Background: In University Clinical Center, Department of Obstetrics and Gynaecology is using reference data from 1974 developed for the infants born in Belgrade (Serbia). It estimates the standards of term infants for neonatal weight, length and head circumference. Aim: This study was create to develop charts for birth weight, lenght and head circumference specific to gestational age, gender and parity for term singleton infants in Tuzla Canton. Methods: The study was conducted at University Clinical Center Tuzla, Department of Obstetrics and Gynecology, a primary obstetrical care facility for residents of Tuzla Canton over the one-year period. During the one year study period, 01.01.- 31.12.2009, there were 4106 infants born at 37th to 41th weeks of gestation (GW), 2168 (52.8 %) males and 1938 (47.2%) females. We analysed gestational age, birth weights, body length and head circumference. Results: Females infants of primiparae, born at 40th gestational week, had the lowest median birth weight, 3500 g, followed by female infants of multiparae, 3640 g, and male infants of primiparae, 3650 g. The greatest median birth weight, 3730 g, had male infants of multiparae. Median birth length value at the 40th gestational week for male infants of primiparae and multiparae, as well as female infants of multiparae is the same, 55 cm, while is lower in female infants of primiparae (54 cm). There is no difference in median head circumference at the 40th gestational week between female infants of primiparae and multiparae, and male infants of primiparae (35 cm). Mean birth weight and length of liveborn infants at 37. to 41. gestational week differed significantly between certain parities (F=8,723, Df=2, p<0,001; F=3,292, Df=2, p=0,037, respectively). No significant difference was found for head circumference (F=0,983, Df=2, p=0,374). Conclusion: The average birth weight of infants within Tuzla Canton is bigger in comparison with the centile that have been used so far.

OBJECTIVE To compare the rate of uterine scar disruption after a locked versus an unlocked single-layer closure of the hysterotomy incision at a previous cesarean. METHODS A retrospective cohort study in a population where both locked and unlocked single-layer closure are commonly used. All singleton pregnancies at 24 weeks' gestation or more with a previous single cesarean were included. Rate of uterine scar disruption (complete uterine rupture and uterine scar dehiscence) were compared between women with a previous locked and those with a previous unlocked single-layer closure of the uterus. RESULTS Out of 388 women included in the study, 272 had a previous unlocked single-layer closure and 116 had a locked single-layer closure. We found no significant difference in the rate of uterine scar disruption between the two groups (5.9% vs 8.6%, p = 0.32). CONCLUSION Locking a single-layer closure was not associated with an increase rate of uterine scar disruption at the next pregnancy in our retrospective analysis. A randomized trial should be performed.

The aim was to determine the incidence of perinatal mortality, as well as the frequency of premature deliveries. Methods: We analyzed the data of birth protocol at the Clinics for Gynecology and Obstetrition at the University Clinical Centre in Tuzla in period 1992-2006. Results: Perinatal mortality gradu-ally declines in the period of 1992-2000. The decline owns mostly to early neonatal mortality more than to fetal which also shows the trend of decrease. During the first analyzed years (1992 and 1993) the incidence of premature deliveries was below 10% but that number increased during 1994 and 1995 (15.8%). The most interesting finding is that the highest level of incidence of premature deliveries was registered in the first postwar year – 1996 (16.4%) when we also noted the largest number of deliveries for the analyzed period and most of which were finished between 32 and 36 weeks. The frequency of delivery of underweight babies (500-2499g) was between 3.8 to 12.2%. The highest frequency was registered during the 1994 and 1995 when it reached 12.2%. The frequency of delivery of extremely underweight babies (500 – 999g) for the analyzed period was about 0.1% with significant increase during the wartime (1995 even 0.6%). Conclusion: We found that during the period of 15 years a significant decline of perinatal mortality is registered, due to early neonatal death. Limited accessibility and quality of perinatal health care during the war period had detrimental effects on the healt and survival of newborns.

