Optimal outcome factors in maternity and newborn care for inpatient (hospital maternity ward-HMW) and outpatient deliveries (outhospital maternity clinics -OMC).

BACKGROUND AND OBJECTIVES: The aim of the study was to use the United States Optimality Index (OI-US) to assess the feasibility of its application in making decisions for more optimal methods of delivery and for more optimal postpartum and neonatal outcomes. Numerous worldwide associations support the option of women giving birth at maternity outpatient clinics and also at home. What ought to be met is the assessments of requirements and what could be characterized as the birth potential constitute the basis for making the right decision regarding childbirth. MATERIALS AND METHODS: The study is based on a prospective follow-up of pregnant women and new mothers (100 participants) who were monitored and gave birth at the hospital maternity ward (HMW) and pregnant women and new mothers (100 participants) who were monitored and gave birth at the outhospital maternity clinics (OMC). Selected patients were classified according to the criteria of low and medium-risk and each of the parameters of the OI and the total OI were compared. RESULTS: The results of this study confirm the benefits of intrapartum and neonatal outcome, when delivery was carried out in an outpatient setting. The median OI of intrapartum components was significantly higher in the outpatient setting compared to the hospital maternity ward (97 range from 24 to 100 vs 91 range from 3 to 100). The median OI of neonatal components was significantly higher in the outpatient compared to the inpatient delivery. (99 range from 97 to 100 vs 96 range from 74 to 100). Certain components from the intrapartum and neonatal period highly contribute to the significantly better total OI in the outpatient conditions in relation to hospital conditions. CONCLUSION: Outpatient care and delivery provide multiple benefits for both the mother and the newborn.

HPV TYPING AS A SCREENING PROGRAM FOR PREVENTION AND EARLY DETECTION OF CERVICAL CANCER IN DIFFERENT MONTENEGRO REGIONS.

The objective of our research was to compare the results of human papillomavirus (HPV) typing and occurrence of the most important risk factors for cervical cancer obtained in the towns of northern, central and southern regions of Montenegro, in subjects between 30 and 35 years of age, in accordance with the new screening program introduced by the Ministry of Health of Montenegro in 2018. The study included 400 patients aged 30-35 years from Rozaje, Berane, Budva and Podgorica, 100 from each town, who underwent HPV typing in accordance with the latest screening program for early detection and prevention of cervical cancer, approved by the Ministry of Health of Montenegro in 2018. The material was obtained and sampled at the Health Clinics in Rozaje, Berane, Podgorica and Budva. Specially designed brushes were used to take swabs from the cervices, which were then sampled in separate collection tubes that contained a liquid transport medium. The samples were then sent for further analysis to the Institute of Public Health of Montenegro where HPV typing was performed using the real-time polymerase chain reaction method. The results were encrypted and obtained electronically. The data obtained from the questionnaires each subject filled out in accordance with this program were analyzed and the subjects willingly agreed to partake in the screening program. Nearly one-quarter of subjects had a positive HPV finding. The group of HPV positive women included significantly more women from Podgorica (χ2-test=26.455, p<0.001), women with very good living conditions (χ2-test=12.264, p<0.001), women who smoked cigarettes (χ2-test=5.074, p=0.024), women who had the first sexual intercourse between the ages of 17 and 20 (χ2-test=5.874, p=0.015), and women who did not have permanent partners (χ2-test=6.061, p=0.014). Among the observed socio-demographic characteristics and sexual behaviors of our subjects that proved to be non-significant variables in their HPV statuses we excluded the length of smoking habit (χ2-test=0.638, p=0.424) and protected sexual intercourse (χ2-test=2.628, p=0.105). By implementing the screening program and HPV typing, we came to a conclusion that the problem of cervical cancer could be solved or at least mitigated by raising awareness of the causes and incidence of cervical cancer, as well as by being well informed on its curability, predictability and protection during intercourse, which would contribute to positive changes.

The Prevalence of the Most Important Risk Factors Associated with Cervical Cancer.

