ABSTRACT Aim: The objective of the study was to examine whether cardiotocography can (CTG) predict asphyxia of the embryo, manifested as hypoxic-ischemic encephalopathy (HIE), and to what extent one can rely on CTG record. Material and methods: Retrospective research was carried out at the Clinic for Gynecology and Obstetrics UKC Tuzla and medical documentation from the history of mothers and newborns was used. The study group consisted of 68 pregnancies and newborns who developed HIE. The control group consisted of 40 pregnancies, which resulted in birth of healthy newborns – without signs of asphyxia. CTG records were analyzed, Apgar score, the ways of finishing delivery. Results: Pathological CTG records (bradycardia 100, tachycardia 180, silent type of curve, late decelerations) were found in 45 (66,17%) cases of the study group in comparison to 11 (27,5%) in the control group. In the study group Apgar score in 5th minute lower than 7 had 17,46% newborns and the highest incidence of the normally finished deliveries. We conclude that cardiotocography is one of the reliable methods of fetal monitoring in pregnancy and delivery, and that pathological CTG record very likely indicates the possible presence of perinatal asphyxia. Conclusion: Achieving a low degree of correlation between pathological intrapartum cardiotocography findings and long-term outcome of children can be achieved by rapid and adequate obstetric intervention and the relatively short duration of fetal acidosis, and optimal procedures during intensive care of newborns.

The exact incidence and mortality rate in Bosnia and Herzegovina are unknown as there are no National Cancer Register. The available data are mostly based on the estimation from neighboring countries. Therefore, the aim of this study was to present the preliminary but more accurate estimates of cervical cancer incidence and mortality rates in Bosnia and Herzegovina. The data on cervical cancer cases in Bosnia and Herzegovina were collected from different sources and varies depending on the size of the city or region. To calculate the crude rates for the period from 2000 to 2008, we used the Bosnian and Herzegovinian population census for 1991. Thus, the crude incidence rate in Sarajevo region is more equable (app. 30.4/100,000 women-year), while in Tuzla Canton it varied from 18.5 in 2005 to 4.8/100,000 in 2000. In Tuzla Canton, in the period 1993-2006, 27.1% of all women with cervical cancer were younger than 30. However, the exact crude incidence in Bosnia and Herzegovina could be even higher. Data from Tuzla Canton showed slight increase in mortality rate in the last 5years (4.9/100,000), with the peak in 2007 (7.0/100,000). The presented data reflects the situation throughout Bosnia and Herzegovina and underline the necessity of the implementation of cervical cancer register and organized screening program.

Introduction: Hydatidiform mole is a gestational trophoblastic disease characterized by a range of disorders of abnormal trophoblastic proliferation.Methods: This was a retrospective study of 70 singletone pregnancies until the 12th week of gestational age diagnosed with hydatidiform mole or spontaneously aborted physiological pregnancy. The pregnantwomen had almost similar demographic features and were divided into two groups. 35 pregnant women with a molar pregnancy were included in the study group; while 35 pregnant women with physiologicalpregnancy spontaneously aborted were included in the control group. Analyzed parameters included a pregnant woman’s age, blood type, parity and previous pregnancies (course and outcomes).Results: In the study group 11.43% of cases had hydatidiform mola during previous pregnancies as well as the advanced average gestational age of an ongoing pregnancy (9.63±1.83 in contrast to 8.25±2.03in the control group). The pregnant women with the hydatidiform mole were reported to have statistically significantly greater number of irregular villous borders (71.43%); slightly enlarged villi (54.29%); moderatedpresence of cisterns (65.71%) as well as mild avascularisation of villi (57.14%).Conclusion: It was concluded that a previous molar pregnancy represents the highest risk for hydtidiforme mole and the pathomorphologic analysis of vilous changes can be a reliable parameter for establishingproper diagnosis of partial hydatidiform mole.

