Forensic obstetrics attracts much attention from forensic experts and the public owing to the professional, legal, public health, and not inconsiderable social-emotional aspects and directly correlates with maternal, fetoneonatal, and iatrogenic risk factors. Modern obstetrics and fetomaternal medicine must not be quantified and qualified based only on perinatal disease but also according to current obstetric problems that burden forensic obstetrics. Therefore, high-risk obstetrics as a significant medico-legal problem should be viewed from the point of view of the entire perinatal period with possible long-term consequences, hence the monitoring of complete perinatal and infant morbidity is of immediate importance for quality control and risk control in the profession. The task of forensic obstetrics is to assess the impact of risk factors on the occurrence of an adverse event and to assess whether it is an obstetric complication or obstetric malpractice. Acknowledging the mentioned facts is the only way we will develop high obstetric awareness, and we and pregnant women, birth attendants, midwives and patients, fetuses, and newborns will have professional safety with imminent but controlled obstetric risk and controlled expected complications. On the other hand, the fact that the statistics of perinatal (obstetrical) malpractice globally is not abating requires a change in obstetrical philosophy, especially the unreasonable epidemic increase of cesarean sections with a significant percentage of cesarean sections without medical indication and complications. It is necessary to introduce and maintain solid professionalism and bioethical norms in obstetrics with constant training of skills, which is emphasized by numerous authors and with which we fully agree. Forensic obstetrics is based on the principles of good clinical practice, professional guidelines of modern obstetrics, and ethical and deontological principles. It clearly shows the perfection and imperfection of biological systems that we can and cannot influence. However, we must act according to the rules of the clinical profession, deontological rules, and health laws to reduce clinical risk to the smallest possible extent. Attention should certainly be focused on reducing the disproportion between iatrogenic and maternal-fetoneonatal risk factors, which is the most common reason for litigation today.

INTRODUCTION   The main advantage of extraperitoneal cesarean section (EXPCS) is not only less pain, faster recovery, and less potential for infection but also a possible lack of intraperitoneal adhesions. METHODS   In a 3-year period from 2019 to 2022, 88 EXPCSs were performed. A comparison was made with 90 patients who underwent a standard transperitoneal cesarean section (TPCS). For both groups, the inclusion criterion was uterine inertia and prolonged labor as an indication for cesarean section. Only pregnant women from 37 to 42 weeks were included. After this, 51 patients remained in the EXPCS arm, and 49 remained in the TPCS arm. RESULTS   No statistical difference was found in gestational weeks, newborn weight, Apgar score, erythrocyte (Er), hemoglobin (Hgb), and hematocrit (Htc) values and duration of operative time between the EXPCS and TPCS groups. Leukocytes, C-reactive protein (CRP) with fever higher than >38°C on the third postoperative day were found statistically significantly (p=0.005) higher in the TPCS group. The usage of tramadol + metamizole at 3, 6, and 9 hours after delivery and diclofenac at 6, 12, and 18 hours after surgery was statistically significantly (p<0.05) higher in the TPCS group. On the visual analog scale (VAS) 24 hours after surgery, a statistically significant difference was found (p = 0.001) between the two groups. In the small group of patients who underwent a TPCS section after an EXPCS, intraperitoneal adhesions were not found; in another group of patients who underwent a TPCS twice, adhesions were found in 12 patients; Fisher's exact test (p=0.04). CONCLUSION   The protective effect of EXPCS for infection could be proven in prolonged delivery. EXPCS could be a good solution in the fight against adhesions and infection in women who undergo second, third, or even fourth cesarean sections.