INTRODUCTION/ GOALS: The aim of our study was to point out the importance of the risk factors associated with cervical cancer in an asymptomatic population. METHODOLOGY: The study included 860 patients in the period from January 2017 to January 2018, which covered more than 80% of the targeted population in this municipality over the one year study, according to the National Program for Cervical Cancer Prevention in Montenegro. RESULTS: The incidence of PAP III results was statistically significantly higher in women between 40 and 45 years of age compared to other age groups (p< 0.001). PAP III was statistically significant high in subjects who had vaginal delivery (p<0.001), and was statistically significantly more frequent in women with more than two children (p = 0.011), while all the subjects with positive PAP results III had children. PAP III results were statistically significantly higher in subjects who had sexual intercourse before the age of 18 (p< 0.001), and were statistically significantly more frequent in subjects who were on oral contraceptives (p< 0.001). PAP III test results also show a significant difference related to cigarette consumption (p< 0.001). PAP III results were significantly more frequent in subjects with grade III vaginal cleanliness compared to grade II vaginal cleanliness (p<0.001). CONCLUSION: The number of patients with cervical cancer in Montenegro increased in the period from June 2016 to June 2017, compared to previous years, even though the National Program for Cervical Cancer Prevention that aimed to reduce the number of such patients has been in use in Montenegro since 2011.

The role of echocardiography in the evaluation of cardiac re-modelling and differentiation between physiological and pathological hypertrophy in teenagers engaged in competitive amateur sports.

Aims "Athlete's heart" is a cardiac adaptation to long-term intensive training. The aims of this study were to show the prevalence of left ventricular hypertrophy in teenagers who participate in sports, to define the different types of cardiac re-modelling, and to differentiate between physiological and pathological hypertrophy. METHOD: Echocardiographic measurements were obtained by M-mode, two dimensional, and Doppler techniques of participants from sports and control groups. RESULTS: The echocardiographic examinations included 100 healthy teenagers taking part in dynamic sports such as football and basketball and 100 healthy teenagers taking part in static sports such as karate and judo. The control group (n=100) included healthy, sedentary teenagers. Sports participants had significantly higher left ventricular mass when compared with the control group, (p0.05). Respondents from both groups had E/A ratios (transmitral flow velocity ratio)>1, preserved diastolic function, and statistically they did not differ from the control group. CONCLUSION: Echocardiographic parameters show that physiological hypertrophy and cardiac re-modelling are present in teenagers who play sports. Unexpectedly, the prevalence of concentric and eccentric types of re-modelling is equally possible in the group of static sports participants.

Clients' Perception of Outcome of Team-Based Prenatal and Reproductive Genetic Counseling in Serbian Service Using the Perceived Personal Control (PPC) Questionnaire.

This is the first study in Serbia and the region of South-East Europe dedicated to clients' perception of outcome and efficiency of prenatal and reproductive genetic counseling. The primary aim of this study was to assess overall value and success of genetic counseling in prenatal and reproductive care with regard to perceived personal control of clients, reflecting also in a part patient comprehension, knowledge retention, and empowerment in decision-making. The standardized Perceived Personal Control questionnaire (PPC) was used for the assessment of 239 female participants. First, we performed a complete validation of the psychometric characteristics of the Serbian-language version of the PPC questionnaire. The validation of the questionnaire permits other researchers from Serbian-speaking regions of South-East Europe to use this standard instrument to assess the effectiveness of prenatal genetic counseling in their communities and analyze advantages and disadvantages of their counseling models. We also measured social and demographic characteristics of participants. Further, we analyzed effects of our team-based prenatal and reproductive genetic counseling model through (a) calculation of PPC scores at three different stages (before initial, after initial, and before second counseling session), and (b) by assessing participants' responses by indication for referral (advanced maternal age, abnormal biochemical screening, family history of hereditary disorders, maternal exposure to drugs, exposure to radiation, exposure to infective agents, infertility or recurrent abortions, and miscellaneous). The results indicate that participants' knowledge after initial counseling increased significantly and after that remained stable and sustainable. A satisfactory level of confidence among participants had been achieved, in that many felt an increased sense of control over their situation and emotional response to it. Indirectly, these results indicate the success of a team-based prenatal genetic counseling model, which has not been assessed in the literature to date.

Fetal and maternal plasma homocysteine levels during the second half of uncomplicated pregnancy.

OBJECTIVE: To measure fetal and maternal plasma homocysteine (Hcy) concentrations in uncomplicated pregnancies. METHODS: Paired maternal venous and fetal umbilical cord blood (n = 81) samples were evaluated for plasma Hcy and vitamin B12 levels, in addition to eight neonatal umbilical cord blood samples obtained immediately following delivery. RESULTS: Both fetal and maternal Hcy concentrations were positively correlated with advancing gestational age (ρ = 0.44, p < 0.0001; and ρ = 0.27, p < 0.05, respectively). Fetal plasma Hcy concentrations [2.2 µmol/l (IQR: 2.0-3.2)] were significantly lower than both neonatal umbilical vein [5.0 µmol/l (IQR: 4.4-6.5); p < 0.001] and maternal plasma Hcy levels [4.4 µmo/l (IQR: 3.4-5.4); p < 0.001]. In addition, Hcy values at term were higher in the umbilical vein compared with the umbilical artery [5.0 µmol/l (IQR: 3.4-5.4) versus 4.2 µmol/l (IQR: 3.7-5.5), respectively; p = 0.016]. Significant correlation was noted and between fetal and maternal Hcy levels (ρ = 0.50, p < 0.0001), while fetal Hcy was negatively correlated with maternal B12 concentrations (ρ = -0.32, p < 0.001). CONCLUSIONS: Fetal Hcy levels were significantly lower than maternal and neonatal levels and correlated with gestational age across the second half of pregnancy.