Introduction: Partial molar trophoblast degeneration is a benign disease characterised by numerous complications such as an invasive mole and malignant alteration.Methods: This was a retrospective study which recruited 70 pregnant women diagnosed with hydatidiform mole or with physiological pregnancy spontaneously aborted. The pregnant women had similar demographic features and were included in two groups. 35 pregnant women with a molar pregnancy diagnosed during the first trimester were included in the study group; while 35 pregnant women with miscarriages during the fi rst trimester were included in the control group.Results: Examined trophoblast changes were: type of atypia, amount and mass of trophoblast proliferation. Specifi c β HCG serum levels were observed in all pregnant women before the treatment. Pregnantwomen in the study group had statistically signifi cant higher levels of β HCG serum in comparison with the control group (both average levels 60191.37±49662.75 and levels according to gestational age). Statisticallysignifi cant changes of villous trophoblast were observed by the pathomorphological analysis: mild trophoblast atypia (57.14%); pronounced trophoblast mass (45.71%) and mild trophoblast proliferationamount (51.43%).Conclusion: Serum β-HCG level measurements and pathomorphological analysis of chorionic villi are reliable and effective methods in a partial mole diagnostics.

The objective of this study was to compare acceptance rate of immediate postpartum contraception and other characteristics among HIV-infected and HIV-non-infected parturients. Delivery logbooks from January 1990 to June 1994 were reviewed and 776 HIV -positive females  were identified. Data of these women were abstracted together with those of 1,552 HIV-negative women whose names were immediately before and after the HIV-Infected ones(1:2 ratio). HIV infected  women were more likely to be younger, have lower number of gravida, have baby with lower birthweight and lower first-minute APGAR score, and accept immediate postpartum contraception. However, the two groups did not differ in terms of mode of delivery.Stratification of acceptance rates of postpartum contraception revealed that the rates among multigravida were not different (39% vs 33%, OR = 1.30 [0.95-1.77)). However, HlV-infected primigravidous women were more likely than the non-infected to accept contraception (17.9% vs 0.9%, OR =  22.81(lO.03-54.65)).This was probably due to the policy of the hospital in encouraging HlV infected  mothers to adopt permanent or semipermanent methods of contraception.

Introduction: Preterm delivery is the delivery before 37 weeks of gestation are completed. The incidence of preterm birth ranges from 5 to 15%. Aims of the study were to determine the average body weight, Apgar score after one and five minutes, and the frequency of the most common complications in preterminfants.Methods: The study involved a total of 631 newborns, of whom 331 were born prematurely Aims of this study were to (24th-37th gestational weeks-experimental group), while 300 infants were born in time (37-42 weeks of gestation-control group).Results: Average body weight of prematurely born infants was 2382 grams, while the average Apgar score in this group after the fi rst minute was 7.32 and 7.79 after the fifth minute. The incidence of respiratory distress syndrome was 50%, intracranial hemorrhage, 28.1% and 4.8% of sepsis. Respiratory distresssyndrome was more common in infants born before 32 weeks of gestation. Mortality of premature infants is present in 9.1% and is higher than that of infants born at term.Conclusions: Birth body weight and Apgar scores was lower in preterm infants. Respiratory distress syndrome is the most common fetal complication of prematurity. Intracranial hemorrhage is the second most common complication of prematurity. Mortality of premature infants is higher than the mortality of infants born at term birth.

Introduction: The aim of this paper is to study the distribution of the therapy dosage applied by a modified conventional “field in field” technique and compare it to the distribution of the dosage applied by the standard conventional technique.Methods: The study included ten patients with right side breast cancer, after they were exposed to radical mastectomy and chemotherapy. Radiotherapy dosage of TD 50 Gy in 25 fractions was applied to the anterolateral side of the right thoracic wall, with two opposite conventional tangential fields by the linear accelerator Elekta Synergy and the energy of 6 megavolts (MV). A delineation of the target volume (CTV – Clinical Target Volume) was done within conventional fields. At the XiO system for planning we included additional fields within the existing conventional fields, which was the so called “field in field” technique. On the basis of CTV the Dose Volume  Histogram (DVH) was calculated for conventional and “field in field” plans. VD90%, VD95%, VD107%, VD115%, CI and HI were calculated for both techniques. Means were pared with the paired Student's t-test. The results were considered significantly different if p<0.05.Results: VD90% and VD 95% were significantly higher for the “field in field” technique. Therefore, CI also favored the “field in field” technique (p=0.02). There was no difference in VD107% and VD115% between the compared groups. Consequently, there was no statistically significant difference in HI (1.13±0.03 vs.1.13±0.03, p=0.06).Conclusion: Conventional postoperative radiotherapy of localized right side breast cancer by “field in field” technique provides excellent coverage of the target volume by radiotherapy isodose.

