The aim of the study was to assess the effect of smoking during pregnancy on the physical growth data of newborns. This prospective study was performed at the Department of Gynaecology and Obstetrics, University Clinical Centre Tuzla in the period from January 2001 to December 2004. 300 newborn infants chosen at random, whose mothers had smoked more than 15 cigarettes per day during pregnancy were compared to a control group of 300 newborns of non-smoking mothers. Four parameters were examined: birth weight, length, head circumference and chest circumference. The birth weight in the investigated group was less than 2500 grams in 156 (52%) infants compared to only 36 (12%) cases in the control group. All the other investigated growth measures in the investigated group were less than in the control group: the mean birth weight was less by 411.96 grams; the mean length at birth was less by 1.41 cm, the mean head circumference was less by 1.99 cm and the mean chest circumference was less by 2.02 cm. All the differences were significant at the level of p<0.05. It is concluded that smoking during pregnancy has a deleterious effect upon the newborns’ physical growth.

INTRODUCTION In present clinical practice there is an increasing number of patients with delivery with previous cesarean section which is frequent reason for the repeated one. The most serious complication in labour with previous cesarean section is the rupture of the uterus which is as frequent in labour by natural way as in repeated cesarean section. This is a reason that many of obstetricians do not support attitude "Once cesarean section, always a cesarean". THE AIM In a retrospective study in five years period beginning January 1, 1998, we analyzed total number of deliveries, total number of cesarean section, way of deliveries with previous cesarean section and frequency of complications. METHODS We used Chi2 test and Contigency table. RESULTS In analyzed period from January 1, 1998 through December 31, 2002, we completed 24,194 deliveries at Ob/Gyn Clinic in Tuzla. Out of this number we performed 4073 cesarean sections or 16.83%. Out of 24,194 deliveries we had 1328 (5.49% of all deliveries) deliveries after performed cesarean in previous pregnancy. Out of 1328 deliveries following cesarean we completed by natural way 323 pregnancies or 24.33% and by repeated cesarean 1005 or 75.67%. Previous one cesarean had 1191, previous two cesarean 126, and previous three cesarean had 11 women. Out of 1328 deliveries by previous cesarean we had 12 (0.90%) or 1:111 cases, complicated by intrapartum rupture of the uterus. It was significantly more than in group of deliveries by unscarred uterus (1:16,849 deliveries). Three of 12 ruptures of the uterus were in group by natural way of delivery and 9 cases in group by repeated cesarean, no statistical difference (p>0.05). Out of 12 cases complicated by rupture of the uterus, ten cases were incomplete and two complete rupture of the uterus. CONCLUSION Repeated cesarean section by his complications imposes the careful choice of indication for primary cesarean section and by this way make maternal mortality and morbidity significantly lower, specially in the light of the fact that only 24.33% deliveries following cesarean is completed vaginally. The most frequent complication was rupture of the uterus in relation 1:111 deliveries.

SUMMARY. Objective. The aim of this study is to appreciate the mode of delivery in the pregnant women with placenta praevia. Methods. Retrospective study. We analized 9010 deliveries (two years period, 2001 and 2002) performed at the University Clinical Center, Tuzla, Ob/Gyn Clinic. Control group were 16 pregnant women without placenta praevia. In statistical analysis t-test was used. Results. The incidence of placenta praevia was 0.17% (16 out of 9010 deliveries). Placenta praevia partialis was established in 8 (50%), placenta praevia centralis in 4 (25%) and placenta praevia marginalis in 4 (25%) pregnant women. All pregnant women with placenta praevia were secundiparas and multiparas. The caesarean section was previously performed in 8 (50%) pregnant women. In actual pregnancy in 14 (87.5%) of pregnant women with placenta praevia the mode of delivery was by caesarean section, in the control group in 3 (18.75%), the t-test is 5.72, p<0.05. Apgar score 8–10 was in 12 and 4–7 in 4 (25%) neonates; in the control group Apgar score 4–7 was only in one case (6.25%); the statistical difference is not significant. The gestational age at delivery in 8 cases was ≤37 weeks, in the control grup in 2; the difference is statistically significant (t=2.51, p<0.05). Conclusion. Placenta praevia is a serious complication of pregnancy. The method of choise in the delivery for pregnant women with placenta praevia is caesarean section.