Our experience with intraoperative cell salvage during cesarean delivery in women with uterine myomas--four case reports.

INTRODUCTION: Cesarean section is more frequent in pregnant women with uterine myomas, and is usually complicated with perioperative hemorrhage. In some cases, cesarean myomectomy represents an inevitable surgery, adding risk of hemorrhage occurrence. Massive obstetric hemorrhage is the most common cause of maternal mortality and morbidity. The aim of this study was to show our experience and results of the implementation of intraoperative blood salvage during cesarean section in the patients with uterine myomas. MATERIAL AND METHODS: The study encompassed four patients with uterine myomas who had cesarean delivery at our Department in the period from 2010 to 2011. RESULTS: Postoperative transfusion of packed red blood cells was given to one patient. No complications resulting form the intraoperative blood salvage were recorded in our research. CONCLUSION: Intraoperative blood salvage should be applied in patients with uterine myoma, and certainly in those who are planned for cesarean myomectomy and particularly in cases when massive intraoperative hemorrhage is expected.

Micronutrients in women's reproductive health: I. Vitamins.

Proper nutritional status of women before, during, and after pregnancy is an important element of reproductive health. It maintains maternal health and reduces the risk of adverse pregnancy outcome, birth defects and chronic disease in children later in postnatal life. Pregnancy creates a special metabolic demand for high-quality nutrients. With careful food selection, it is possible to obtain most of the recommended levels of nutrients. Apart from the dietary intake, nutrition is highly dependant on economic status, social and cultural environment, and personal habits of the mother. Nutritional imbalance could cause detrimental effects to the pregnant woman, influence pregnancy outcome, and impair breast milk composition. Despite the extensive research, we still do not have a complete understanding how nutritional status of the mother influences her health as well as fetal growth and development. It is well known that fetal growth and development is strongly linked with maternal supply of essential nutrients, e.g. vitamins. The exact role of the variety of micronutrients in fetal growth and development has yet to be explored in detail. It is estimated that up to 30% of pregnant women suffer from a vitamin deficiency. Without supplementation, about 75% would show a deficit of at least one vitamin. Moreover, multivitamin deficit combinations often co-exist, and subclinical depletations are probably common; consequences could be severe. Studies carried on in developing countries have shown that improving micronutrient intake in deficient women can reduce maternal morbidity and mortality. Also, proper maternal intake of important micronutrients directly enhances the quality of breast milk. To meet the increasing demands during pregnancy and the breastfeeding period women should not be dependent only upon the dietary intake: adequate reserve is essential for the successful pregnancy outcome.

Micronutrients in women's reproductive health: II. Minerals and trace elements.

It is widely accepted that micronutrients have a major function in many periods of women's life, particularly during pregnancy and lactation. Inadequate stores or intake of micronutrients might have adverse effects both to the mother (hypertension, anemia, complications of labor) and the fetus (congenital malformations, pre-term delivery, intrauterine growth retardation). The effect of improper nutrition is influenced by gestational age, severity of deficiency, or both. Generally, the daily requirements in minerals and trace elements are easily met in women having a balanced diet. Such diet during pregnancy should provide the recommended daily allowance of all nutrients except elemental iron. Consequently, deficiency states are supposed to be rare in developed countries, and supplementation should be made on an individual basis. On the other hand, nutritional deficiencies during pregnancy might be difficult to detect. Studies from developing countries where micronutrient malnutrition is common during pregnancy gave us strong evidence that supplementation of certain trace elements and minerals could prevent some of the most severe adverse pregnancy outcomes. While some micronutrients have been studied extensively (e.g. calcium, iron, zinc, iodine), much less is known about others. It has been shown that multiple micronutrient deficiencies, rather than single deficiencies, are common. Our knowledge about the significance of interactions between micronutrients in relation to pregnancy outcome is limited. The role of these interactions in improving pregnancy outcome need to be investigated more precisely. According to the summarized data, the potential benefits of routine supplementation seem to outweigh any potential adverse reaction that can be attributed to their consumption.