Background: The endometrial microbiome, its composition, and the quantity of some bacteria could be predictors of successful implantation in vitro fertilisation (IVF) treatment. The presence of Lactobacillus, which negatively correlates with pathogenic bacteria, could be a contributing factor to endometrial ecosystem stability. The study aimed to determine whether the quantity of Lactobacillus spp and Gardnerella vaginalis in the endometrium depends on estrogen levels. A secondary aim was to determine whether the decreased number of Lactobacillus spp leads to increased pathogenic bacteria such as Gardnerella vaginalis in the endometrial cavity. Materials and Methods: This prospective study was conducted in a private IVF center in Tuzla, Bosnia and Herzegovina. Participants were recruited from February 2023 to December 2023. The tip of a double-lumen catheter was used to collect samples from the endometrium. QIAamp DNA Mini Kit was used for DNA isolation. A commercial real-time polymerase chain reaction (RT-PCR) kit was used to detect Lactobacillus spp and Gardnerella vaginalis quantitatively. Results: In total, 92 participants were included in the study, 57 in the fresh cycle and 35 in the frozen cycle of IVF. The youngest participant was 18 years old, and the oldest was 45 years old. The mean age of participants was 34.3 years with a standard deviation of 5.7. After RT-PCR, 90 participants had positive tests on Lactobacillus spp, Gardnerella vaginalis was positive in 31 participants. Conclusion: Supraphysiological estrogen levels do not significantly change the quantity of Lactobacillus spp and Gardnerella vaginalis in the endometrial cavity. Decreasing the number of Lactobacillus spp increased the number of pathogenic bacteria Gardnerella vaginalis in the endometrial cavity.

AIM To investigate an influence of age and body mass index (BMI) as determinants of infertility treatment success in vitro fertilization (IVF) procedures confirmed so far, on the amount of Lactobacilus spp. (LS) and Gardnerella vaginalis (GV) in the endometrium in fresh IVF cycles at the time of embryo transfer. METHODS This a prospective single-centre study included patients who underwent fresh embryo transfer (ET) in a private IVF Centre. A catheter tip for embryo transfer was used for collecting samples from the endometrial cavity. Real time polymerase chain reaction (RT PCR) was used to determine LS and GV quantity. Patients were divided into two age groups: <35 years and ≥ 35 years. Normal BMI group included patients with 18.-24.9 kg/m2, and the increased BMI group patients with BMI ≥ 25kg/m2. RESULTS Tips for embryo transfer catheters were positive on LS in 55 (96.4%) patients. The median of quantification cycle of RT-PCR (Cq RT-PCR) for LS was 33, and 31 for the younger and older groups, respectively. Twenty-one (36.8%) patients tested positive for GV. The median of Cq RT-PCR for GV was 33 and 34 for the younger and older groups, respectively. There were 36 patients with normal and 18 with increased BMI. BMI showed no correlation with LS amount in the endometrial cavity. CONCLUSION Aging affects the endometrial microbiome resulting in an increase of Lactobacillus number, but not the number of GV.

Aim To investigate clinical and obstetrical characteristics, an outcome and a prognosis for pregnant women with diagnosed and treated genital or extragenital cancer and their newborns. Methods This retrospective cohort study included pregnant and childbearing women with a history of cancer diagnosed before pregnancy during the period between 1 January 2014 and 31 December 2018. Data related to the course of pregnancy and childbirth were collected from medical records (mothers' disease history and partogram). The analysis covered clinical and histopathological characteristics of cancers, type of the treatment (surgery, chemotherapy, radiotherapy), demographic data, obstetric characteristics, comorbidities of women, and outcome of the newborns. Results The study recorded 18 414 deliveries, of which 30 (0.16%) were pregnancies in women who had been diagnosed and treated earlier for genital or extragenital cancer. The average age of the women at the time of delivery was 29.43±5.97 years. There were six (20%) women with genital and 24 (80%) with extragenital cancer. The most frequent extra genital cancer was Hodgkin lymphoma, in eight (26.6%) cases; ovarian cancer was the most frequent genital cancer, in four (13.3%) cases. The average time span from the cancer diagnosis and start of the treatment to the delivery was 59.2±44.4 months (5 years) (range 12 months - 15 years). Two (6.6%) women died. Conclusion Our data demonstrate a favourable obstetric and neonatal outcome for women who have survived cancer.