BACKGROUND Thanks to modern methods of assisted reproduction (ART), parenthood has become an attainable goal for couples in which the male partner has experienced spinal cord injury (SCI). OBJECTIVE The aim of our study was to determine the success of the treatment of infertile patients with SCI with intracytoplasmic sperm injection (ICSI) of cryopreserved sperm obtained by the testicular sperm aspiration (TESA) procedure. METHODS In this retrospective study 156 infertile couples were included, in which the male partner is primarily infertile due to azoospermia. Infertile couples were divided into two groups. The first group (n= 82) includes men with SCI, and the second (n= 74) men with obstructive azoospermia (OA) as the cause of infertility. All infertile men were examined and processed in the diagnostic procedure, and based on the urological findings, surgical extraction of sperm from the testicles was indicated. Exclusion criteria were the age of women over 40 and men over 45. RESULTS We found that the quality of sperm was worse in the group with SCI, compared to the group with OA, but without statistical significance. Zenica and Johnsen score (p= 0.001; p= 0.000) showed worse semen characteristics in the group with SCI.     There were no significant differences in the average number of embryos (p= 0.698), pregnancy rates per cycle (p= 0.979) and pregnancy rates per embrio transfer (ET), clinical pregnancy rates per ET (p= 0.987) and delivery rates per ET (p= 0.804) in couples with SCI, compared to couples with OA. CONCLUSION Based on the results of this research, the TESA and ICSI procedures can be recommended as a successful method in the treatment of male infertility caused by azoospermia due to SCI.

BACKGROUND Despite improvements, survival rates for gastric cancer remain low, even in developed countries, confirming the role of primary and secondary prevention. OBJECTIVE This study aims to demonstrate the role of additional suspension sutures on the esophagojejunal anastomosis (EJA) to strengthen the anastomosis, i.e., relieve the mechanical suture. METHODS A retrospective cohort study was conducted from 2011 to 2022 at the Clinic for Surgery, University Clinical Center Tuzla, Bosnia and Herzegovina. The experimental group consisted of patients placed with a suspension suture at the esophagojejunal anastomosis (EJA) site after total gastrectomy. The control group was patients without a suspension suture. The clinical and laboratory parameters available from the medical history were analyzed, X-ray passage, surgical complications, non-surgical complications, the length of hospitalization, the postoperative course, time of onset of postoperative complications, postoperative radiological follow-up and endoscopic postoperative follow-up were then analyzed. RESULTS A total of 212 patients were included in the study: 87 in the experimental group with suspension sutures on the EJA and 125 in the control group without suspension sutures on the EJA. The two cohorts did not differ in other clinicopathologic parameters except perineural invasion, which was more prevalent in the control group. Patients in both groups were anemic and elevated values of C reactive protein (CRP) and decreased levels of proteins, albumin and globulin, with no significant difference between the two groups. The most common general complication was pleural effusion (28%), followed by pneumonia (∼22%). The most common complication in the experimental group was an intraabdominal abscess, while in the control group, it was a surgical wound infection. CONCLUSION Our study did not show a statistically significant difference between the two analyzed EJA techniques created with a circular stapler, when it comes to postoperative course and outcome in patients with gastric cancer.

Background : Both objective and subjective transvaginal sonography (TVS) methods are used to assess the degree of myometrial invasion (MI). Subjective TVS assessment of MI ( < 50% or > 50%) may be as good or better than any objective measurement technique. The aim of this study is to examine the ultrasound characteristics of endometrial cancer (EC) in two groups of patients; with myometrial invasion less and greater than 50%. Methods : This is a prospective cohort study included 60 female patients with pathohistologically (PHD) proven endometrial cancer. Patients were divided into two groups, after surgery and PHD assessment of MI degree, into those with less and more than 50% MI. The degree of MI was performed by subjective assessment ( < 50% and > 50%). Results : The frequency of anteroposterior (AP) diameter of EC greater than 2 cm was statistically significantly higher in the group of subjects with MI > 50% ( p < 0.00001). The volume of EC in the group of patients with MI > 50% is statistically significantly higher, with a difference of 10.48 milliliters compared to the group of subjects with MI < 50% ( p < 0.00014). The difference in the average distance of the EC from the serosa is 0.11 cm between the two examined groups and is statistically significant ( p = 0.0394). The kappa concordance coefficient for the subjective TVS method versus the PHD finding was statistically significant ( p < 0.001), and was kappa = 0.72. Analysis of the diagnostic accuracy showed that the subjective TVS method compared to the gold standard in the diagnosis of MI > 50% has a good diagnostic value: accuracy = 0.87; sensitivity = 0.77; specificity = 0.94; positive predictive value = 0.91; negative predictive value = 0.84; positive likelihood ratio = 13.08; negative likelihood ratio = 0.25. According to the subjective method of TVS, the degree of MI was overestimated in 5.9% of respondents, underestimated in 23.1%. Conclusions : The three dimensions, as well as the volume of endometrial cancer, obtained by TVS, are significantly higher in subjects with > 50% myometrial invasion; there is also a significantly higher frequency of EC diameter greater than 2 cm in the group of subjects with > 50% myometrial invasion.