THE AIM To determine the incidence of perinatal mortality, as well as the frequency of premature deliveries. METHODS We analyzed the data of birth protocol at the Clinics for Gynecology and Obstetrition at the University Clinical Centre in Tuzla in period 1992-2006. RESULTS Perinatal mortality gradually declines in the period of 1992-2000. The decline owns mostly to early neonatal mortality more than to fetal which also shows the trend of decrease. During the first analyzed years (1992 and 1993) the incidence of premature deliveries was below 10% but that number increased during 1994 and 1995 (15.8%). The most interesting finding is that the highest level of incidence of premature deliveries was registered in the first postwar year--1996 (16.4%) when we also noted the largest number of deliveries for the analyzed period and most of which were finished between 32 and 36 weeks. The frequency of delivery of underweight babies (500-2499 g) was between 3.8 to 12.2%. The highest frequency was registered during the 1994 and 1995 when it reached 12.2%. The frequency of delivery of extremely underweight babies (500-999 g) for the analyzed period was about 0.1% with significant increase during the wartime (1995 even 0.6%). CONCLUSION We found that during the period of 15 years a significant decline of perinatal mortality is registered, due to early neonatal death. Limited accessibility and quality of perinatal health care during the war period had detrimental effects on the healt and survival of newborns.

The purpose of this study was to determine how increased inaccessibility of health care during the war reflected on maternal outcomes in Tuzla Canton, Bosnia and Herzegovina. We retrospectively collected data from the databases of University Department for Gynecology and Obstetrics and Department of Patology. During war years (1992–1995), the rate of maternal mortality was 87/100,000 births, in the prewar (1986–1991) was 49/100,000 births, in the postwar (1996–2000) was 50/100,000 births, and in the 2001–2005 period was 23/100,000 births. Maternal mortality was significantly higher during the war, mainly due to lower adequacy and accessibility of health care, explosive injuries, and inadequate nutrition.

Objective. To examine whether short-term postnatal health-related quality of life differed among women after different methods of cesarean sections. Methods. One hundred forty-five women were evaluated with previous CS (85 by Misgav Ladach and 60 by Pfannenstiel–Dörffler). Short-time quality of life was measured using the Croatian version of Short Form Health Survey (SF – 36). Short-term postoperative recovery was assessed using two criteria: febrile morbidity and degree of pain. Incidence of peritoneal adhesions was assigned using Bristow scoring system. Results. Four weeks after delivery women with previous Misgav Ladach cesarean section significantly scored higher on the bodily pain (72.4 vs. 56.7, p < 0.05), social functioning (71.5 vs. 60.4, p < 0.05), and the vitality (61.7 vs. 50.3, p < 0.05) subscales. These differences disappeared in the second assessment (12-weeks postpartum) except in the bodily pain (74.7 vs. 61.2, p < 0.05) subscale. There was a significant trend toward a higher requirement for postoperative analgesics in the Pfannenstiel–Dörfler group (doses: 5.4 vs. 8.7, p < 0.05; hours: 17.9 vs. 23.3, p < 0.05), and they had a significantly higher rate of febrile morbidity than the Misgav Ladach group (5.7 vs. 9.4%, p < 0.05). Hospitalization time was reduced in the Misgav Ladach group (4.2 vs. 7.3, p < 0.05). The incidence of adhesions was significantly lower in patients who had undergone a previous operation using the original Misgav Ladach method (0.47 vs. 0.77, p < 0.05). Conclusion. Misgav Ladach cesarean section method might lead to better short-time quality of life resulting in reducing postoperative complications compared to Pfannenstiel–Dörfler cesarean section method.

Sarcomas of the female genital tract in general are rare and ovarian sarcomas comprise less than 1% of ovarian malignancies. In the literature there are 15 reported angiosarcomas of patients 21 year old and younger with no one originated in the ovary. We report a case of ovarian angiosarcoma in an 11 year old girl, presented with left side hip pain. MRI of abdomen and pelvis confirmed expansive solid and cystic mass occupied both ovaries. Imunohistochemistry staining was performed, CD34, Factor VIII, CD31, in order to confirm the diagnosis. Final diagnosis was angiosarcoma. The patient received 6 cycles of chemotherapy, according to the CWS-2002P protocol. 8 months after the diagnosis was established, there were no signs of any tumors according to the ultrasound, CT scan, and MRI. Although, extremely rare, angiosarcoma can also affect children and this diagnosis should be considered carefully in tumor with rich vascular network, necrosis and brisk mitotic activity.

