Cystatin C Concentration During the First Three Postnatal Days in Healthy Term Newborns.

OBJECTIVE: Cystatin C (Cys-C) concentration has not been examined sufficiently among healthy newborn population, particularly in terms of reference values. This study aimed to establish gender-, postnatal age- and birth weight-specific Cys-C concentration for healthy term newborns. Its objective was also to examine if there were any differences between our measured concentration and the reference interval established by the CALIPER study. METHODS: Serum samples from a total of 90 healthy term newborns were used to determine Cys-C concentration. Cys-C was measured within first three days of birth using particle-enhanced turbidimetric immunoassay (PETIA) on the Architect plus ci8200 analyzer. RESULTS: Median concentration of the Cys-C was 2.05 mg/L. There were no statistically significant differences in Cys-C concentration regarding gender (p=0.779), birth weight (p=0.505), postnatal age (p=0.512) or Apgar score (p=0.799). The value of the 2.5th and 97.5th percentile for Cys-C concentrations for girls was 0.93-3.15 mg/L and for boys it was 1.5-3.36 mg/L. CONCLUSION: Cys-C concentration in healthy term newborns does not depend on gender, birth weight, postnatal age, or Apgar score. Our measured concentration range of CyS-C in healthy newborns turned out to be slightly wider than the interval determined in the CALIPER study.

Relationship between Education of Pregnant Women and Listening to Classical Music with the Experience of Pain in Childbirth and the Occurrence of Psychological Symptoms in Puerperium.

INTRODUCTION: Pregnancy is a unique experience accompanied by significant physiological, biochemical, and psychological changes that may affect a woman's mental health status. With the development of a holistic approach, midwives have become continuous support during pregnancy and childbirth. Childbirth education is an intervention that affects delivery outcomes and the experience of childbirth. Music therapy has been proven to be a safe and effective non - pharmacological method to gain in pregnancy and puerperium. The study aimed to prove the impact of educating pregnant women and listening to classical music on the experience of childbirth pains and the occurrence of psychological symptoms during puerperium. METHODS: A prospective randomized controlled trial (n=198) was conducted. The experimental group of pregnant women was educated during pregnancy and listened to classical music the rest of the pregnancy, while the control group received the usual care. The VAS scale was used to assess pain, and the 90 - point scale was used to assess the incidence of psychological symptoms. RESULTS: The difference in pain assessment between the experimental and control groups was significant (p<0.001). The experimental group rated their childbirth pain as moderate (M=5.98), while the control group experienced severe pain (M=8.42). A significant difference in the incidence of psychological symptoms between groups was found in the dimensions of interpersonal sensitivity, hostility, phobic anxiety, and paranoid ideations (p=0.042; p=0.014; p=0.013; p=0.008). CONCLUSION: This study demonstrated the impact of midwifery education and listening to classical music on the perception of childbirth pain and mental health in the puerperium. The experimental group rated childbirth pain significantly lower compared to the control group and had significantly fewer psychological symptoms 6 weeks after delivery.

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).

Personality traits and quality of life of mothers who have children with cerebral palsy.

BACKGROUND: The quality of life (QOL) of mothers who have children with cerebral palsy (CP) is significantly worse than in mothers with typically developing children. In available literature we have not found an approach which analyzes the correlation of mothers' personality traits with their QOL and health related quality of life (HrQOL). SUBJECTS AND METHODS: The study included 101 mothers of children with CP, aged 4 to 18 years. Mothers' personalities have been assessed by Eysenck EPQ - R questionnaire that determines three personality traits: neuroticism/emotional stability, extroversion/introversion and psychoticism. Maternal HrQOL was assessed by SF-36 questionnaire, Short Form, and their emotional well-being by WHO 5 well-being index. In addition, the influence of mothers' religiosity was also analyzed, using DUREL Religiosity Questionnaire. Motor assessment of children was performed using Gross Motor Function Classification System. The control group consisted of mothers of typically developing children of the same age. RESULTS: Participants with high levels of extraversion had better QOL and HrQOL, as opposed to those with high levels of neuroticism and psychoticism, who had worse physical and mental health. The degree of children's motor impairment and mothers' religiosity did not influence QOL. Regression analysis distinguishes the following predictors for better mothers' QOL: better their mental health, greater level of their vitality, extroversion, living with a partner, a lesser degree of children's motor impairment and better their QOL. CONCLUSIONS: It is vital to identify the factors that affect QOL of a mother and a child with CP. We consider it justified to regularly conduct mothers' professional monitoring and treatment simultaneously with children's treatment and we propose the protocol for the individual and targeted approach.

