, in four (13.3%) cases. The average time span from the cancer diagnosis and start of the treatment to the delivery was 59.2±44.4 months (5 years) (range 12 months - 15 years). Two (6.6%) women died. Conclusion Our data demonstrate a favourable obstetric and neonatal outcome for women who have survived cancer.

Aim To compare maternal, foetal and neonatal characteristics, and perinatal outcome of preterm and term deliveries in twins pregnancies in order to improve perinatal care in Bosnia and Herzegovina. Methods This retrospective cohort study included pregnant women with twin pregnancy who delivered during the period between 1 January 2012 and 31 December 2018 at the Clinic for Gynaecology and Obstetrics, University Clinical Centre Tuzla. Results During the seven-year period 26 734 deliveries were recorded, out of which 362 (1.35 %) were twin pregnancies, 226 (62.4%) preterm and 136 (37.5%) term ones. In the preterm group 38 (16.8%) pregnancies were assisted medical reproduction, and 16 (11.7%) of those were in the term group. The average birth weight was significantly higher for the first twin in both groups (p<0.00001). Incipient intrauterine foetal asphyxia was more frequent in the preterm group (p<0.05). The most common indication for Caesarean section was abnormalities of foetal presentation and lie, 176 (68.2%) for the overall sample. Conclusion Cornerstone of twin pregnancy antenatal care is to get correct data about amnionicity and chorionicity. Since majority of prenatal data did not have this information we call all obstetricians to declare about amnionicity and chorionicity in twin pregnancies during the first trimester ultrasound examination.

Abstract We present an overview of the case of a patient with early hysterorrhaphy dehiscence (uteroperitoneal fistula) with endomyometritis and post-cesarean section peritonitis and puerperal acute abdomen in a 35-year-old puerpera. A exploratory relaparotomy, necrectomy, and resuture of the dehiscent part of the hysterotomy were performed with placement of hemostatic sponges on the same portion of the uterus with good recovery.

Abstract Fetal shoulder dystocia (FSD) is an unpredictable and critical obstetric intrapartum emergency, where an objective problem is the relationship between the mother's pelvis and the child, i. e., an anthropometric disorder of delivery mechanics and dynamics. It is evident that the need to perform other maneuvers indicates the severity of FSD, which in turn correlates with the consequent iatrogenic injury of the fetus and/or mother. FSD is certainly the most controversial forensic obstetric problem, with the most disputes, compensation for damages due to peripartum injury to the child and/or mother, pain suffered, the need for someone else's care, and permanent disability. Suboptimal procedures and inadequate documentation are factors of forensic risk and subsequent litigations. Prevention of FSD is generally not possible, although good antenatal care can sometimes exclude risky cases of FSD, and some rare, chronic intrauterine disorders can result in orthopedic and neurological sequelae, which is especially important in forensic analysis. Because FSD is largely impossible to predict, it must be viewed as an intrapartum acceptable risk. During childbirth, FSD may compromise the safety of the mother and unborn child, therefore education and skills acquisition are necessary for obstetric work. Risk control, proper procedures, and proper documentation, along with good communication with the pregnant women and their families, significantly reduce litigation procedures.

Background: To investigate the total survival of low birth weight infants (LBWIs) in the Federation of Bosnia and Herzegovina (FB and H) and selected by subgroups of birth weight (BW) and gestational age (GA). Methods: This cross-sectional study included newborns of both genders, GA of 22–42 weeks and BW of less than 2500 g of 10 cantons territory of the FB and H. In the examined period, 22,897 children were born in the FB and H, of which 669 (2.9%) had BW less than 2500 g. Results: Surviving of LBWIs in the FB and H out of the 669 LBWIs in the first level perinatal healthcare institutions (PHI) was 29 (4.3%), the second level was 286 (42.8%), and the third level was 354 (52.9%). The total stillborn rate was 3.9%. The overall perinatal mortality rate for all levels of PHI was 8.6%. The overall rate of early neonatal mortality of LBWIs in all three levels of PHI in the FB and H was 12.7%. By the end of the first month of life (up to 28 days) and to the end of the neonatal period, 385 (57.5%) of LBWIs survived, and 284 (42.4%) died. The LBWIs by subgroups of BW up to 28 days had lower survival rates in second-level PHI than infants of the same BW subgroups (500–999 and 1000–1499) treated in third-level PHI (P = 0.0089 and P = 0.004). Conclusions: Our results show that B and H belongs to developing countries according to perinatal mortality. A unique database system is necessary to follow progress and trends.

Introduction: The association of acute intermitetn porphyria (AIP) with pregnancy and as a cause of spontaneous abortion is rare. Aim: To show a case of AIP known before pregnancy in a patient who had a spontaneous abortion. Case report: A gynecologist examined 26-year-old patient in the 8th week of gestation, due to initial spontaneous abortion, abdominal pain, constipation, muscle weakness, vomiting and dark colour of urine. Her therapy was dydrogesterone. In consultation with an anesthesiologist, a short intravenous anesthesia, vacuum aspiration, and curettage were performed.During hospitalization, the patient ceased to take harmful drugs and she was given haemarginate, glucose and symptomatic drugs, and she recovered completely. Conclusion: Treatment of threatened spontaneous abortion in AIP remains the subject of dilemma and controversy, and future research is needed.

