20 Years of Follow-up Alloimmunization and Hemolytic Disease in Newborn: Has Anything Changed in the Field Over the Years?

OBJECTIVE: of the study is to research the epidemiological aspects of maternal alloimmunization against erythrocyte antigens of fetuses (AB0, Rhesus, Lewis, Kell, Duffy and others) and to identify the most common types of hemolytic disease of the newborn (HDN) in the West Herzegovina region. STUDY DESIGN: The 20-year retrospective epidemiological study includes all pregnant women who had been immunologically tested and newborn treated for HDN. RESULTS: The indirect antiglobulin (IAT) detected antibodies against antigens in 545 (1.8%) pregnant women of the 29 663 who were tested at the Department of Transfusion Medicine. During the 20-year-long study 310 (1.0%) newborn with HDN were treated. Our results indicate that 42% (230/545) of the pregnant women had AB0 immunization. The most common form of HDN is AB0 HDN 64% (199/310), whereas RhD HDN was treated in 19% (59/310) of the newborn infants. ETR was performed on 29 (19%) infants, 21 (72.4%) with AB0 HDN, and 7 (26%) with RhD HDN. CONCLUSION: This 20-year-long study concludes that, even though there has been significant progress in the prevention of immunization and proactive treatment of HDN, precautionary measures are still required as is the need for gynecologists and obstetricians to be active. The reasons for this are the non-existence of preventive measures for non-RhD immunization, the irregular immunological screening of RhD positive women in pregnancy in the region encompassed by the study in the past few years. The above raises new questions and recommends further research and monitoring of immunization and HDN treatment worldwide.

Perinatal complications in two cohort groups of preterm newborns in Intensive care unit for Children's Diseases of University Clinical Hospital Mostar.

AIM: To determine the frequency and type of complications in two cohort groups of preterm newborns. SUBJECTS AND METHODS: The research involved 100 preterm newborns divided into two groups according to their gestational age: newborns from 24 to 33+6/7 weeks GA and newborns from 34 to 36+6/7 weeks GA. Parameters which were observed with mother were: age, number of births, course and complications in pregnancy. Parameters with infant: gestational age, weight, newborn small for gestational age (IUGR), asphyxia, respiratory distress syndrome, sepsis, hyperbilirubinemia, apnea, anemia, intracranial hemorrhage and metabolic disorder (hypoglycaemia, hypocalcaemia). Research criterion for exclusion was all preterm newborn infants with chromosome anomalies which cause death, fetal death during pregnancy (in utero) and newborns (born after full 37 weeks). RESULTS: After dividing exminees according to their gestational age into two groups, the group with higher gestational age (from 34 to 36+6/7 weeks GA) had 76% and the group with lower gestational age (from 24 to 33+6/7 weeks GA) had 24% of infants. The course of pregnancy was pathological in 68% of pregnancies and normal with 32% of pregnncies, the difference is statistically significant. 97% of pregnant woman had pathological course in the group of preterm newborns with lower GA. The most common perinatal complication was hyperbilirubinemia in 42% of cases, while sepsis was present in 1% of infants. The first group of infants (<33 GA) had mostly combination of 3 or more complications in 46% of infants while the other group mostly had hyperbilirubinemia in 50% and combination of complications in 24% of infants. CONCLUSION: Perinatal complication occurence depends on premature birth and course of pregnancy. Larger number of complications and harder complications which may result with death are more common in patients with lower gestational age (24 to 33+6/7 weeks GA) than in patients with higher gestational age (34 to 36+6/7 weeks GA).

Correlation of psychological symptoms with cortisol and CRP levels in pregnant women with metabolic syndrome.