Medical students' attitudes towards contraception.

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.

Association of MTHFR polymorphism, folic acid and vitamin B12 with serum homocysteine levels in pregnant women.

Homocysteine is known to be associated with adverse vascular and metabolic effects, as well as pregnancy complications. Its serum levels are influenced by the function of the enzyme methylenetetrahydrofolate reductase (MTHFR) and the dietary intake of folic acid, vitamin B12, and methionine. In this cross-sectional study, we investigated the association of genetic polymorphisms of the MTHFR gene with vitamin status in pregnant women during mandatory folic acid supplementation. The study included 102 pregnant women between 24 and 28 weeks of gestation who were attending regular outpatient examinations at the maternity clinic. Homocysteine, folic acid, vitamin B12 levels, and MTHFR gene polymorphisms (C677T and A1298C) were analyzed. Significant associations were found between vitamin B12 and folic acid levels with homocysteine (P < 0.001), with lower serum levels of these vitamins being associated with higher homocysteine levels. Surprisingly, there was no significant association between MTHFR genetic polymorphisms and serum homocysteine levels, likely attributed to the supplementation of folic acid and vitamin B12 in vitamin supplements for pregnant women, which counteracts the effect of the mutation. Remarkably, a high prevalence of MTHFR gene mutations was found, with the C677T polymorphism present in 56.9% and the A1298C polymorphism in 87.2% of pregnant women. These findings emphasize the importance of adequate folic acid and vitamin B12 intake during pregnancy to regulate homocysteine levels. Although the MTHFR gene mutations were highly prevalent, their influence on homocysteine levels in this population appears to be mitigated by vitamin supplementation. Further research is warranted to explore the impact of these mutations on other aspects of pregnancy outcomes. The trial is registrated at Clinicaltrail.gov (NCT04952324).

Clinical Significance and Expression Pattern of RIP5 and VGLL4 in Clear Cell Renal Cell Carcinoma Patients Treated with Sunitinib.

While clear cell renal cell carcinoma (ccRCC) is curable, advanced metastatic (mRCC) remains a clinical challenge. We analyzed clinical, pathohistological, and molecular data (Receptor Interacting Protein 5-RIP5 and Vestigial Like Family Member 4-VGLL4 expression) of 55 mRCC patients treated with first-line treatment with sunitinib. The trend of linear increase in the protein expression of RIP5 was observed with the progression of tumor grade. Overall, 80% of RIP5-positive cells were in the control kidneys and high-grade mRCC. On the contrary, RIP5 displayed low expression in grade 2 mRCC (5.63%). The trend of linear decrease in the expression of VGLL4 was observed with the progression of tumor grade. The highest protein expression of VGLL4 was observed in grade 2 (87.82%) in comparison to grade 3 and 4 and control. High expression of RIP5 mRNA was associated with longer first-line overall survival and longer progression-free survival in mRCC. In addition, a high VGLL4 mRNA expression showed better overall survival in patients with ccRCC. In conclusion, high mRNA expression of RIP5 and VGLL4 are important markers of better survival rates in mRCC patients.

Comparison of Lanolin and Human Milk Treatment of Painful and Damaged Nipples: A Randomized Control Trial.

BACKGROUND: Painful and damaged nipples are frequently associated with breastfeeding cessation in the early postpartum period. The results of researchers' studies utilizing different treatments have been inconclusive. RESEARCH AIM: To compare the intensity of nipple pain and the healing of damaged nipples during the first 10 days postpartum using either lanolin or human milk treatments. METHODS: This single-blind randomized controlled trial included participants (N = 206) who were primiparous with painful and damaged nipples. Participants were recruited from the tertiary teaching hospital within the first 72 hr after delivery and randomized to the intervention group with lanolin (n = 103) and a human milk control group (n = 103). Data were collected in the maternity ward, 3 and 7 days after randomization. The primary outcome was nipple pain intensity and quality measured 3 and 7 days after randomization by the McGill Pain Questionnaire - short form. The nipple damage self-assessment questionnaire was used for the assessment of nipple healing. Breastfeeding self-efficacy, breastfeeding duration, and exclusivity were assessed as secondary outcomes. RESULTS: Participants in both groups reported a statistically nonsignificant reduction in pain (quality and intensity of pain) as well as improved nipple healing 7 days after randomization. Participants in the lanolin group exclusively breastfed their infants 3 days after randomization-significantly more often than participants in the control group (p = .026). The study did not reveal any statistically significant differences for other secondary outcomes. CONCLUSION: Both lanolin and human milk are equally effective in treating painful and damaged nipples.Registered with Clinicaltrials.gov (NCT04153513).

