Aim. To evaluate the incidence of peritoneal adhesions as a post-operative complication after caesarean section following the Misgav Ladach method and compare it with peritoneal adhesions following traditional caesarean section methods (Pfannenstiel-Dörffler, low midline laparotomy-Dörffler). 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 (data from 1 January 2001 to 31 December 2005). We analysed previous caesarean section dependent on caesarean section method (200 by Misgav Ladach method, 100 by Pfannenstiel-Dörffler method and 100 caesarean section by low midline laparotomy-Dörffler). Adhesion scores were assigned using a previously validated scoring system. Results. We found statistically significant difference (p < 0.05) in incidence of peritoneal adhesions in second and third caesarean section between Misgav Ladach method and the Pfannestiel-Dörffler and low midline laparotomy-Dörffler method. Difference in incidence of peritoneal adhesions between low midline laparotomy-Dörffler and Pfannenstiel-Dörffler method was not statistically different (p > 0.05). The mean pelvic adhesion score was statistically lower in Misgav Ladach group (0.43 ± 0.79) than the mean score in the Pfannestiel-Dörffler (0.71 ± 1.27) and low midline laparotomy-Dörffler groups (0.99 ± 1.49) (p < 0.05). Conclusions. Our study showed that Misgav Ladach method of caesarean section makes possible lower incidence of peritoneal adhesions as post-operative complication of previous caesarean section.

We report genetic counseling and prenatal diagnostics in the Obstetrics and Gynecology Department of the Clinical Center Brcko District (BiH) which works for more than 4 years in prevention of giving birth to children with hereditary diseases and congenital malformations. Pregnant women from Brcko District, Tuzla Canton and wider area of BiH underwent genetic counseling. In the period from 2003 to 2007, 1234 pregnant woman underwent amniocentesis and genetic counseling. Among them 27 foetuses with chromosome disorders were discovered (2.19%). There were 9 (0.72%) cases of autosomal numerical aberrations, 9 (0.72%) of numerical anomalies of sex chromosomes and 12 (1.07%) of structural chromosome aberrations. Chordocentesis was performed in 86 pregnant women: 7 foetuses were found carrying chromosome aberrations (8.14%). Frequency of chromosomes in comparison to the Centre of Medicine Genetics in the Children Clinic in Novi Sad (Serbia) indicates that it is significantly higher (1.67% compared to 2.19%), and in both cases the populations are significantly large (12210:1234)--there is a large difference in structural chromosomal aberrations (0.39% -1.07%). This could point to harmful factors of the environment which contribute to induced genome damages. Frequency of chromosomopathies found by prenatal diagnostics is high. The causes for this have to be looked for, but the increase of structural anomalies points to environmental factors.

Aim. To determine the incidence rate and causes of perinatal mortality and make a comparison between the incidence rate and causes of perinatal mortality in the prewar (1986–1991), war (1992–1995) and postwar (1996–2005) periods in Tuzla Canton, Bosnia and Herzegovina. Methods. We retrospectively collected data from the databases of University Department for Gynecology and Obstetrics Tuzla. Data on the number of live births, stillbirths, early neonatal deaths, causes of death, gestational age and birth weights were collected. Results. There were 101712 deliveries alltogether in the above mentioned period, out of which 101638 resulted in liveborn children. Perinatal mortality gradually declines in the period of 1986–2000. The decline owns mostly to early neonatal mortality more than to fetal which also shows the trend of decrease. Statistically significant difference in perinatal mortality was found between period 2001–2005 and another analysed periods, and the most difference was found between 1991–1995 and 1996–2000 (p < 0.01). Statistically significant difference in fetal mortality was found between period 2001–2005 and 1986–1990. Statistically significant difference in early neonatal mortality was found between period 2001–2005 and 1986–1990 (p = 0.005; p < 0.005). Conclusion. Perinatal mortality in Tuzla Canton were significant higher during the war, mainly due to lower adequacy and accessibility of perinatal health care. During the peace period a significant decline of perinatal mortality is registered, due to early neonatal death.

