This retrospective cohort study aimed to analyze the clinical manifestations, complications, and maternal-fetal outcomes in patients affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during delivery. The cohort included 61 pregnant women positive for SARS-CoV-2 infection at the time of delivery. Patients were divided into two groups: symptomatic and asymptomatic. We found a significantly higher rate of leukocytosis (p < 0.00078) and lymphopenia (p < 0.0024) in symptomatic women compared with asymptomatic ones. Other laboratory parameters, such as CRP (p = 0.002), AST (p = 0.007), LDH (p = 0.0142), ferritin (p = 0.0036), and D-dimer (p = 0.00124), were also significantly more often increased in the group of symptomatic pregnant women. Overall, symptomatic pregnant women with SARS-CoV-2 infection at the delivery show more often altered laboratory parameters compared with asymptomatic ones; nevertheless, they have a slightly higher but non-significant rate of preterm delivery, cesarean section, as well as lower neonatal birth weight and Apgar score, compared with asymptomatic women.

Fundal or Kristeller’s pressure (FP) is known to be associated with numerous reports of severe maternal and fetoneonatal injuries, although it is used in a variety of modifications in many maternity hospitals and there is no evidence based on medical evidence of its effect on good clinical practice (Habek et al. 2008; Gimovsky and Berghella 2022). Peripartum pneumothorax (PPT) is a life-threatening clinical curiosity most commonly associated with pre-existing lung disease (lung cysts, tumours and bronchiectasis) and increased intrathoracic pressure associated with peripartum induced Valsalva’s manoeuvre and distal alveolar rupture. It is more common in pregnancy than in childbirth alone or in combination with Hamman’s syndrome (pneumomediastinum, pneumothorax and subcutaneous emphysema) with also extremely rare incidence in 1:2000 to 1:100,000 births (Najafi and Guzman 1978; Oshovskyy and Poliakova 2020). From the non-litigating Croatian obstetric practice, the case of a PPT in healthy primipara, without comorbidity and normal course of pregnancy and spontaneous term delivery is known. The parturient somatogram was unfavourable in terms of short stature (156 cm) and body weight of 68 kg, orderly eutrophic newborn and the course of the first labour phase. During the end of the II labour stage, the obstetrician decided on FP and with episiotomy, a live eutrophic newborn was born with Apgar score 10/10. Immediately after the birth, the mother became tachydyspnoic, cyanotic, tachycardic, hypotonic, with signs of acute respiratory insufficiency, so obstetric embolism was suspected, which was excluded by radiographic, electrocardiographic and laboratory methods. However, right-sided complete PPT without pulmonary or other intrathoracic pathological condition was verified, and with thoracentesis and drainage, there was complete reexpansion of the lungs and recovery of the mother with several days of subcutaneous emphysema. In 1978, seven cases of spontaneous PPT were presented in a pulmonary comorbidity (pulmonary cyst) using forceps with episiotomy in childbirth (Najafi and Guzman 1978), and Oshovskyy and Poliakova (2020) recently demonstrated intrapartum development of the syndrome Hamman which fully recovered by thorakocenthesis. FP could certainly have been avoided due to the orderly course of labour and the absence of maternal pulmonary comorbidity, and its application has contributed to the emergence of a life-threatening condition of the mother, which is beyond the scope of good clinical obstetric practice. Based on many years of clinical and forensic practice, we agree with the opinion of the authors of numerous papers and reviews of cases of obstetric injuries (Habek et al. 2008; Hasegawa et al. 2015; Zaami et al. 2018; Malvasi et al. 2019; Habek 2021; Gimovsky and Berghella 2022), FP is not recommended in modern obstetrics as a method of assistention during delivery. In this case shown, it can certainly be interpreted as iatrogenic rather than spontaneous PPT due to unnecessary and inappropriate force in normal, spontaneous childbirth.

Obstetric shock (OS) has been defined as a life-threatening cardiovascular collapse syndrome associated with pregnancy, childbirth and puerperium (obstetrics causes), and is the most significant cause of high maternal mortality (MM) throughout human history. Shock in obstetrics (SIO) refers to indirect causes of non-obstetrics causes in pregnancy, childbirth and puerperium (polytrauma, aesthetic incidents, cardiovascular or cerebrovascular incidents, other septic syndromes). The goals of OS treatment are: to quickly detect the location or cause of bleeding / injury / inflammation, prevent the progression of shock, prevent massive transfusions, preserve the uterus (and adnexa), and preserve fertility if possible. Surgical treatment of septic shock includes exploratory laparotomy (laparoscopy), ectomy or resection of the necrotized organ, abdominal lavage with multiple drainages, continuous peritoneal drainage with lavation, extensive triple antibiosis per admission or per antibiogram and thromboprophylaxis. OS seems to remain a permanent miasma in practical clinical obstetrics, which we will not be able to influence, because we have obviously caused today's increase in MM from haemorrhagic OS by iatrogenic increase in the number of caesarean sections, especially elective ones.

