Biological Activity of Genus Hypericum Sect. Hypericum Species-H. tetrapterum, H. maculatum subsp. immaculatum, H. triquetrifolium.

St. John's wort (Hypericum perforatum, Hypericaceae) has long been used in traditional medicine as a potent remedy, while many other species of this genus have not been thoroughly investigated. The study aimed to detect the biological activity, including antioxidant, antihyperglycemic, anticholinergic, antimicrobial and monoaminoxidase inhibitory potential, of water-alcoholic extracts of three species autochthonous for Serbia and Greece from plant genus Hypericum (section Hypericum-H. tetrapterum, H. maculatum ssp. immaculatum and H. triquetrifolium), followed by phytochemical profiling. The highest amount of phenolics was recorded in H. maculatum subsp. immaculatum extract, while the highest abundance of flavonoids was characteristic of H. tetrapterum extract. Hypericin and hyperforin, quercetin, and its flavonoid, rutin, were present in all of the evaluated species. The evaluated species were good scavengers of DPPH, OH and NO radicals, as well as potent reducers of ferric ions in FRAP assay. Furthermore, the evaluated species were shown as potent inhibitors of monoaminoxidase A and α-glucosidase and modest inhibitors of acetylcholinesterase, monoaminoxidase B and α-amylase. No anti-Candida activity was recorded, but the extracts were effective against MRSA Staphylococcus aureus and Enterococcus sp., as well as against Proteus mirabilis. The obtained results strongly highlight the need for further in vivo studies in order to better define the potential of the medicinal application of the studied species.

Diagnostic Tests in the Prediction of Neonatal Outcome in Early Placental Fetal Growth Restriction.

Background and Objectives: Monitoring pregnancies with fetal growth restriction (FGR) presents a challenge, especially concerning the time of delivery in cases of early preterm pregnancies below 32 weeks. The aim of our study was to compare different diagnostic parameters in growth-restricted preterm neonates with and without morbidity/mortality and to determine sensitivity and specificity of diagnostic parameters for monitoring preterm pregnancies with early preterm fetal growth restriction below 32 weeks. Materials and Methods: Our clinical study evaluated 120 cases of early preterm deliveries, with gestational age ≤ 32 + 0 weeks, with prenatally diagnosed placental FGR. All the patients were divided into three groups of 40 cases each based on neonatal condition,: I-Neonates with morbidity/mortality (NMM); II-Neonates without morbidity with acidosis/asphyxia (NAA); III-Neonates without neonatal morbidity/acidosis/asphyxia (NWMAA). Results: Amniotic fluid index (AFI) was lower in NMM, while NWMAA had higher biophysical profile scores (BPS). UA PI was lower in NWMAA. NWMAA had higher MCA PI and CPR and fewer cases with CPR <5th percentile. NMM had higher DV PI, and more often had ductus venosus (DV) PI > 95th‱ or absent/reversed A wave, and pulsatile blood flow in umbilical vein (UV). The incidence of pathological fetal heart rate monitoring (FHRM) was higher in NMM and NAA, although the difference was not statistically significant. ROC calculated by defining a bad outcome as NMM and a good outcome as NAA and NWMAA showed the best sensitivity in DV PIi. ROC calculated by defined bad outcome in NMM and NAA and good outcome in NWMAA showed the best sensitivity in MCA PI. Conclusions: In early fetal growth restriction normal cerebral blood flow strongly predicts good outcomes, while pathological venous blood flow is associated with bad outcomes. In fetal growth restriction before 32 weeks, individualized expectant management remains the best option for the optimal timing of delivery.

Bioactivity Profiling of Daedaleopsis confragosa (Bolton) J. Schröt. 1888: Implications for Its Possible Application in Enhancing Women's Reproductive Health.