Aim To determine stereological structural parameters of the parenchymal part of the placenta, placental weight and volume of adolescent pregnant women and their correlation with newborns' birth weight. Methods This prospective study was conducted on a total of 60 human placentas of term pregnancy, divided into two groups according to the age of pregnant women. Experimental group consisted of 30 placentas of pregnant women aged 13-19 years. Control group consisted of 30 placentas of pregnant women aged 20-35 years. Stereological analysis was performed. Results Volumetric density of terminal villi of adolescent placentas was significantly higher than the one of control group (p <0.0001). The volumetric density of fibrinoid of adolescent placentas was significantly lower than of the control group (p <0.0001). Total volume of terminal villi of adolescent placentas was significantly higher than of the control group (p<0.0001). The total volume of fibrinoid of adolescent placentas was significantly lower than of the control group (p<0.0001). Newborns of adolescent pregnancies had in average lower birth weight of 439.01 g compared to the newborns of the control group (p <0.00001). Conclusion Adolescent pregnancy affects placental structure, weight and volume. Newborns of adolescent pregnancy have optimal body weight.

Introduction/Background Malignant ovarian germ cell tumors (MOGCTs) account for 2–5% of all ovarian cancers and among them pure embryonal cell cancer is rare condition.1 2 3 4 Methodology Aim: To show successful pregnancy after unilateral salpingooopherectomy and chemotherapy in a girl with embryonal carcinoma of ovary (ECO). Results Case report: A 11 year old girl presented in January 2008. with pain in abdomen and abdominal wall hardness. CT revealed a 12 × 10 × 11 cm heterodense mass. Right sided salpingoophorectomy, omentectomy, biopsy left sided ovary was done. Histopathology examination and immunohistochemistry revealed embryonal cell cancer of ovary. Patient had FIGO stage III c disease. After the surgical removal of the tumour, the patient underwent six cycles of adjuvant chemotherapy with bleomycin, etoposide and cisplatin. Within eight year after the completion of chemotherapy she conceived spontaneously. At 39th gestational week, laparotomy as well as a C-section was done and the patient was managed successfully in giving birth to a healthy female baby (birth weight and lenth 3,430 gm/53 cm, Apgar score: 9/9). At the last follow-up visit (May 5, 2018), all the tumor markers were negative, and the control MRI and ultrasound examinations did not reveal tumor recurrence or pathological lymph nodes. Conclusion Fertility preservation surgery followed by chemotherapy may be considered as standard care of treatment in embryonal carcinoma of ovary in young girls, who want to retain fertility. Disclosure Nothing to disclose.

Introduction: Knowledge of the size of surfaces available for transport is important for assessing the amount of nutrients that can be transmitted to the fetus for its normal growth and development. Aim: The aim of our study, was to determine the stereological structural parameters of the parenchymal part of placenta, ratio of birth weight and placental weight, and to determine their correlation with the body length and head circumference of the newborns of adolescent pregnant women. Methods: The study was conducted on a total of 60 human placentas of term pregnancy, divided into two groups according to the age of pregnant women. The experimental group consisted of 30 placenta of pregnant women aged 13-19. The control group consisted of 30 placenta of pregnant women aged 20-35. Computer assisted morphological analysis of images of histological preparations using stereological methods was performed. Results: Surface density of terminal villi of adolescent placentas is significant higher than the control group (t = 14,179, df = 29, p <0,0001). The T-test (t = -5,868, df = 29, p <0,0001) showed statistically significant difference in the surface density of fibrinoid in two compared groups. T-test (t = 6.438, df = 29, p <0.0001) found that total surface of terminal villi was significantly higher in adolescent placentas. The T-test (t = -6,747, df = 29, p <0,0001) found that total surface of fibrinoid was significantly lower in adolescent group. The T-test (t = 4.203, df = 29, p <0.0001) found that the ratio of birth weight of newborn and adolescent placental weight was significantly higher in relation to the control group. Conclusion: Adolescent placentas was more efficient in increasing the weight of newborns, compared to the control group placentas.