Backround : Surgical site infection (SSI) is defined as an infection occurring within 30 days after a surgical operation and affecting either incision or deep tissues at the operation site. The aim of this study was to examine the incidence, identify bacterial agents and determine their antibiotics sensitivity of SSI following cesarean section (CS). Methods : This retrospective cohort study included women who undervent Misgav-Ladach method CS after which a SSI developed during the period from 01 January 2019 to 31 December 2019 at the Clinic for Gynecology and Obstetrics, University Clinical Center Tuzla. Results : During the observed period we recorded 3345 deliveries, out of which 946 (28.3%) were by cesarean section, and out of which 50 (5.28%) was with SSI. The most commonly isolated bacteria from SSI were: Escherichia coli ; Enterococcus faecalis ; Staphylococcus aureus ; Klebsiella pneumoniae . Fluoroquinolnes had the highest antibacterial activity against gram-positive pathogenes isolated. Staphylococcus aureus isolates is highly resistant to penicilline (100%). Conclusions : The prevalence of SSI following cesarean section was high and Enterococccus faecalis and Escherichia coli was the commonest pathogens isolated.

Abstract Background We compared the accuracy of preoperative transvaginal ultrasound (TVUS) versus magnetic resonance imaging (MRI) for the assessment of myometrial invasion (MI) in patients with endometrial cancer (EC), while definitive histopathological diagnosis served as a reference method. Patients and methods Study performed at a single tertiary centre from 2019 to 2021, included women with a histopathological proven EC, hospitalized for scheduled surgery. TVUS and MRI were performed prior to surgical staging for assessment MI, which was estimated using two objective TVUS methods (Gordon’s and Karlsson’s) and MRI. Patients were divided into two groups, after surgery and histopathological assessment of MI: superficial (≤ 50%) and deep (> 50%). Results Sixty patients were eligible for the study. According to the reference method, there were 34 (56.7%) cases in the study with MI < 50%, and 26 (43.3%) with MI > 50%. Both objective TVUS methods and MRI showed no statistical significant differences in overall diagnostic performance for the preoperative assessment of MI. The concordance coefficient between both TVUS methods, MRI and histopathology was statistically significant (p < 0.001). Gordon’s method calculating MI reached a positive predictive value (PPV) of 83%, negative predictive value (NPV) of 83%, 77% sensitivity, 88% specificity, and 83% overall accuracy. Karlsson’s method reached PPV of 82%, NPV of 79%, 69% sensitivity, 88% specificity, and 80% overall accuracy. Accordingly, MRI calculating MI reached PPV of 83%, NPV of 97%, 97% sensitivity, 85% specificity, and 90% overall accuracy. Conclusions We found that objective TVUS assessment of myometrial invasion was performed with a diagnostic accuracy comparable to that of MRI in women with endometrial cancer.

The aim of our manuscript is to report of a successful perinatal outcome after treatment of acute polyhydramnios caused by duodenal atresia. A 34-year-old G3P1 was referred due to polyhydramnios in the 30th week of pregnancy. Ultrasound revealed polyhydramnios, amniotic fluid index (AFI) 28, and a double bubble sign that indicated duodenal atresia and dilatated oesophagus. In the 32nd week of gestation, the volume of amniotic fluid increases, AFI 35, along with symptoms of dyspnea and abdominal pain. Due to the clinical picture and the early gestational age, it was decided to perform an amnioreduction. In the 36th week of gestation cesarean section was performed. The baby was taken for exploratory laparotomy and found to have a simultaneous complete duodenal atresia and annular pancreas with associated dilated the first portion of the duodenum and the stomach. A side-to-side duodenoduodenostomy via single-layer hand-sewn anastomosis was performed over a transanastamotic feeding tube (TAFT). The postoperative course was uneventful. Amnioreduction is useful and safe in the treatment of acute polyhydramnios caused by duodenal atresia and thus has a significant role in prolonging gestation until fetal maturity.