This study investigates the bioactivity profile of wood-rotting fungal species Daedaleopsis confragosa (Bolton) J. Schröt. 1888, focusing on its antioxidant, cytotoxic, and genotoxic activities and enzyme modulation properties with respect to its possible application in terms of enhancing women's reproductive health. Two types of extracts, including those based on EtOH extraction (DC) and hydrodistillation (DCHD), were investigated. The results indicate that the radical scavenging capacity against the DPPH radical and reduction potential were stronger in the DC extracts owing to the higher total phenolic content (TPC) and total flavonoid content (TFC) (25.30 ± 1.05 mg GAE/g d.w. and 2.84 ± 0.85 mg QE/g d.w., respectively). The same trend was observed in the protein phosphatase-1 (PP1) activity and in the genotoxic activity against the δ virus since only the DC extract exhibited DNA disintegration regarding a dilution of 1:100. Conversely, the DCHD extract exhibited increased hemolytic and cytotoxic effects (339.39% and IC50 = 27.76 ± 0.89 µg/mL-72 h incubation, respectively), along with greater inhibition of the AChE enzyme (IC50 = 3.11 ± 0.45 mg/mL) and hemolytic activity. These results suggest that terpenoids and steroids may be responsible for the observed activity in DCHD as these compounds could potentially be extracted following the HD procedure. This comprehensive bioactivity profiling offers valuable insights into the potential therapeutic applications of D. confragosa from Serbia and underscores the importance of further investigations for harnessing its pharmacological potential.

Effects of UV Stress in Promoting Antioxidant Activities in Fungal Species Тrametes versicolor (L.) Lloyd and Flammulina velutipes (Curtis) Singer.

Trametes versicolor and Flammulina velutipes, after submerged cultivation, with intermittent exposure to ultraviolet light (UV), were studied for Total Phenolic content (TP) and Total Proteins (TPR) contents and antioxidant properties against free radicals. The TP and TPR were determined by a spectrophotometric method and Lowry's assay, respectively. Liquid chromatography with mass spectrometry (LC-MS/MS) was used to quantify polyphenols. Different in vitro assays determined the antioxidant activities of the extracts. Mycelia extract from F. velutipes after 14 days and filtrate from T. versicolor after 21 days of incubation gave the highest TP 59.60 ± 0.14 and 50.03 ± 0.66 mg GAE/g d.w., respectively. Mycelia extract from T. versicolor after 28 days of incubation had the highest TPR (183.53 ± 2.84 mg BSAE/g d.w.). The LC-MS/MS analysis indicated that p-hydroxybenzoic and protocatechuic acids are the most abundant. Trametes versicolor filtrate after 14 days and F. velutipes filtrate after 21 days (71.29 ± 0.54% and 73.5 ± 1.81, respectively) had the highest scavenging activity in SOA. Correlation analysis indicated that all extracts' antioxidant (AO) potential strongly correlated with TP (R2 = 0.83-1.0). The data confirmed that stress factors such as UV exposure could stimulate the production of secondary metabolites and natural AOs, especially phenolic acids in test fungi.

Disturbance of oxidative balance in the pregnancy with fetal trisomy 21.

BACKGROUND/AIM: Location of the gene encoding superoxide-dismutase on chromosome 21 suggests a possible impact on the maternal oxidative stress parameters. The aim of the study was to investigate the possible impact of the fetal trisomy 21 on the level of oxidative stress in mothers. METHODS: The study involved two groups of pregnant women: a study group (n = 30) with fetal trisomy 21 and a control group (n = 50) with physiological pregnancy and normal fetal karyotype. The following parameters were compared between two groups: pro-oxidative (lipid peroxidation), anti-oxidative (SOD, glutathione peroxidase and uric acid), and biochemical markers of the aberrant karyotype (free beta-HCG and PAPP-A). RESULTS/CONCLUSIONS: Our data suggest that there may be a change in oxidative stress balance in the study group with trisomy 21 which may lead to the excessive hydrogen peroxide production, compared to the control group with normal pregnancy.

A Prospective Study of Mid-Trimester MCP-1 Levels as a Predictor of Preterm Delivery.

Background: The prevention of preterm delivery (PTD) represents one of the major topics in modern obstetrics. The aim was to design a prospective study and investigate if mid-trimester serum and amniotic fluid levels of MCP-1 could predict the occurence of spontaneous PTD. Methods: The study involved 198 women who underwent genetic amniocentesis and blood sampling in the middle of their trimester. After applying the criteria for inclusion in the study, there were 16 respondents in the study group, and 38 respondents in the control group. Level of MCP-1 in amniotic fluid and serum was measured with commercially available enzyme-linked immunosorbent assays (ELISA) and statistical analysis was conducted. Results: There was no statistically significant difference in serum or amniotic fluid MCP1 levels between PTD and the control groups. Conclusion: The results suggest that MCP-1 is probably not the most relevant marker for predicting PTD. This study provides new normative data for MCP-1 levels in amniotic fluid and maternal sera and is a valuable tool for future diagnostic and comparative studies.