ABSTRACT The aim of this prospective study was to investigate a value of insulin-like growth factor-binding protein-1 (IGFBP-1) in cervical secretion in women with symptoms of preterm delivery and correlate this test to the Bishop Score in prediction of a preterm delivery. The study group included 30 pregnant women with singleton pregnancy between 24 – 34 gestational weeks who were hospitalized because of a threatening preterm delivery with intact fetal membranes. A positive Actim Partus test (concentration higher than 10 μg/l) and Bishop Score higher than 4 signify a risk of the preterm delivery. The Bishop Score is a better predictor of the preterm delivery in patients with symptoms of the preterm delivery.

In about 70% of cases, ovarian carcinoma has been diagnosed at an advanced stage. Invasion and metastasis of solid tumors request protease activity resulting in basal membrane destruction and surrounding matrix. In that process, urokinase plasminogen activator (uPA) and its receptor, urokinase plasminogen activator receptor (suPAR) play a key role, that via plasmin activation lead to basal membrane and matrix degradation in surrounding of the tumor, enable to its invasion and metastasis. Determination of serum concentration of those tumor markers can be useful in preoperative as well as in postoperative period. Their serum concentrations in ovarian cancer patients may help in good monitoring of remission or progression during chemotherapy treatment. In late 1950s and ear1y 1960s, when it was found out that malignant ovarian tumors were chemosensitive, their chemotherapy treatment has begun. In the beginning it was used only mono-therapy, and by discovering new cytostatics it was replaced by poly-chemotherapy. Now days, in the therapy of advanced stages of ovarian carcinoma combination of cisplatine or carboplatine with paclitaxel is considering as standard treatment. Aim of this study was to determine serum uPA, suPAR and CEA in FIGO II and III patients with different histological type (serous, mucinous, clear cell tumor) before and after PT chemotherapy protocol during following three cycles. In this prospective study we have analyzed 17 patients with ovarian carcinoma, those have been after surgery treated by chemotherapy. Serum levels of uPA and suPAR have been determined by ELISA-test (Imubind uPA, Imubind uPAR, American Diagnostica), and CEA by OPUS Imunoassay method. Results of this study have shown that uPA, suPAR and CEA met criteria for prognostic markers for monitoring of successfulness of platina/taxol chemotherapy protocol for serous, mucinous and clear cell tumor FIGO II and III stage of ovarian carcinoma. In case of PT chemotherapy protocol suPAR was better prognostic marker for monitoring of chemotherapy successfulness (Pearson coefficient 0,9 do 1,0; p<0,00l) than uPA (Pearson coefficient between 0,86 and 0,92; p<0,02) and CEA (Pearson coefficient 0,5 do 0,89; p<0,04).

Aim – The aim of the study was to discover risk factors for delivery-plexus brachialis injury in newborns.  Methods – The data on plexus brachialis paralysis during the delivery of 45503 newborns were analyzed studying retrospectively babies who were delivered from 1 January 1996 to 31 December 2004 at Clin­ics for gynecology and obstetrics at the University-clinical centre in Tuzla. In the analyzed population we found 86 newborns with plexus brachialis injury which developed during delivery (examinees). The control group was formed of 86 newborns without plexus brachialis injury, chosen randomly as a sample from the same population (control group). The examinees and control group were compared regardless of gender, gestation period, delivery weight, presentation (occipital and pelvic) of the fetus during deliv­ery, as well as the Apgar score after the first and fifth minutes. The statistic significance of the results was evaluated with the I‡2 test.  Results – There were no differences in gender between the examinees and the control group. A signifi­cant difference in distribution of delivery weight was found between examinees and the control group: a frequency of delivery weight from 4000-4599 grams, and especially weight higher than 4500 grams, was significantly higher than in the control group. The discovered difference in incidence of occipital presentation during delivery in favor of the examinees was not statistically significant. Examinees had a significantly lower Apgar-score (≤7) - after both the first and fifth minutes. In 35 of 86 (42.5%) examinees we found combined clavicle fracture, plus in one humerus fracture and in one rib fracture.  Conclusion – The result of this research corresponds to findings from literature on risk factors for plexus brachialis injury: the most noticeable risk factors are delivery weight over 4000 grams and a low Apgar-score as a result of traumatic delivery, whereas in our research, contrary to other sources, the pelvic posi­tion of the foetus during delivery was not a statistically proven risk factor, at least in our case.