Among obstetric techniques, cesarean section seemed to represent a well-defined procedure and significant advances in this intervention were considered to be unlikely. However, obstetric surgery has recently undergone many improvements. In 1972, Joel-Cohen presented a new method for transverse incision of the abdomen. This method, with some modifications, was integrated into the Misgav-Ladach cesarean section. The philosophy of this technique is to cause the least possible damage to tissues, to refrain from superfluous steps, and to make the intervention the simplest possible. Advantages of this method are lower incidence of fever and urinary tract infection, reduced use of antibiotics and narcotics, faster re-establishment of normal bowel function, shorter maternal hospital stay and less postoperative adhesion formation. The Misgav-Ladach method of cesarean section is suitable for emergency and elective procedures, justifying its use in daily routine.

Objective. To evaluate whether the single-layer closure as is a routine by the Misgav–Ladach method compared to the double-layer closure as used by the Dörfler cesarean method is associated with an increased risk of uterine rupture in the subsequent pregnancy and delivery. Methods. The analysis is retrospective and is based on medical documentation of the Clinic for Gynecology and Obstetrics, University Clinical Centre, Tuzla, Bosnia and Herzegovina. All patients with one previous cesarean section who attempted vaginal birth following cesarean section were managed from 1 January 2002 to 31 December 2008. Exclusion criteria included multiple gestation, greater than one previous cesarean section, previous incision other than low transverse, gestational age at delivery less than 37 weeks and induction of delivery. We identified 448 patients who met inclusion criteria. Results. We found that 303 patients had a single-layer closure (Misgav–Ladach) and 145 had a double-layer closure (Dörffler) of the previous uterine incision. There were 35 cases of uterine rupture. Of those patients with previous single-layer closure, 5.28% (16/303) had a uterine rupture compared to 13.11% (19/145) in the double-layer closure group (p < 0.05). Conclusion. We have not found that a Misgav–Ladach cesarean section method (single-layer uterine closure) might be more likely to result in uterine rupture in women who attempted a vaginal birth after a previous cesarean delivery. This cesarean section method should find its confirmation in everyday clinical practice.

UNLABELLED The aim of this paper was to determine the incidence of operative deliveries and to make a comparison between the incidence rate in the pre-war (1986-1991), war (1992-1995) and post-war (1996-2005) periods. METHODS We retrospectively collected data from the databases of University Clinic of Gynecology and Obstetrics Tuzla for the period of twenty years (January 1st, 1986 - December 31st, 2005). RESULTS The frequency of Cesarian section was in constant rise since 1990 when it surpassed 11%, with the exception of two war years 1992 and 1993 when it was 9.5%. The highest frequency was registered in 2004 - 20.7%. Statistically significant difference in Cesarean section was found between period 2001-2005 (18.5%) and other analysed periods. Vacuum extraction methods were most used in 1989 - 3.7%, and least in 2004 - 1.1%. In 1991, 50 - 0.8% of deliveries were finished with forceps, and since 2000 this method has not been used in any delivery. The frequency of pelvic presentation for the analyzed period varied less and was between 2.9% and 5.1%. CONCLUSION During the period of twenty years at the Clinic of Gynecology and Obstetrics in Tuzla a significant increase in the incidence of deliveries finished with Cesarean section was found.

Abstract Objective: The aim of this prospective study was to compare serum and urine concentrations of progesterone-induced blocking factor (PIBF) and serum concentrations of anti-inflammatory (IL10) and pro-inflammatory (IL6, TNFα, IFNγ) cytokines of women with threatened spontaneous abortion with normal pregnancy and to evaluate the impact of PIBF on outcome of pregnancy. Methods: A sample of 30 women with threatened spontaneous abortion (study group) and 20 healthy pregnant women (control group) between 6th and 24th gestational weeks was studied. Serum and urine PIBF, IL10 and IL6, TNFα, IFNγ cytokine concentrations were measured by enzyme-linked immunosorbent assay (ELISA). Results: Five (16.7%) pregnancies in the study group ended missed abortion vs. none in the control group (P<0.05). Five (20%) threatened aborters delivered between 24th and 37th weeks of gestation, whereas two (10%) preterm deliveries occurred in the controls (P>0.05). PIBF concentrations in urine (19.5±12.9 ng/mL) and serum (214.4±120.6 of patients with threatened abortion were significantly lower than in healthy pregnant women (45.3±33.7 ng/mL and 357.3±159.9 ng/mL, respectively). Women with threatened abortion had significantly lower serum levels of anti-inflammatory cytokine, but levels of proinflammatory cytokines were higher in this group compared with healthy controls. Conclusions: Determination of progesteron-induced blocking factor level in body fluids in early pregnancy might be used for the diagnosis and prognosis of threatened abortion.