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.

Assessment of mothers' satisfaction with health care during childbirth in a tertiary-level maternity ward.

Aim To evaluate satisfaction of mothers who gave birth at term with received hospital care and to find areas for improvement at a tertiary hospital. Methods A cross-sectional study at the Department of Obstetrics & Gynaecology at the University Clinical Hospital Mostar was conducted by an anonymous survey using a questionnaire designed exclusively for this study. A total of 100 mothers were included in the study. Results Satisfaction with midwives' communication and their approach to the women during their stay in the delivery room was rated significantly higher (4.7±0.6) when compared to obstetricians-gynaecologists (4.5±0.8) (p=0.02). Midwives were rated better in providing breastfeeding information (4.5±0.8) than for the speed of arrival after a call bell (average grade 4.2±1.0). Respondents were least satisfied with the hygiene (toilet, shower and rooms) and the quality of food (average grades 3.8±1.1 and 3.9±1.0, respectively). Mothers with previous experience in childbirth at the same hospital rated current stay with a similar level of satisfaction. Conclusion Good communication skills of medical and non-medical staff are a recommended step to maintain mothers' childbirth satisfaction, while improvement in quality of nutrition and hygiene should be mandatory.

Urine neutrophil gelatinase-associated lipocalin concentration in healthy newborns during the first three postnatal days.

INTRODUCTION: Urine neutrophil gelatinase-associated lipocalin (uNGAL) is a biochemical marker significant for early prediction of acute kidney injury in adults. However, it has not been examined sufficiently among the infant population, particularly newborns in terms of reference values. The aim of our study was to determine the concentration of uNGAL in healthy term newborns and to determine if there was a difference in uNGAL concentration according to gender, postnatal age and birth weight. MATERIALS AND METHODS: Our study involved 81 healthy term newborns birth (≥ 37 weeks, Apgar score ≥ 8 in the first minute after birth, CRP < 5 mg/L). Urine NGAL was measured using chemiluminescent microparticle immunoassay (CMIA) within 72 hours after birth, on Architect plus ci8200 analyser (Abbott, Chicago, USA). Data were analysed using Statistica software. RESULTS: The median concentration of uNGAL in the whole study group of healthy term newborns was 27.1 ng/mL (16.5-56.0 ng/mL) (newborn girls, 27.1 ng/mL (15.8-47.9 ng/mL); newborn boys, 27.9 ng/mL (16.5-61.0 ng/mL), P = 0.941). Median uNGAL concentration according to postnatal age expressed in days was 28.2 ng/mL (11.7-57.2 ng/mL) 1st day, 28.9 ng/mL (16.5-64.2 ng/mL) 2nd day and 23.9 ng/mL (20.2-46.6) 3rd day, P = 0.863. Regarding birth weight for newborns < 3500 g, median concentration was 25.0 ng/mL (16.5-45.4 ng/mL) and for weight ≥ 3500 g 30.6 ng/mL (16.5-64.2 ng/mL), P = 0.455. CONCLUSIONS: There were no significant difference in uNGAL concentration in relation to gender, postnatal age and birth weight.

CD25+ FOXP3+ and CD4+ CD25+ cells distribution in decidual departments of women with severe and mild pre-eclampsia: Comparison with healthy pregnancies.

PROBLEM: The aim of this study was to quantify and compare the distribution of regulatory CD25+ FOXP3+ and activated CD4+ CD25+ T cells in decidua basalis and parietalis of severe and mild pre-eclampsia (PE) to normal healthy pregnancies. METHOD OF STUDY: Decidual tissue (decidua basalis and parietalis) of 13 women with mild PE, 15 women with severe PE, and 19 women with healthy term pregnancies were analyzed by immunohistochemistry and double immunofluorescence. RESULTS: The total number of CD25+ FOXP3+ cells/mm2 in decidua basalis was decreased in the severe and mild PE versus normal pregnancy group. The total number of CD4+ CD25+ cells/mm2 in decidua basalis was decreased in the severe PE versus normal pregnancy group. The number of CD25+ FOXP3+ and CD4+ CD25+ cells in decidua parietalis was decreased in both PE groups. CONCLUSION: Our data suggest that immunological changes of PE reflect on decidua basalis and parietalis and emphasize the importance of characterizing T cells in both decidual departments.