Many earlier papers have been reported Rh incompatibility as a reason of hydrops fetalis in 80 percent of all cases but with the decreasing frequency of Rh isoimmunization (the introduction of Rh D immune globulin prophylaxis), nonimmune hydrops fetalis becomes a relatively more frequent kind of hydrops. Nonimmune hydrops fetalis has been reported with an incidence of 1 in 2 500 to 1 in 4 000 deliveries.1-4

Aim. To investigate risk factors for brachial plexus palsy in newborns. We analyzed 45 544 live-born children, born over a nine-year period from January 1, 1996 to December 31, 2004. Methods. The analysis was retrospective and based on the medical documentation of the Clinic for Gynecology and Obstetrics, Clinic for Neurology, and Clinic for Physical Medicine and Rehabilitation of the University Clinical Center Tuzla. We compared study and control groups of newborns. Rates among groups were compared using Chi-square, with significance at p < 0.05, and with significance at p < 0.01. Results. Examining epidemiological characteristics, 86 newborns with brachial plexus palsy had been recorded, thus, the prevalence was 1.86 per 1000 live-born children. Analyzing maternal and neonatal factors, and the labor pattern itself, it was found that the highest factors of risk for brachial plexus injury were birth weight of over 4000 g, a precipitous second stage of labor (<15 minutes), and vacuum-extractor assisted labor. Brachial plexus palsy was more frequent when the mothers were overweight, with a body mass index ≥29 kg/m2. None of the parturient women, whose newborns were diagnosed with brachial plexus palsy, had external conjugate diameter <18 cm. Newborns delivered vaginally were not diagnosed with a higher frequency of brachial plexus palsy when compared to newborns who were delivered by cesarean section, but newborns who were vaginal breech-delivered were diagnosed to have a higher incidence of brachial plexus palsy. Newborns whose mothers were older than 35 years were diagnosed to have brachial plexus palsy more frequently, but a statistically significant difference between primiparas and multiparas was not found. A total of 39 newborns (45.2%) were diagnosed with a fracture of the clavicle, which was the most frequently combined damage with brachial plexus injury. Forty-two newborns (48.8%) had an Apgar score of ≤7 in the first minute after delivery, which indicates intrapartal fetal distress and is an indication of the traumatic nature of these deliveries. The average birth weight of newborns with brachial plexus damage was 3858.1±587.7 g, which for an average gestational age of 38.8±1.8 weeks, corresponds to eutrophic newborns. Both male and female newborns were diagnosed to have brachial plexus palsy comparably frequently, and almost all deliveries (97.7%) were initiated spontaneously. The majority of newborns were born between the hours of 02:00 and 03:00 and between the hours of 14:00–15:00.

Normal pH value of vagina from 3.8 to 4.2 has regulatory and protectors mechanisms of vaginal environment. The change in the pH value indicates to presence of disbalance in the ecosystem of vaginal environment. The value of pH above 4.0 is indicator of the decreased number of lactobacillus bacteria and the increased number of other microorganisms in the vaginal environment. This situation is present in the case of developing of bacterial vaginosis. One of the bacteria which is often isolated from vaginal swabs is Enterococcus faecalis. Aims of this study are to examine presence o f Enterococcus faecalis in vagina in healthy women and womenwith signs of bacterial vaginosis, the most often present signs in patients with bacterial vaginosis and isolated Enterococcus faecalis from vaginal swabs, and to determine whether the change of the pH value of vaginal environment could be indicator for bacterial vaginosis associated with Enterococcus faecalis. In this study there were included 90 patients. To all patients there were done: gynecological survey, determined pH of vaginal environment and color of vaginal secret, amino odor test, and taken vaginal swabs for microbiological examination. Enterococcus faecalis was found in the patients with pH 4.0 in 24.05 % cases, but in the patients with signs of bacterial vaginosis it was found in 52.78 %. Positive findings of Enterococcus faecalis was the most often associated with presence of all tree signs of bacterial vaginosis (pH>4.0, changed color of vaginal secret and positive amino odor test) it is in 60.78 6% cases. With two signs of bacterial vaginosis (pH>4.0, changed color of vaginal secret) Enterococcus faecalis was present in 60 % cases. The only presence of change in the pH>4.0 was associated with Enterococcus faecalis in 52.78 %. This study showed that pH change of vaginal environment was associated with Enterococcus faecalis in bacterial vaginosis in high percentage but it can not be used as the sure sign of presence of Enterococcus faecalis in vaginal discharge. Therefore it is necessary to make microbiology examination vaginal discharge.