Case presentation We describe the case of the lethal full trisomy (T) 14 in a fetus from bichorionic biamniotic (BCBA) twin pregnancy. This is a case of a 28-year-old primigravida, with an unremarkable personal and family history, who just like her 30-year-old husband, was without consanguinity between spouses. She conceived spontaneously, without a burdened gynecological-obstetric history. By the 12th week of pregnancy, she had hyperemesis gravidarum and one episode of bleeding due to which progesterone supplementation was prescribed. Due to asymptomatic bacteriuria, she took cefuroxime axetil in the 13th week of pregnancy and azithromycin in the 15th week due to cervicitis with ureaplasma urealyticum.

Introduction: Providing adequate healthcare for premature infants is an important issue in perinatal medicine. The aim of this study is to assess the level of the perinatal healthcare institution (PHI) where the newborns were delivered and the possibilities of transporting them to the cantons of the Federation of Bosnia and Herzegovina. The authors also aimed to examine the overall survival of low birth-weight infants (LBWI) in the Federation of Bosnia and Herzegovina and to compare the survival of newborns according to the PHI where they were born and the PHI where they were treated. Materials and methods: This cross-sectional study included newborns of both sexes that were born in the maternity wards in 10 cantons of the Federation of Bosnia and Herzegovina with a gestational age between 22 and 42 weeks, and a birth weight less than 2500 g. Result: From the PHI of the first and second level, 159 newborns were referred to the third level. A total of 159/669 (23.7%) were referred from a second level PHI to a third level PHI, and 127/669 (l8.9%) LBWI were definitely taken care of. A total of 513/669 (76.8%) LBWI were definitely taken care of in the third level PHI. Out of a total of 159 LBWI referred from other PHI, only 31 (19.5%) LBWI were transported in less than 4 h, and 128 (80.5%) newborns were admitted to the third level PHI within 4 h of birth (P<0.0001). In second level PHI, most LBWI died in the first 12 h after birth, while in third level PHI, 69.2% of LBWI died after 1 week of life. Conclusion: Based on world experience and assessment of the situation in Federation of Bosnia and Herzegovina, it is necessary to take measures to improve perinatal care and its regional organization.