Antimicrobial and Toxic Effects of Boswellia serrata Roxb. and Mentha piperita Linn. Essential Oils on Vaginal Inhabitants.

Commercial essential oils (EOs) of incense, Boswellia serrata Roxb, and mint, Mentha piperita L., were investigated against vaginal bacterial and Candida albicans isolates for antimicrobial potential and safety use. The antimicrobial activity of EOs was investigated through a double-dilution micro-plate assay. A brine shrimp assay was used for the determination of toxicity, while the determination of the chemical composition of EOs was carried out using GS-MS. Obtained minimal inhibitory (MIC) and minimal bactericidal concentration (MBC) point to the activity of mint essential oil (EO) against the multi-resistant P. aeruginosa isolate (MIC/MBC at 6.25 µL/mL), while MIC and MBC values for other isolates were reached at higher concentrations (25-50 µL/mL). According to the toxicity assay, the incense EO reached the LC50 value at 3.07 µL/mL, while mint EO showed higher toxicity at lower concentrations (0.5 µL/mL) and the LC50 could not be determined. The highest antimicrobial potential was obtained for incense against P. aeruginosa. Although the toxicity assay showed high toxicity of mint EO to the eggs of aquatic crustaceans Artemia salina, further testing of EO toxicity is proposed, for example on healthy cell-lines. According to the GC/MS spectrometry, the most represented components of mint EO were the oxygenated hydrocarbons L-menthone (20.86%) and menthol (31.86%), and they could be proposed for further antimicrobial and toxicity investigation.

Serum proinflammatory cytokine - interleukin-8 as possible infection site marker in preterm deliveries.

AIM: To evaluate serum level of proinflammatory cytokine interleukin-8 as a biochemical marker of local infections in patients with clinical symptoms of preterm deliveries. METHODS: We studied 74 pregnant women at 24-36 gestational weeks (GW) with preterm delivery. Serum interleukin-8 was measured. RESULTS: The mean value of interleukin-8 in the study group (n=36) was 19.13 pg/mL vs. 5.02 pg/mL in the controls (n=38). CONCLUSIONS: The results indicate that serum level of interleukin-8 might be used as non-invasive marker of infections in pregnancy, as well as a marker of preterm deliveries.

Intrauterine treatment of large fetal neck lymphangioma with OK-432.

Lymphangiomas are benign vascular malformations of the lymphatic system and most commonly present in the neck area. Large lymphangiomas may compress and/or displace the larynx, trachea and esophagus and cause serious respiratory and feeding problems in neonates. Prenatal therapy could eliminate the risks of the mentioned complications. Prenatal therapy may include the EXIT (ex utero intrapartum treatment) procedure. As this procedure has certain risks for both the neonate and mother, the introduction of a safer method is justified. The use of OK-432, as a sclerosing agent, has shown positive results in several published cases of cystic hygroma, but there is no study about the prenatal use of this agent in the treatment of lymphangioma. The aim of this study was to present our experience with intrauterine intralesional injection of OK-432 in the treatment of neck lymphangiomas. Two cases of large multicystic neck lymphangiomas that were closely situated to the fetal airway were treated by single intralesional injection of OK-432. We noticed a progressive decrease in tumor volume throughout gestation. We did not experience any complications and there were no respiratory or feeding problems in the neonates. The esthetical appearance was satisfactory and both children were normal at the age of 2 years and 6 months, respectively. This report suggests that prenatal intralesional injection of OK-432 might be a safe and effective treatment in selected cases with large fetal neck lymphangiomas.

Chemical composition, antioxidant and antibacterial properties of Achillea collina Becker ex Heimerl s.l. and A. pannonica Scheele essential oils.