BACKGROUND: In pregnancy occurs series of physiological, organic and psychological changes in the female organism. Particularly are significant hormonal and metabolic changes. Elevated cortisol levels are reduced by linking the transport of globulin (transcortin). Triglycerides were increased 50% and other lipids from 20 to 30%. The values of CRP were slightly elevated in the third trimester of pregnancy (10-15 mg/L). To investigate the association of psychological symptoms with the level of cortisol and CRP in women with metabolic syndrome. SUBJECTS AND METHODS: From 1646 pregnant women cross-sectional, prospective study included 180 pregnant women divided into three groups by applying the inclusion and exclusion criteria. Research methods are laboratory and clinical tests and questionnaires. Every pregnant woman have been made complete laboratory findings and determined cortisol in 8 and 17 hours using the chemiluminescent immunoassay method. All pregnant women filled in several questionnaires: socio-demographic, obstetrical-gynecological, standardized psychometric questionnaire (SCL 90-R), a questionnaire syndrome of depression according to ICD 10 and Beck self depression scale. The study was conducted from August 2011 to mid-November 2012. RESULTS: From the total of 1646 hospitalized pregnant women, 176 pregnant women had a BMI>30 and 120 of them were tested, but 60 had criteria for MS. The concentration of morning and afternoon cortisol is increased in pregnant women with the metabolic syndrome Obese pregnant women have a statistically higher level and morning and afternoon cortisol levels than women with normal body weight and without the metabolic syndrome, but these differences are smaller than in the case of pregnant women with the metabolic syndrome. CRP is significantly higher in women with metabolic syndrome. CRP concentration is significantly higher in obese pregnant women compared to pregnant women with normal weight and without the metabolic syndrome, but it is lower than in pregnant women with the metabolic syndrome. The incidence of psychological symptoms as somatization, obsessive-compulsive symptoms, depression, anxiety, phobia, and nonspecific symptoms is statistically increased in pregnant women with elevated morning cortisol, but in women with elevated afternoon cortisol also occurring aggressiveness and paranoia. In pregnant women with elevated CRP is statistically higher incidence of psychological symptoms such as somatization, obsessive-compulsive symptoms, depression, anxiety, and nonspecific symptoms. CONCLUSION: There is a statistically significantly higher levels of cortisol and C-reactive protein in obese pregnant women and pregnant women with the criteria of MS. Morning cortisol has a specific predictive value for the diagnosis of MS, but the values of CRP are changing in numerous physiological and pathological conditions and cannot be taken as a predictive factor in the diagnosis of MS. Pregnant women with MS and elevated morning and evening levels of cortisol and CRP shows a statistically significant higher number of complications in pregnancy and psychological symptoms.

Pathological pregnancy and psychological symptoms in women.

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.

Aggression in war veterans suffering from posttraumatic stress disorder with co-morbid alcoholism.

For thousands of years it has been known that aggression as a symptom appears in numerous psychiatric disorders and diseases. During the last decade the appearance of the aggressive behavior related to the posttraumatic stress disorder (PTSD) has been frequently investigated, often associated with war trauma. The goal of this study is to analyze the impact of alcoholism on a way war veterans suffering from chronic PTSD express and control aggression. The sample included 240 war veterans with chronic PTSD. The subjects were divided in two groups. PTSD group (n=147) and controlled group composed of those suffering from alcoholism in addition to PTSD (n=93). In this study, the following psychological instruments were used: The Harvard trauma questionnaire for PTSD diagnosis (HTQ); the questionnaire for self-evaluation of aggression (STAXI); The Profile Index Emotion (PIE); questionnaire for auto-diagnosis of alcoholism (CAGE). The obtained results indicate that subjects who have PTSD with co-morbid alcoholism are more deprived, aggressive (p < 0.001) and oppositional (p < 0.05) in comparison to subjects whose PTSD is not combined with alcoholism (PIE). The aggression is statistically more expressed in subjects with PTSD who have also been diagnosed with alcoholism on all subscales in comparison to subjects with PTDS who have not been diagnosed with alcoholism: the current state of aggression, the general state of aggression, aggression towards an unfair treatment, aggression directed inwards and outwards (p < 0.001); aggression towards nonspecific provocation and a general way of expressing aggression (p < 0.05) (STAXI). Subjects that had PTSD combined with alcoholism show a higher degree of aggression in comparison to subjects with PTDS who are not diagnosed with alcoholism.

Metabolic syndrome and psychological symptoms in pathological pregnancy.

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.

Hypertensive disorders in pregnancy: a 5-year analysis of the wartime and postwar period in South-Western region of Bosnia and Herzegovina.

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.