Background: Human papillomavirus is a risk factor in the development of cervical cancer. Other risk factors are frequent vaginal infections, cigarette smoking, use of oral contraceptives, but also lack of lacrobacillus in women with HPV infection. Objective: The objective of our study was to determine the risk factors for the development of cervical intraepithelial lesions in women with normal and pathological Pap test results. Methods: The research is a prospective study conducted in the Gynecology Center "Dr. Mahira Jahić" Tuzla and Dom Zdravlja Tešanj since February. 2023 to March 2024. The research included 200 respondents aged 25 to 50. Tested group: 100 subjects with pathological Pap smear findings (ASCUS, LSIL and HSIL) and a control group of 100 subjects with normal Pap smear findings. Sociodemographic data were obtained from the subjects during interviews and examinations: age, cigarette consumption and frequency of previous vaginal infections and the presence of lactobacilli. The obtained results were processed using the methods of descriptive statistics, student's t test and X2 test. A difference for a value of p<0.5 was considered statistically significant. Results: The mean age of the dpbo examined group was 38.1±1.7, while in the control group it was 39.6±1.9 years. Cigarettes were consumed by 62 (31%), 38 (19%) of the examined group, and 24 (12%) of the control group with a statistically significant difference of p<0.05. Out of a total of 100 in the examined group, 60 subjects had LSIL, 9 subjects had HSIL (CIN 2 two subjects and CIN 3 had 7), and ASCUS 29 and ASC-H 2 subjects. Subjects with pathological findings had significantly more vaginal infections during one year (p<0.05). HPV was positive in 65 (65%) subjects with a pathological Pap smear test, and negative HPV in 35 (35%). HPV 16,18 was present in 19 (19%) test subjects in combined form, and mono-isolate HPV 16 in 14 (14%) and HPV 18 in one case. In the combined form of several HPVs, HPV 16 and HPV 31, 33, 35, 45, 56 were found in 5 (5%), and HPV 18 in 4 (4%) with HPV 36, 59, 68. The most frequently isolated HPV 16 in 38 (38%) as monoisolate and in combined form. Lactobacilli were present in 26 (13%) subjects in the test group and in 60 (30%) subjects in the control group, with a statistically significant difference (p<0.05). The presence of Lactobacillus in subjects with a regular Pap test is significantly more frequent compared to women with cervical intraepithelial lesions (ASCUS, LSIL, ASC-H and HSIL) ) in the finding of the Pap test. Conclusion: Altered microflora of the vagina, lack of lactobacilli, frequent vaginal infections and smoking are risk factors for the development of CIN lesions in women positive for high-risk HPV.

Background : Acute abdomen (AA) is a synonym for a condition caused by an acute disease of an intra-abdominal organ that requires urgent surgical intervention. The gynecological-obstetrical etiopathogenesis of AA is based on pathological events on the genital organs due to hemorrhagic, inflammatory, and ischemic/obstructive genesis, and is a significant reason for admission to emergency gynecological departments, and emergency surgery. Methods : A retrospective clinical research was performed from 2005 to 2021, from the surgical protocol of the University Department for Gynecology and Obstetrics, Clinical Hospital “Sveti Duh” in Zagreb. In the examined sixteen-year period, 703 patients (4.06%) had surgery with a diagnosis of AA. Results : The largest number of surgeries due to AA was performed in the age group of 21–45 years (74.40%), i.e., in the reproductive age, followed by 106 patients aged 46–52 years (15.07%), then 46 (6.54%) patients in children and adolescent age up to 20 years of age, then from 53–60 years 23 (3.27%) patients, and in the elderly > 60 years old, with 5 (0.71%) patients. The etiopathogenetic factors of AA were: the most common intra-abdominal hemorrhage in 68.14%, followed by inflammation and the most common complications of pelvic inflammatory disease in 25.60%, ischemic-obstructive causes in 2.56% and other causes in 3.7%. Out of the total number of surgeries, 450 (64.01%) were due to ectopic tubal pregnancy. Out of the total number of surgeries, 549 (78.09%) were performed (completed) by laparoscopy procedures, and by laparotomy and/or relaparotomy in 154 cases (21.90%). Regarding laparoscopy, 93.48% was performed in the age group up to 20 years, 83.56% in the age group of 21–45 years, and 62.26% was performed in the age group of 46–52 years. Regarding laparotomy, 69.57% was performed in patients aged 53–60 years, and 100% in the age group of patients > 60 years. A pathological substrate was found for all operated patients, which they undergo for surgery, and we had no cases in which we did not prove a perioperative or pathohistological reason for AA. There were no patients’ deaths in the current study, which had to undergo for surgery for AA. Conclusions : We emphasize the urgent need for proper and continuous education of hospital teams, as well as extra-hospital emergency teams in recognizing AA symptoms of gynecological genesis based on history, clinical palpation examination, and ultrasound examination as a fundamental triad in the diagnosis of this life-threatening condition that requires only surgical treatment.