The in vitro antioxidant and antimicrobial activities of two Achillea millefolium (Adanson) Koch s.l species essential oils (A. collina Becker ex Heimerl s.l. and A. pannonica Scheele, Asteraceae) originating from the Golija and Radan mountains (Serbia) were investigated. The chemical profiles of the essential oils were evaluated by GC-MS. Antioxidant activity was assessed as free radical scavenging capacity (RSC) towards 2,2-diphenyl-1-picrylhydrazil (DPPH) radicals, together with effects on lipid peroxidation (LP). Antibacterial activity was examined on 21 bacterial strains. Based on the chemical composition of the essential oil, A. collina s.l. from Mount Golija was classified as a chamazulene chemotype (tetraploid). The high percentage of oxygenated monoterpenes and absence of azulene in the essential oil obtained from A. pannonica from Radan pointing that this population is octaploid. Essential oil of A. pannonica expressed stronger antimicrobial activity on almost all tested bacteria. Furthermore, this essential oil expressed higher scavenging effects on DPPH radical (IC(50) = 0.52 comparing to 0.62 mug/mL). Only in the LP evaluation, essential oil of A. collina s.l. from Golija exhibited stronger antioxidant activity (IC(50) = 0.75 comparing to 2.12 mug/mL).

Serum magnesium level in the first trimester of pregnancy as a predictor of pre-eclampsia - a pilot study.

OBJECTIVES: The aim of this study was to evaluate the importance of serum concentration of magnesium (Mg) in the first trimester of pregnancy for predicting pre-eclampsia (PE). METHODS: This prospective study included 403 pregnant women over 18, with singleton pregnancy (from 11 to 14 weeks of pregnancy). The subjects were divided into a group who subsequently developed PE (PEKT) (n = 61), and a group of healthy pregnancies with no complications and with normal outcomes (TNT) (n = 342). In the first trimester, urea, creatinine, uric acid, Mg, free beta subunit of human chorionic gonadotrophin, plasma protein A related to pregnancy, and C-reactive protein were determined. We followed all subjects until the end of pregnancy. RESULTS: Serum Mg is significantly lower in PEKT than in TNT group (p < 0.001). The serum first trimester Mg level cutoff at ≤0.81 mmol/L had a sensitivity of 77.0% and specificity of 71.6% for the detection of women with PEKT. The level of serum Mg has the strongest significant positive correlation (p < 0.05) with the week of gestational outcomes (R = 0.442), weight (R = 0.416), and Apgar score (R = 0.343) of the newborns, and the strongest significant negative correlation with the number of miscarriages (R = -0.413), serum creatinine (R = -0.471), and the number of pregnancies (R = -0.326). The week of gestational outcome is predicted with the greatest reliability by the serum Mg. CONCLUSIONS: Serum Mg level during the first trimester of pregnancy is a significant prediction tool for PE and could also play an important role in predicting the week of gestational outcome and birth weight of newborns.

Early pregnancy angiogenic proteins levels and pregnancy related hypertensive disorders.

INTRODUCTION: Normal placental vascular development depends on multiple interactions of many regulatory molecules including pro and antiangiogenic proteins. It is considered that these vascular modulators might be one of the factors responsible for development hypertensive disorders in pregnancy. OBJECTIVE: To evaluate and compare the early pregnancy (11-14 week of gestation) serum level of angiogenic proteins sFlt1, VEGF i PIGF between different types of pregnancy related hypertensive disorders. MATERIALS AND METHODS: The study included 177 pregnant women between 11 and 14 weeks of gestation, divided into four study subgroups (preeclampsia group-41, gestational hypertension group-31, chronic hypertension group-32 and miscarriage group-19) and control group-54. Blood samples (serum) were taken for measuring sFlt1, VEGF i PIGF by a quantitative ELISA technique and measuring other biochemical and hematological parameters. RESULTS: Significantly higher levels of sFlt1 were in the subgroups with preeclampsia and miscarriages, significantly lower level of VEGF in the all study subgroups and lover level of PIGF were in miscarriage group. In the groups with chronic and gestational hypertension there were higher level of sFlt1 and lover level of VEGF than in the control group, but the differences did not reach statistical significance. CONCLUSION: Early pregnancy imbalance between antiangiogenic protein sFlt1 and proangiogenic molecules VEGF and PIGF could have impact on pathophysiology of placental disorders which leads to development of pregnancy related hypertensive disorders.

Antimicrobial Potential of Rosmarinus officinalis Commercial Essential Oil in the Treatment of Vaginal Infections in Pregnant Women.