INTRODUCTION The objective is to examine the efficiency of the application of prostaglandins (PgE2) in labours with the complications of premature rupture of membranes (PRM) for the purpose of their more frequent use. STUDY DESIGN Two groups of term labours with the complications of PRM were observed in Gynaecology and Obstetric Clinic in Tuzla, in 2002. In the examination group No=59 (46.82%), we used vaginal suppositories prostin E2 (3 mg) for stimulation of labour. In the second group of pregnant women, No=67 (53.17%) we used oxytocin for stimulation. The following was observed: the age of pregnant women, parity, Bishop score, latent period (time from application of the medicine until delivery), manner in which the labour was ended, birth weight, Apgar score after the first and the fifth minute, incidence of complications (infections and bleeding) in the period of confinement/puerperium). RESULTS PgE2 were applied in pregnancies in earlier gesational age (37.31 versus 39.13), more often in nulliparous women (86.46%), in the case of immature cervix (Bishop score 3.70 versus 5.95). There were 80.45% successful stimulation, the same incidence of Cesarean sections, with no difference in the condition of newborns at birth (average Apgar score in the group with Pg 8.63), without difference in the incidence of complications in the confinement puerperium. In the group with Pg, there was a small percentage of infections, although the latent period was in 5.67% pregnancies longer than 24 hours. CONCLUSION The application of PgE2 vaginal suppositories for maturing and stimulation of labour is a modern, efficient and easy to use method in obstetrics which is very acceptable.

INTRODUCTION Preterm labour is most common complication of second half of pregnancy, incidence is 7 to 10% of all delivers. One of most important causes of increased mortality and morbidity of neonates is respiratory distress syndrome. Numerous studies prove that corticosteroids given antenatal to mother decrease the incidence of preterm delivered neonates. AIM OF THIS STUDY IS: To determined influence of dexamethasone given prepartal on maturation of neonatal lungs in correlation with gestational age. METHOD This study include 150 pregnant women which delivered before 37 week of gestation. They are divide in three groups: two experimental and one control group. Group E1 consists of the pregnant women which received dexamethasone for five days in a single dose of 12 mg. Group E2 consists of the pregnant women which received dexamethasone less then five days, in a single dose of 12 mg. In the control group consists of the pregnant women which did not received dexamethasone. In this work we used gestational age in the moment of delivery. State of neonate is determined on the base of presence of clinical signs of respiratory distress syndrome after birth. Statistical method used in this work was test of proportion. RESULTS In this work we find that there is a less number of neonates who has respiratory distress syndrome in group consists of the pregnant women which received dexamethasone for five days, 5 (10%). In group consists of the pregnant women which received dexamethasone less then five days, number of neonates with respiratory distress syndrome was 12 (24%). The number of neonates with respiratory distress syndrome in control group was 21 (42%). The value of test of proportion: K/E1 (the pregnant women received dexamethasone for five days)-z = 1.95, p < 0.05; K/E2 (pregnant women received dexamethasone less than five days)-z = 3.92, p < 0.05. In all three groups largest number of neonates with respiratory distress syndrome was between 31-34 week of gestation. Highest mortality of neonate with respiratory distress syndrome was in control group, 7 (14%), than in group consists of the pregnant women received dexamethasone lass then five days, 4 (8%). In group consist pregnant women received dexamethasone for five days, there were not cases of mortality caused by respiratory distress syndrome. The value of test of proportion was z = 2.85 (p < 0.05), between control group and group consists of the pregnant women received dexamethasone for five days. CONCLUSION Dexamethasone accelerates maturation of fetal lungs, decrease number of neonates with respiratory distress syndrome and improves survival in preterm delivered neonates. Optimal gestational age for use of dexamethasone therapy is 31 to 34 weeks of gestation.