Introduction: Doppler analysis of the feto-placental and fetal circulation give dynamic information on the condition of the bloodstream during pregnancy, and early detection of fetal hypoxia. The objectives of the study were: testing whether there is influence of smoking on feto-placental circulation; determining whether there is a link to a number of smoked cigarettes during the day; assessing the benefits of Doppler ultrasonographic screening in detection of fetal hypoxia in pregnant women who smoke during pregnancy. Methods: 300 pregnancies were included in the prospective research. With regard to a number of smoked cigarettes the pregnant women were divided into three groups: I. the first group (moderate smokers) consisted of 100 pregnant women who smoked up to 15 cigarettes a day during pregnancy; II. the second group (heavy smokers) 100 pregnant women who smoked more than 15 cigarettes a day during pregnancy and III. the third group (control group) 100 pregnant women who did not smoke during pregnancy. All pregnant women underwent Doppler measurements of blood circulation (determination of resistance index – RI) in the umbilical artery, fetal aorta and middle cerebral artery. Results: The intensity of smoking has influence to circulation because RI in the umbilical artery and fetal aorta is increased and RI is decreased in the middle cerebral artery in pregnant women heavy smokers in comparison to pregnant women moderate smokers. Conclusion : Doppler sonography of the blood vessels could have an important role in detection of hypoxia and monitoring of the condition of the fetus of pregnant women who smoked during pregnancy.

Introduction: Gynaecological and obstetric surgeries are high risk operations for the development of postoperative inflammatory complications due to the proximity of the genitourinary tract. The aim of this study was to compare the frequency of inflammatory complications in emergency or elective cases of caesarean sections as well as the frequency of complications related to the method of surgical treatment used.Methods: We analyzed inflammatory complications in 450 caesarean sections, which developed in a one year period from June 1st, 2000. to June 1st 2001. Patients were grouped according to the method of the surgery, and on emergency or elective case. Misgav Ladach or Dorfler surgical methods were used.Results: The most common inflammatory complication was wound infection and the most common risk factors for inflammatory complications were premature rupture of membranes and anemia.Conclusions: Long term use of one antibiotic was the most commonly implemented form of antibiotic prophylaxis.

Introduction: The aim of the research was to determine the effect of breakthrough pain (BTP) on heart and lung function in patients whose cancer pain had been treated with strong opiates.Methods: A prospective study was conducted on 80 patients who were treated in recumbent patients’ hospice of Palliative Care Centre (hospice) University Clinical Centre Tuzla. The effect of pain breakthrough onheart function was monitored by blood pressure and pulse measuring outside. The effect on respiratory function was monitored by measuring the respiration number with SpO2 and pCO2 and pO2 capillary blood valuesoutside, during and after relieving pain breakthrough.Results: Mean value for Karnofsky score for patients upon admission was 47.13 ± 11.05 and on discharge 51.25 ± 11.73. The total number of pain breakthroughs for patients within the 10 days of the treatment was1396. During the pain breakthrough the mean of systolic pressure was 133.1 mmHg and it was statistically significantly higher than the mean of systolic pressure measured after BTP relief with oral morphine. Themean of diastolic pressure measured outside of pain breakthrough was 75.9 mmHg and after the BTP relief it was 72.9 mmHg. The mean pulse outside of pain breakthrough was 92.7 heartbeats per minute and afterthe BTP relief 8 9.1 heartbeats per minute.Conclusion: Pain breakthrough leads to pulse acceleration, increased systolic and diastolic blood pressure and it also affects respiratory function by accelerating the respiration