Treating inflammatory conditions .such as vaginosis, vaginitis, and vulvovaginitis in pregnancy is- a special problem due to limitations. of available drugs. However, possible treatment options can be found also in naturally originated products, such as essential oils (EOs) of different plants. The aim of this study was to evaluate in -vitro antimicrobial and toxic activities of the commercial EO of Rosmiarinus officinalis L. (Lamiaceae) against five Gram-positive and Gram-negative bacterial strains and two Candida strains obtained from pregnant women with Vaginal infection. Gas chromatography-mass spectrometry of the tested EO revealed oxygenated monoterpenes to be the major ingredients, while microdilution assay showed the highest activity on Staphylococcus aureus II strain at 6.2 mg/mL. After 24 hours, toxicity was determined at 19.4 mg/mL on Artemia salina nauplii. The obtained results show this EO to be a promising alternative therapy for vaginal infections, although further toxicity and safety research is required.

Disturbance of oxidative balance in the first trimester of spontaneous abortions.

Background/Aim: Pregnancy is defined as a condition of increased oxidative stress. The aim of this research was to determine the intensity of pro-oxidative processes and the content of GSH, as well as antioxidative enzymes: superoxide dismutase (SOD), catalase (CAT), gluthatione peroxidase (GSH-Px), and the total antioxidative status (TAS) in patients with spontaneous abortions. Methods: A total of 120 patients were involved in the research (70 spontaneous abortions and 50 healthy pregnancies). The patients were divided into groups: 35 patients with incomplete and complete spontaneous abortion (group S), 35 patients with missed abortion (group M) and a control group of 50 healthy pregnancies (group N), all of them being in the first trimester of pregnancy. The intensity of lipid proxidation (LPx) was determined with a modified thyobarbituric acid method. The GSH content in erythrocytes was determined by the method ba-sed on the amount of non-protein sulfhydryl residues using the Ellman's reagens. The following antioxidative parameters in the blood were measured: SOD ­ by the method with xanthine oxidase-using commercial RANSOD sets; CAT ­ by the method of Aebi (the enzyme activity was measured by monitoring the decomposition of H2O2 at 240 nm); GSH-Px was determined using hydrogen peroxide as a substrate. The TAS was determined using the ferric reducing autioxidant potential (FRAP) met-hod. Results: The highest average value of LPx was recorded in the spontaneous abortion group (48.03 pmoL/mg Hgb), and the lowest value was recorded in the control group (26.06 pmoL/mg Hgb). A statistically significant positive correlation between LPx and CAT in the group of patients with missed abortion was also noted (p < 0.05, r = 0.37). There was a statistically highly significant difference (p < 0.001) in SOD and in CAT activitices be-tween the examined patients (groups S and N) and the control group (Student's t-test and ANOVA). The highest average value of TAS was recorded in the group S (710.39 µmol/L), while the value in the group M was 277.66 µmol/L. The average value of TAS in the control group was 452.12 µmol/L. Student's t-test showed a statistically highly significant difference in the values of TAS between the examined patients (groups S and M) and the control group. Conclusion: Determination of the value of pro-oxidative and antioxidative parameters in patients with sponta-neous abortion can be the indicator of condition of fetoplacental unit and these analyses can be included in the protocol of the rutine perinatal diagnostics.

[Cardiorespiratory Disorders of Infants of Diabetic Mothers].

INTRODUCTION: One of the characteristics of modern era is the explosion of diabetes in the world. Today more than 400,000,000 people suffer from diabetes in the entire world. During the last decade the number of women with the disorder of glucose homeostasis is six to seven times greater than in the previous period. Therefore, the re-evaluation of the impact of glucose intolerance on the course and outcome of pregnancy is very current. OBJECTIVE: The aim of the study was to evaluate the data on the influence of mothers' glucose homeostasis disturbances on the occurrence of cardiorespiratory disorders in newborns, as well as their influence on the perinatal outcome. METHODS: Prospective examination included 102 newborns in total - 31 infants of mothers with glucose homeostasis disorder (Group 1) and 71 infants of healthy mothers (Group II). Average age, body height, body weight, body mass index, parity and illness duration of the pregnant women had been determined, as well as the delivery method. Every newborn was provided with physical examination, Apgar score was calculated, body weight and body length were measured. Also, electrocardiography and brain ultrasound, as well as the basic hematology biochemical and microbiological analysis, were performed within the examinations of the infants. RESULTS: The average weight and obesity incidence with diabetic women was higher than in the control group and their infants were heavier and with lower gestational age. Heart failures were diagnosed in five (16.1%) infants of diabetic mothers and in one (1.4%) infant of a healthy woman (p<0.01). Respiratory disorders were diagnosed in 48.4% infants of diabetic mothers and in 12.6% of healthy mothers (p<0.01). Forty-two percent of infants of diabetic mothers and 19.7% infants of healthy mothers needed additional oxygen. CONCLUSION: Congenital anomalies of the cardiovascular system and respiratory disorders in the infants of diabetic mothers were six to eight times more frequent than in the infants of healthy mothers.