Background: To investigate the total survival of low birth weight infants (LBWIs) in the Federation of Bosnia and Herzegovina (FB and H) and selected by subgroups of birth weight (BW) and gestational age (GA). Methods: This cross-sectional study included newborns of both genders, GA of 22–42 weeks and BW of less than 2500 g of 10 cantons territory of the FB and H. In the examined period, 22,897 children were born in the FB and H, of which 669 (2.9%) had BW less than 2500 g. Results: Surviving of LBWIs in the FB and H out of the 669 LBWIs in the first level perinatal healthcare institutions (PHI) was 29 (4.3%), the second level was 286 (42.8%), and the third level was 354 (52.9%). The total stillborn rate was 3.9%. The overall perinatal mortality rate for all levels of PHI was 8.6%. The overall rate of early neonatal mortality of LBWIs in all three levels of PHI in the FB and H was 12.7%. By the end of the first month of life (up to 28 days) and to the end of the neonatal period, 385 (57.5%) of LBWIs survived, and 284 (42.4%) died. The LBWIs by subgroups of BW up to 28 days had lower survival rates in second-level PHI than infants of the same BW subgroups (500–999 and 1000–1499) treated in third-level PHI (P = 0.0089 and P = 0.004). Conclusions: Our results show that B and H belongs to developing countries according to perinatal mortality. A unique database system is necessary to follow progress and trends.

Introduction: There are many ethical and moral dilemmas regarding the termination of pregnancy(TOP) with severe fetal anomalies. Aim: Our aim is to present a case of severe fetal hydrocephalus (HCP), spina bifida aperta and, meningomyelocoella (MMC). Case report: A gynecologist examined a 23-year-old patient with vital pregnancy of 24/25 week of gestation (WG) with the anomaly of the fetus. At the Perinatological Medical Advisory Board, a decision was made that the pregnancy should be continued and monitored bearing in mind that pregnancy exceeded the legal framework for TOP. Medical Advisory Board’s ultrasound examination showed the following: severe hydrocephalus (HCP), spina bifida aperta, hyperehogen intestine, pes equinovarus. Via multidisciplinary consultation it was decided to make a delivery with the elective caesarian section (CS) causing as little trauma to the fetus as possible, with 37 WG completed due to the pelvic presentation and fetal anomalies. The patient gave birth via CS to a live female newborn–birth weight 3920 grams, birth length 56 cm, head circumference 48 cm, and Apgar score 8/8. The head was hydrocephalic with spaced suture. There was thoracolumbar defect of spina bifida aperta and meningomyelocele (MMC) 10x12 cm in size. An urgent surgical procedure - the external ventricular derivation of the liquor, and then the successful resection and plastic meningomyelocele was performed by a team of neuro and plastic surgeons. During the fourth postoperative day due to a suspicion of abscess collection and febrility of the mother a relaparotomy is performed and the abscess collection of Retzius space was found. Due to the fall in blood count, blood transfusion in a total dose of 580 ml was given. The patient was discharged on a home treatment as she had a regular general and local status. After the surgery, the condition of the newborn resulted in deterioration, the progression of HCP and dehiscence of head wounds and the thoracolumbar region, in spite of all the measures taken. At that time a decision was made to provide palliative care and this decision was conveyed to the mother. The child had a prolonged apnoeic episode and was not resuscitated. The child died in hospital after surviving for two months postpartum. Conclusion: Indication of TOP based on fetal anomalies could be a medical decision but also a personal moral choice of the mother related to legal rules, socio-cultural values and religious beliefs.

Stem cells are basic cells of the human body; it builds human body, but also participate in the regeneration of damaged tissues and organs. They are undifferentiated that can differentiate into various types of cells in an organism, which is very important in terms of therapeutic applications. They differ in embryonic and adult stem cells. Adult cells are divided into pluripotent and unipotent. Pluripotent cells are found in the blood and in the tissue of the umbilical cord. Stem cells taking process is performed immediately after birth, sampling blood and cord tissue. Today, stem cells are used to treat more than 80 different diseases. The number of possible treatments increases every day, and treatment of stem cell becomes a special branch of medicine.