Heterotopic pregnancy refers to the presence of simultaneous pregnancies at two different implantation sites. Heterotopic pregnancy is rare, estimated to occur in 1 per 30,000 pregnancies. We report a case of a 27-year-old woman presented to the emergency department with the diagnosis of ruptured ectopic pregnancy. Careful ultrasound assessment indicated the diagnosis of heterotopic pregnancy. Right salpingectomy with removal of the hemoperitoneum and suction curettage were performed. Our operative diagnosis of heterotopic pregnancy was confirmed by histopathology. Heterotopic pregnancy can occur in the absence of any predisposing risk factors, and the detection of intrauterine pregnancy does not exclude the possibility of the simultaneous existence of ectopic pregnancy. Transvaginal ultrasound and assessment of the whole pelvis, even in the presence of intrauterine pregnancy, can be an important aid in the diagnosis of heterotopic pregnancy.

Aim.Goal of the study was to assess the frequency of birth and mortality of low birth weight infants based on the level of neonatal institution where they were born and/or treated according to gestational age, in the Federation of Bosnia and Herzegovina. Methods. Through the prospective study over one-year period from 01.01. to 31.12.2009, the infants were analysed (stillborn and liveborn) of both genders, gestational age 24-42 weeks and birth weight below 2500 grams. Results. During the assessment period, 22897 infants were born, 669 with low birth weight, so that the incidence was 2.9 %. Gender breakdown is proportional. Most of the infants were born in two largest Cantons, Sarajevo and Tuzla. In the first level neonatal institutions 29 infants were born, 286 in the neonatal institutions of the second level, and 354 low birth weight infants were born in the neonatal institutions of third level. There is statistically significant discrepancy in frequency of low birth weight infants' births between neonatal institutions of first and second level (χ2=272.1; P<0.0001), as well as second and third level (χ2=13.4; P<0.0002). Of 29 low birth weight infants born in neonatal institutions of first level, 26 were referred to other institutions, while 3 died in the institution where they were born. Neonatal institution of second level kept 127 infants at treatment, 53 of whom died. There was no statistically significant discrepancy in mortality of low birth weight infants between the institutions of first and second level (χ2=0.71; P=0.398), with relative risk [ RR=0.507 (95% CI 0.148- 1.738) ]. In third level neonatal institutions, 513 infants were treated and 461 survived, while 52 died. Statistically significant discrepancy was found in the mortality rate of low birth weight infants between the institutions of second and third level ( χ2=71.8; P<0.0001), with high relative risk [ RR=6.349 (95% CI 4.030-10.003) ]. Conclusion: Survival of low birth weight infants born in the maternity hospitals with neonatal institutions of third level is statistically higher than the survival rate of infants born in the maternity hospital with neonatal institutions of first and second level.

The opinion regarding sexual and vaginal function of patients with advanced cervical cancer treated primarily by chemoradiotherapy has still not been formed, mainly due to inappropriate methodology as the control group was comprised of healthy women. The aim of this study is to, by means of interview, evaluate vaginal and sexual function of patients with advanced cervical cancer before and after chemoradiotherapy and compare the results. A number of 35 patients were irradiated by teleradiotherapy dose of 45 Gy in 25 fractions over 5 weeks to the pelvis and additional 20-24 Gy in 4-6 fractions were given by intracavitary HDR brachytherapy. Patients received 40 mg/m(2) of cisplatin once a week, which is a total of 4-6 cycles of cisplatin. Patients answered the questions in a form of a questionnaire specifically created for cervical cancer (EORTC-QLQ-Cx 24), for the period immediately before diagnosed cervical cancer (thus being a control group). They also answered the same questions for the period starting 12 months after the completion of concomitant chemoradiotherapy, and were an experimental group at the time. For the testing of statistical significance of differences among the examined groups parameter and non-parameter tests were used (the Wilcoxon signed ranks test and Student's t-test). The difference p<0.05 was considered statistically significant. Vaginal problems of patients after chemoradiotherapy were statistically reduced (44 versus 0; p<0.0001). There is no statistical significance in the vaginal function among the analyzed groups but weaker pain during intercourse was registered after chemoradiotherapy (p=0.009). After chemoradiotherapy, patients' vaginal function is extremely improved whereas there is no difference in the sexual function. Pain during intercourse is statistically reduced after chemoradiotherapy.