Spontaneous and habitual abortions are one of most painful experiences for couples expecting a child. It is an extraction or expulsion from its mother of a fetus weighing 500 g or less or pregnancy termination before 24 completed weeks of gestation. The incidence of spontaneous abortion is 15%-25% of all recognized pregnancies. 1%-2% of all women abort habitually. Beside many recognized causes of spontaneous and habitual abortion, 10%-50% are still unknown etiology. The larger numbers of unexplained abortions have immunological reason. By pre-embryonic reorganization of maternal immune system starts subsequent immunoprotective mechanism. There the key role has PIBF (Progesterone induced blocking factor) whose production depends of sufficient circulating progesterone concentration. PIBF supports Th-2 cytokines, inhibits nuclear killer cells (NK cells), induces an increased production of asymmetric, non-cytotoxic blocking antibodies. The production of pro-inflammatory, cytotoxic cytokines interferon-y (IFN-y), tumor necrosis factor-alpha, (TNF-alpha), interleukin-2 (IL-2) is reduced. There is the controversy about treatment of spontaneous and habitual abortion: from "do nothing" to routine pharmacological "support of every the pregnancy".

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).

Vulvovaginitis is the most common gynecologic condition in childhood. The susceptibility of young girls to infection is high because of thin vaginal mucosa and poor hygiene of genital area, recurrent respiratory and urinary infection. The cause of recurrent vulvovaginitis could be the presence of foreign bodies in vagina. We present the case of 5-yaer-old girl who suffered from a vaginal discharge for a long time. All the time she had been under supervision by gynecologists and pediatrician. An episode of vaginal bleeding was the reason for the hospitalization at the Department of pediatrics. After complete evaluation vulvovaginitis was diagnosed, the treatment was continuated by gynecologist. The vaginal examination and vaginoscopy was performed under anesthesia and foreign body was found in vagina. The removal of the foreign body was the definitive treatment and did not require additional measures.

This investigation had an aim to establish the incidence of Enterococcus faecalis in vaginal smears and its correlation with antibiotics used for the treatment of genital and extragenital diseases, as well. By this prospective study 300 women in reproductive period have been involved. An average age was 34.5 years and 282 of them are married. They have been divided in 4 groups, 75 in every group. First group consisted women who have not been treated by an antibiotic in last 6 months; second group--women who have been treated due to infections of genital tract; third group--women were treated for unspecific colpitis and last one group were women treated for extragenital infections. A special designated questionnaire has been used to collect data from patients. A vaginal smears for microbiology examination has been taken at the Gynecological Clinic and Clinic for Infective diseases of The University Clinical Center Tuzla from patients of group I, II and IV and at the Outpatient Clinic from patients of group III. Enterococcus faecalis has been found in 112 patients (37.33%); in first group in 13 (17.33%) cases, in second group in 26 (34.66%), in third group 39 (52%), and in last group in 34 (45.33%) patients, which significantly different. Investigation on sensitivity showed a minimal sensitivity on Penicillin and Streptomycin and no resistance on Vancomycin. In conclusion, it could be said that Enterococcus faecalis was found in 17.33% patients who has not been treated by antibiotics and in 44% who used antibiotics, which differ significantly (p<0.01).