The promptness of providing services to patients directly affects the success of healthcare organizations. In this regard, the implementation of contemporary concepts in healthcare organizations is synonymous with success. Subject of research: The subject being researched in this paper is the possibility of applying the SIPOC method to the clinical process in obstetrics. A more precise application of the abovementioned method would mean a prompter implementation of activities within the clinical process (pregestational counseling, antenatal care of expectant mothers, deliveries, supervision of women during puerperium). Through the activities of the abovementioned clinical process, an effort is made to meet the health needs of expectant and new mothers. The application of the SIPOC method is not sufficiently present in clinical processes, especially the clinical process in obstetrics, and therefore this paper opens a new research area. Aim: The aim of this paper is to indicate the relevance of the SIPOC method as one of the tools within the Lean methodology, which can be used to improve the clinical process in obstetrics. Materials and methods: The following materials and methods were applied in this study: the method of analysis, the inductive - deductive method, the method of synthesis, the method of description, the method of proof. Case analysis was also used in the application of the SIPOC matrix at a gynecology and obstetrics outpatient clinic. Results: The results of the research showed that there was a positive impact on improving the efficiency of the provision of health services, through the implementation of modern methods. The SIPOC method affected the improvement of the efficiency of the clinical process in obstetrics. The review of the literature and the obtained results revealed that there is no formalized concept with instructions on the implementation of clinical process improvement methods.

Background: Vaginal microflora plays an important role in cervical carcinogenesis. An increase in vaginal pH is associated with the severity of squamous intraepithelial lesion (SIL) and a decrease in the number of lactobacilli. Microbial dysbiosis contributes to the damage of the epithelial barrier, as well as the reprogramming of immune and metabolic signaling. Dysbiotic bacteria cause damage to the epithelial barrier, immune dysregulation and genotoxicity and create a tumor-permissive microenvironment. Objective: The aim of this study was to determine the presence of risk factors (abnormal colposcopic and microbiological status, elevated pH of the vaginal environment) in regular Pap tests and LSIL. Methods: Retrospective prospective study 2021-2022. 90 women with pap smears were analyzed: 40 with LSIL at the Gynecological Center “Dr. Mahira Jahić” Tuzla and 50 with normal findings at the Tesanj Health Center. General data such as: age of the subjects, reproductive status, contraception, smoking and data on colposcopic examination, microbiological findings and vaginal pH value were analyzed. Statistical data processing was done in the SPSS program. Results: The average age of the test subjects is 39.94, in normal Pap 41.20 years, and in LSIL 38.38 years. The vital characteristics of the subjects did not differ significantly, except for smoking, where in LSIL findings, they consumed cigarettes significantly more often. Abnormal colposcopic examination were found in 85% (N-34) of women with LSIL. In subjects with LSIL, a positive microbiological test for enterobacteria was found in 47.5% (N-19) and a normal pap test in 12% (N-6). Statistically significant difference p=0.00523 p<0.05, E faecalis and E coli had the highest prevalence in LSIL. The mean pH value of the vaginal environment in LSIL is 5.38, and 4.96 in a regular pap test. Subjects with LSIL in 10% (N-4) had a normal pH test, and 48% (N-24) had a normal Pap test. P=0.00129 p < (0.05). A normal pH value was significantly more common in subjects with a normal Pap test. Microbiological flora, especially enterogenic bacteria, are more common in LSIL than in women with a regular pap test. Conclusion: when monitoring women with LSIL, special attention should be paid to the elimination of present enterobacteria (E.faecalis and E.coli) as a possible risk factor in the development of precancerous lesions (SIL) and cervical cancer.

Aim of the study Lateral episiotomy is a widely used procedure, although it is rarely mentioned in the literature and its effects on the pelvic floor are largely unexplored. The purpose of this study is to evaluate the impact of lateral episiotomy on the incidence of urinary incontinence (UI) after vaginal delivery in primiparas. Material and methods The study design is a prospective cohort study. The primiparas were divided into two groups. The first group consisted of women who gave birth with lateral episiotomy, while the second group included women who gave birth with an intact perineum or with perineal tears of first and second degree. Assessments of UI were performed at 5 and 8 months after childbirth using the International Consultation on Incontinence Questionnaire – Short Form (ICIQ-SF) questionnaire followed by the stress test. Results The results revealed no significant differences (p > 0.05) in emergence of stress urinary incontinence (SUI) between the groups at the two time points. There were no statistically significant differences in overall rate of UI, urge urinary incontinence (UUI), or mixed urinary incontinence according to the ICIQ-SF questionnaire. The overall incontinence rate on the first examination was 24% in the episiotomy group and 36% in the perineal laceration group, although the difference was not statistically significant (p = 0.064). On the second examination, rates were similar and without a statistically significant difference. Conclusions Lateral episiotomy has a neutral effect on the onset of UI in primiparous women in the first year after delivery.