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).
Fatusić
Z
Z
Department of Obstetrics and Gynecology, Medical School University of Zagreb, Sveti Duh Hospital, Zagreb, Croatia. jax@bih.net.ba
Kurjak
A
A
Grgić
G
G
Tulumović
A
A
D000784:Aortic Dissection / Q000401:mortality; D001014:Aortic Aneurysm / Q000401:mortality; D001238:Asphyxia Neonatorum / Q000401:mortality; D001723:Birth Rate; D017522:Bosnia and Herzegovina / Q000453:epidemiology; D000013:Congenital Abnormalities / Q000401:mortality; D004461:Eclampsia / Q000401:mortality; D004617:Embolism / Q000401:mortality; D005260:Female; D006470:Hemorrhage / Q000401:mortality; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D008428:Maternal Mortality; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000401:mortality; D047928:Premature Birth / Q000453:epidemiology; D011295:Prenatal Care / Q000706:statistics & numerical data; D012127:Respiratory Distress Syndrome, Newborn / Q000401:mortality; D012189:Retrospective Studies; D018805:Sepsis / Q000401:mortality; D014597:Uterine Rupture / Q000401:mortality; D014857:Warfare; D014950:Wounds, Penetrating / Q000401:mortality