Erythropoietin in amniotic fluid as a potential marker in distinction between growth restricted and constitutionally small fetuses.

OBJECTIVE: To determine if there is any difference in amniotic fluid erythropoietin (EPO) concentration between fetuses small for gestational age (SGA) and appropriate for gestational age (AGA), and between the constitutionally small (CSF) and growth-restricted (GRF) fetuses. METHODS: EPO concentrations in the amniotic fluid samples were determined by EpoELISA test in 38 pregnancies with SGA and 15 pregnancies with AGA fetuses. In the SGA group we measured Ponderal index (PI) and skin-fold thickness (SFT). If PI and/or SFT were below 10th percentile the neonate was GRF. If both PI and SFT were above 10th percentile the neonate was CSF. RESULTS: Higher levels of EPO were detected in the SGA in comparison to the AGA fetuses (p < 0.01). EPO concentration was higher in GRF compared to CSF (p < 0.05). The EPO cut-off level between SGA and AGA was 6.81 IU/L (sensitivity 92.3%; specificity 73.3%), and between GRF and CSF was 9.8 IU/L (sensitivity 81%; specificity 80%). CONCLUSION: The preliminary results of this study suggest that amniotic fluid erythropoietin concentration is elevated in growth-restricted fetuses and could potentially be used for distinction between growth restricted and constitutionally small fetuses. Confirmation of these results on a larger group of pregnant women is needed.

The influence of bacterial vaginosis on gestational week of the completion of delivery and biochemical markers of inflammation in the serum.

BACKGROUND/AIM: Preterm delivery is one of the most common complications in pregnancy, and it is the major cause (75-80%) of all neonatal deaths. Bacterial vaginosis predisposes to an increased risk of preterm delivery, premature rupture of membrane and miscarriage. In this syndrome normal vaginal lactobacilli, which produce protective H2O2, are reduced and replaced with anaerobic, gram-negative bacteria and others. The aim of this study was to evaluate the influence of bacterial vaginosis on the week of delivery and biochemical markers of inflammation in the serum. METHODS: A total of 186 pregnant women were included into this study, between the week 16 and 19 of pregnancy. In the study group there were 76 pregnant women with diagnosed bacterial vaginosis by the criteria based on vaginal Gram-stain Nugent score and Amsel criteria. In the control group there were 110 healthy women with normal vaginal flora. Ultrasound examination was performed in both groups. Vaginal fluid and blood samples were taken to determine biochemical markers with colorimetric methods. RESULTS: The week of delivery was statistically significantly shorter in the study group and the levels of biochemical markers of inflammation (C-reactive protein and fibrinogen in the serum) were statistically significantly higher in women with bacterial vaginosis comparing to the control group. Also the levels of uric acid and white blood cells in the serum were higher in the study group compared to the control one. CONCLUSION: Our study indicates that the pregnancy complicated with bacterial vaginosis ends much earlier than the pregnancy without it. Also, higher levels of biochemical markers of inflammation in the serum in the study group, similarly to results of other studies, suggest that pathophysiological processes responsible for preterm delivery can begin very early in pregnancy.

[Cardiovascular diseases during pregnancy and delivery]. / Kardiovaskularna oboljenja tokom trudnoce i porodaja.