Introduction: There are many ethical and moral dilemmas regarding the termination of pregnancy(TOP) with severe fetal anomalies. Aim: Our aim is to present a case of severe fetal hydrocephalus (HCP), spina bifida aperta and, meningomyelocoella (MMC). Case report: A gynecologist examined a 23-year-old patient with vital pregnancy of 24/25 week of gestation (WG) with the anomaly of the fetus. At the Perinatological Medical Advisory Board, a decision was made that the pregnancy should be continued and monitored bearing in mind that pregnancy exceeded the legal framework for TOP. Medical Advisory Board’s ultrasound examination showed the following: severe hydrocephalus (HCP), spina bifida aperta, hyperehogen intestine, pes equinovarus. Via multidisciplinary consultation it was decided to make a delivery with the elective caesarian section (CS) causing as little trauma to the fetus as possible, with 37 WG completed due to the pelvic presentation and fetal anomalies. The patient gave birth via CS to a live female newborn–birth weight 3920 grams, birth length 56 cm, head circumference 48 cm, and Apgar score 8/8. The head was hydrocephalic with spaced suture. There was thoracolumbar defect of spina bifida aperta and meningomyelocele (MMC) 10x12 cm in size. An urgent surgical procedure - the external ventricular derivation of the liquor, and then the successful resection and plastic meningomyelocele was performed by a team of neuro and plastic surgeons. During the fourth postoperative day due to a suspicion of abscess collection and febrility of the mother a relaparotomy is performed and the abscess collection of Retzius space was found. Due to the fall in blood count, blood transfusion in a total dose of 580 ml was given. The patient was discharged on a home treatment as she had a regular general and local status. After the surgery, the condition of the newborn resulted in deterioration, the progression of HCP and dehiscence of head wounds and the thoracolumbar region, in spite of all the measures taken. At that time a decision was made to provide palliative care and this decision was conveyed to the mother. The child had a prolonged apnoeic episode and was not resuscitated. The child died in hospital after surviving for two months postpartum. Conclusion: Indication of TOP based on fetal anomalies could be a medical decision but also a personal moral choice of the mother related to legal rules, socio-cultural values and religious beliefs.

Aim To investigate the prevalence and obstetrical characteristics of low birth weight infants (LBWIs) in ten Cantons of the Federation of Bosnia and Herzegovina (FBiH). Methods The prospective study included newborns of both genders, gestational age (GA) of 22 to 42 weeks and birth weight(BW) of less than 2,500 grams in the period 1 January 2009 to 31 December 2009. Results In the observed period, 22897 neonates were born, out of whom 669 (2.9%) had a BW less than 2500 grams (average BW was 1295 grams; SD ± 234.2; a coefficient of variation of 0.58). The average GA was 31.4 weeks of gestation. The average lifespan of mothers was 27.7 years (SD ± 1.2). The average Apgar scor (AS) in the first minute was 4.6 (SD ± 2.1) and in the fifth minute it was 6.6 (SD ± 1.9). The LBWIs were most commonly delivered by primiparas, 317 (47.5%). Of the 669 LBWIs, 411 (61.4%) were born per vias naturalis, with cephalic presentation. The highest number of LBWIs was born in Sarajevo Canton, 3.7%, and Central Bosnia Canton, 3.7%. The lowest prevalence was in Posavina Canton, 1.1%. The largest late fetal mortality was in Central Bosnia Canton, 7.7 ‰. Conclusion This study has determined a relatively low prevalence of LBWIs and other examined obstetrical characteristics that are in correlation with European and Global World data.

Title of Days of AMNuBiH 2018” and “SWEP 2018” is “Ethical Dilemmas in Science Editing and Publishing”. Why? If one wants to create a scientific work, must have on his mind that creating a scientific work requires creativity and openness, honesty, trust, and obeying the ethical principles for writing a scientific paper. While working on a an biomedical research involving human subjects medical workers should have on mind that it is the duty of the physician to remain the protector of the life and health of that person on whom biomedical research is being carried out. The World Medical Association (WMA) has developed the Declaration of Helsinki as a statement of ethical principles to provide guidance to physicians and other participants in medical research involving human subjects.

Introduction: The method of carrying out PTB is one of the most controversial topics of modern perinatology, because there are no clear and undeniable works and studies that would in any case support vaginal delivery (VD) or delivery to the cesarean section (CS). Aim: To determine more frequent mode of delivery in different groups of birth weights and degrees of prematurity from single and twin pregnancies. To determine the degree of vitality of premature born vaginal delivery (VD) in relation to the cesarean section (CS) in different degrees of prematurity from single and twin pregnancies. Patients and methods: Research has retrospective cohort character. Data were collected from the databases of University Clinic of Gynecology and Obstetrics Tuzla for the period of five years (January 1st, 2012–December 31st, 2016). The study included newborns of both genders, gestational age from 24 to 37 weeks of gestation (WG) in singleton and twin pregnancies. Results: Out of 19506 births, 1350 (6.92%) were preterm birth (PTB). Singleton PTB was 1180 (87.40%), and the twins were 170 (12.59%). Vaginal delivery (VD) was born 788 (58.37%). Cesarean section (CS) was born 562 (41.63%). There was statistically significant association between the mode of delivery (MD) in singleton and twins pregnancy in all three subgroups of birth weight (BW) 1000-1499, 2000-2499 and >2500 grams in 33-37 WG. In this group was more frequent VD than CS mode of singleton delivery, and CS than VD mode of twins delivery. In contrast to newborn with BW 1500-1999 grams (chi-square = 23.16, P <0.0001) in same gestational period where was more frequent CS than VD (OR: 2.56, 95% CI: 1.71-3,85). Apgar score (AS) at first and five minute 5-7 and 8-10 in the period 28-32 and 33-37 was a statistically significant frequent in VD and singletons in contrast to CS and twins. Conclusion: VD was more frequent in the higher WG, as well as the higher AS in singletons in contrast to twins delivery.