Cytomegalovirus Seroprevalence and Birth Prevalence of Congenital CMV Infection in Bosnia and Herzegovina: A Single-Center Experience.

BACKGROUND: Congenital cytomegalovirus infection (cCMV) is a leading cause of sensorineural hearing loss (SNHL) and neurodevelopmental disabilities in developed countries. Although high cCMV rates have been reported in populations with high seroprevalence, the cCMV prevalence in low/middle-income countries in Europe has not been defined. OBJECTIVE: To determine cytomegalovirus (CMV) seroprevalence and the cCMV prevalence in Bosnia and Herzegovina. METHODS: Between March 2010 and February 2019, 5222 sera samples from patients seen at the University Clinical Hospital Mostar were tested for CMV IgG. The cord blood samples collected from 2091 infants between July 2011 and January 2013 were analyzed for CMV IgG and CMV DNA. The cCMV prevalence was determined by testing saliva swabs from 1293 infants between November 2015 and October 2016. RESULTS: The overall CMV IgG prevalence was 81.4% (95% confidence interval: 0.8-0.82). Significantly higher prevalence was observed among females (84.9%) than in males (77.0%), and the rate increased from 50.8% in the 1 to 5 years group to 97.7% in the group > 65 years old. Most cord blood samples (2091/1925, 92.1%) were CMV IgG positive, and 2 (0.1%) were CMV DNA positive. Of the 1293 saliva swabs, 8 (0.62%; 95% confidence interval: 0.3-1.2) were CMV positive. All 8 infected infants had asymptomatic cCMV, and none had SNHL at 18 months of age. CONCLUSIONS: In a highly CMV seropositive population, the prevalence of cCMV was lower compared with that reported from other low/middle-income countries populations. None of the infected infants had symptomatic infection or SNHL at 18 months.

Cerebral palsy: early diagnosis, intervention and risk factors.

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 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.

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.

Patients' experience regarding informed consent in elective and emergency surgeries.

Aim To examine whether there are differences in the experience in giving informed consent of patients whose surgery was elective compared to emergency surgery in the same department. Methods A prospective cross-sectional study was conducted in the Department of Gynaecology and Obstetrics of University Clinical Hospital Mostar during a 6-month period. The sample of respondents consisted of two groups of patients, 145 with elective surgery and 90 patients with emergency surgery. The study was conducted using an anonymous questionnaire. Results Patients in both examined groups were equally satisfied with the procedure of informed consent. Most patients signed the informed consent at the request of a nurse, 195 (83%). During the process of consenting, almost all patients, regardless of whether they had elective or emergency surgery, claimed that they understood the form, which had to be signed, it was important to them, 230 (97.9%), except the patients who had elective surgery, 130 (90.3%), regularly stated that having an opportunity to ask questions was important to them. Respondents with emergency surgery more frequently agreed to sign whatever was in the form, 42 (46.7%). Conclusion Patients who had a planned surgery and patients who had an urgent surgery, mostly declare contentment with the use of informed consent although they did not have the same experience about informed consent.

Macrosomic births at Mostar Clinical Hospital: a 2-year review.

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.

Antibiotic prophylaxis for premature rupture of membranes and perinatal outcome.

AIM: To evaluate the perinatal outcomes of newborns after premature rupture of membranes (PROM) at the term according to the timing of initial antibiotic administration. MATERIAL AND METHODS: This is a retrospective, cohort study investigating perinatal outcomes of newborns in pregnant women with PROM at the term who were treated with ampicillin within or after 6 h from the PROM. Statistical analysis was performed using Student's t-test for continuous variables test and chi-square or for categorical data. RESULTS: The study involved 144 pregnant women with PROM and their newborns, a lower number received antibiotics after birth were in the group who received antibiotics within 6 h of PROM (26.4% versus 73.6%), the mediane values of C-reactive protein were lower (3.0 ± 2.9 mg/l versus 6.1 ± 7.3 mg/l; p < 0.001), their newborns remained shorter in hospital after birth (4.13 versus 4.94; p =0.023) and time between PROM and delivery was shorter (p < 0.001). In group who received prophylactic antibiotics after 6 h of the PROM had significantly higher frequency of infection in newborns (45.3% versus 15.4%), and higher number of chorioamnionitis (9.72% versus 3,47%) compared to group who received antibiotics within 6h. CONCLUSION: Timely usage of antibiotic prophylaxis and shorter time between PROM and delivery improve perinatal outcomes.