INTRODUCTION: Nowadays, cardiovascular diseases are the leading cause of maternal morbidity and mortality in the current obstetric practice. PHYSIOLOGICALLY ADAPTED MECHANISMS OF THE CARDIOVASCULAR SYSTEM IN PREGNANCY: It is normal that during pregnancy some physiological adaptive changes of the cardiovascular system occur and they may contribute to the deterioration of the clinical cardiac status of a patient with preexisting or acquired cardiovascular disease. The most prominent adaptive mechanisms include the increase of circulating blood volume, decrease of peripheral vascular resistance and decrease of plasma colloid-oncotic pressure. MOST FREQUENT DISEASES OF THE CARDIOVASCULAR SYSTEM IN PREGNANCY: Due to these changes, pregnant women are prone to tachycardia, palpitations and peripheral edema. Maternal counseling is obligatory for each pregnant woman in order to decrease the maternal morbidity and mortality. The most important predictors of maternal mortality for pregnant women with cardiovascular diseases are severity of pulmonary hypertension, hemodynamic significance of valvular lesion, cyanosis and functional status in heart failure. Cardiovascular diseases in pregnant women may be congenital or acquired. The most frequent congenital cardiac diseases are atrial and ventricular septal defects as well as persistent ductus arteriosus. These diseases are mainly diagnosed and corrected before the pregnancy, or left untreated if hemodynamically insignificant. The most frequent acquired cardiovascular diseases during pregnancy include arrhythmias, ischemic heart disease, rheumatic mitral stenosis and insufficiency, arterial hypertension and aortic dissection. CONCLUSION: In all cases of pregnancy associated with cardiovascular diseases, early recognition of cardiovascular disease is crucial, as well as correct diagnosis and referral to a tertiary centre equipped for a multidisciplinary approach of specialists experienced in high-risk pregnancies and deliveries in order to prevent maternal mortality.

[Prediction of labor induction outcome using different clinical parameters].

INTRODUCTION: Induction of labor is one of the most common obstetric interventions in contemporary obstetrics. OBJECTIVE: The aim of the study was to evaluate the clinical and sonographic parameters in prediction of success of labor induction. METHODS: The prospective study included 422 women in whom induction of labor was carried out at the Department of Obstetrics and Gynecology of Clinical Centre of Vojvodina. The role of body mass index and age of women, parity Bishop score, cervical length measured by transvaginal ultrasound was evaluated in regard of the success of induction, which was considered successful if a vaginal delivery occurred within 24 hours after the onset of induction. Data were statistically analyzed by univariate statistical analysis and Pearson's chi2 test. RESULTS: Out of 422 women, induction of labor was successful in 356 (84.4%), and it failed in 66 (15.6%) cases. The values of Bishop score and cervical length had positive correlation with the success of induction. CONCLUSION: Bishop score and transvaginal cervical length were both reliable predictors in determining the success of labor induction, as well as parity and BMI. These parameters are mostly complementary, not competitive in prediction of labor induction success.

[Significance of serum ferritin level in the prediction of delivery of low birth weight newborns for gestational age].

INTRODUCTION: Intrauterine growth restriction is one of the leading causes of prenatal morbidity and mortality. As there is no causal therapy, prediction of intrauterine growth retardation is one of the priorities of prenatal healthcare. OBJECTIVE: The purpose of this study was to analyze blood ferritin level, and erythrocyte, hemoglobin and hematocrit count in pregnant women between 30-32 weeks of gestation and to set apart those with a possible development of intrauterine growth restriction. METHODS: A prospective study was conducted that included 220 healthy pregnant women between 30-32 gestational weeks. The study was done at the Clinical Center of Vojvodina, Department of Obstetrics and Gynecology Novi Sad and Clinical laboratory from March 1, 2008 to November 30, 2009. Serum ferritin level, hemoglobin, hematocrit and erythrocyte count were determined from blood samples of all pregnant women. RESULTS: After term delivery, 8.1% of pregnant women gave birth to low birth weight babies for gestational age but without anemia.The value of ferritin, hemoglobin, hematocritanderythrocyte was significantly higher in women with low birth weight babies. In mothers with low birth weight newborns serum ferritin level was on the average for 6.4 g/l higher than in mothers with normal weight newborns (p<0.005). Statistically, ROC curve analysis showed that the pregnant women with the ferritin level above 13.6 microg/L, and with erythrocyte count >3.76x10(12)/L, hemoglobin >117 g/L and hematocrit >32.9%, in the period of 30-32 weeks of gestation, also had a significantly higher probability of having a low birth weight newborn for gestational age (p<0.05). CONCLUSION: Based on the level of ferritin and other parameters in the period of 30-32 weeks of gestation, we can predict pregnant women in whom we can expect development of intrauterine growth restriction.