The influence of the war on perinatal and maternal mortality in Bosnia and Herzegovina.

OBJECTIVE: To investigate the influence of the war on perinatal and maternal mortality during the war conflict in Bosnia and Herzegovina. METHODS: In a retrospective study we analysed perinatal and maternal mortality in the pre-war period (1988-1991), the war period (1992-1995) and the post-war period (1996-2003). We also analysed the number of deliveries, the perinatal and maternal mortality rates and their causes. RESULTS: During the analysed period we had a range of 3337-6912 deliveries per year, with a decreased number in the war period. During the war period and immediately after the war, the perinatal mortality rate increased to 20.9-26.3% (average 24.28%). After the war the rate decreased to 8.01% in 2003 (p < 0.05). Maternal mortality before the war was 39/100,000 deliveries, during the war it increased to 65/100,000 and after the war it decreased to 12/100,000 deliveries (p < 0.05). The increase in maternal mortality during the war was because of an increased number of uterine ruptures, sepsis and bleeding due to shell injury of pregnant women. CONCLUSIONS: During the war we could expect a decreased number of deliveries, and an increased rate of perinatal and maternal mortality and preterm deliveries due to: inadequate nutrition, stress factors (life in refugee's centers, bombing, deaths of relatives, uncertain future...), and break down of the perinatal care system (lack of medical staff, impossibility of collecting valid health records, particularly perinatal information, and the destruction of medical buildings).

Perinatal mortality in the Federation of Bosnia and Herzegovina.

AIM: The aim of the study was to investigate the most frequent causes of perinatal mortality in Bosnia and Herzegovina. METHODS: We analyzed in a retrospective study over a one year period (1999) the following cantons: Sarajevo, Mostar, Tuzla, Bihac, Gorazde, Travnik, Zenica, which represent about one half of the population of Bosnia and Herzegovina. RESULTS: Perinatal mortality in the analyzed regions within Bosnia and Herzegovina was 19.55@1000, which is unacceptable in comparison with developed countries. Early neonatal mortality (9@1000) was lower than late fetal mortality 10.55@1000. The most frequent causes of death were: premature birth, 6.32% of all deliveries; EPH gestosis with a rate of 9% of all deliveries and fetal anomalies with 0.68% of all deliveries. In Bosnia and Herzegovina, prematurity is the cause of early neonatal mortality in 78.5% of cases, while fetal anomalies are the cause in the early new-born period in 10.70% of cases. CONCLUSION: The results of perinatal mortality analyses in Bosnia and Herzegovina confirm that perinatal mortality directly depends on the development of the health care system, economic sustainability, and living conditions. Our results show that Bosnia and Herzegovina fall into the category of developing country with a perinatal mortality rate of 19.55@1000.

[Precarcinoma and early carcinomatous lesions in the uterine cervix and the use of oral contraceptives]. / Prekarcinomske i rane karcinomske lezije cerviksa uterusa i upotreba oralnih kontraceptiva.

Precancerous and early cancerous lesions of the cervix uteri (ASCUS, AGUS, LSIL and HSIL) are precursors of invasive cancer of the cervix uteri. By Papanicolaou test they are graded as Pap III and Pap IV. Different factors may increase a risk for those lesions as well as converting low stage lesion into higher one. Oral contraceptive use is one of the most potential risk factor for those lesions. The goal of this study was to examine a relationship between oral contraceptive use and precancerous and early cancerous lesion of the cervix lesion of the cervix uteri by using Papanicolaou test. After adjustment for other potential risk factors our results have shown: 1) there is high significant positive relationship between oral contraceptives use and precancerous and early cancerous lesions of the cervix uteri; 2) the users of oral contraceptives have shown Pap III and Pap IV smear grade five to ten years earlier than non-users; 3) long-term users have shown Pap III and Pap IV five years earlier than short-term users for middle age group (35-44 years); 4) the border between Pap III and Pap IV is shifted for five years toward earlier age.