BACKGROUND Obstetrical brachial plexus lesion (OPBL) complicates a very small proportion of births. The aim of this study was to establish incidence of OPBL at Department of Gyneclogy and Obstetrics during a period of nine years, from 01.01.1996 to 31.12.2004, and to analyse intrapartum risk factors for OPBL. SUBJECTS AND METHODS The analysis was retrospective and is based on medical documentation from Departments of Gynecology and Obstetrics, Neurology, and Rehabilitation, University Clinical Center Tuzla. We analyzed a group of 86 newborns with OPBL born form 01.01.1996. - 31.12.2004. Differences among study and control groups were compared using Hi2 test. Probability value of p<0.01 was considered significant. RESULTS During nine years period incidence of OPBL was 1.86 per 1000 live-born children. Analyzing maternal factors, and the delivery pattern itself, we have found that the highest factors of risk for OPBL are shortened second stage of delivery (<15 minutes) (p<0.01), and vacuum-extractor assisted delivery of newborns (p<0.01). Newborns, who were delivered vaginally, were not diagnosed to have a higher frequency of OPBL compared to newborns who were delivered by Caesarian section. CONCLUSION Incidence of OPBL at Departmenf of Gynecology and Obstetrics is 1.86/1000 liveborn children. Most important intrapartum risk factor for OPBL are shortened second stage of delivery and vacum-extractor assisted delivery.

AIM To compare perinatal and maternal outcomes in Tuzla Canton during the 1992-1995 war in Bosnia and Herzegovina with those before (1988-1991) and after (2000-2003) the war. METHODS We retrospectively collected data on a total of 59,707 liveborn infants and their mothers from the databases of Tuzla University Department for Gynecology and Obstetrics and Tuzla Institute for Public Health. Data on the number of live births, stillbirths, early neonatal deaths, causes of death, gestational age, and birth weights were collected. We also collected data on the number of medically unattended deliveries, examinations during pregnancy, preterm deliveries, and causes of maternal deaths. Perinatal and maternal outcomes were determined for each study period. RESULTS There were 23,194 live births in the prewar, 18,302 in the war, and 18,211 in the postwar period. Prewar perinatal mortality of 23.3 per 1000 live births increased to 25.8 per 1000 live births during the war (P<0.001), due to a significant increase in early neonatal mortality (10.3 per thousand before vs 15.1 per thousand after the war, P<0.001). After the war, both perinatal mortality (14.4 per thousand) and early neonatal mortality (6.6 per thousand) decreased (P<0.001 for both). The most frequent cause of early neonatal death during the war was prematurity (55.7%), with newborns most often dying within the first 24 hours after birth. During the war, there were more newborns with low birth weight (<2500 g), while term newborns had lower average body weight. Women underwent 2.4 examinations during pregnancy (5.4 before and 6.3 after the war, P<0.001 for both) and 75.9% had delivery attended by a health care professional (99.1% before and 99.8% after the war; P<0.001 for both). Maternal mortality rate of 65 per 100,000 deliveries during the war was significantly higher than that before (39 per 100,000 deliveries) and after (12 per 100,000 deliveries) the war (P<0.001 for both). CONCLUSION Perinatal and maternal mortality in Tuzla Canton were significantly higher during the war, mainly due to lower adequacy and accessibility of perinatal and maternal health care.

Antepartum administration of corticosteroids induces biochemical and structural maturation of a number of fetal organs which enables the reduction of complications caused by pre-term birth. The aim of this study was to assess the impact of antepartum administration of corticosteroids to the mother on the incidence, time, beginning, degree and death rate from intracranial bleeding in pre-term live-borns. The retrospecive study in the Clinic for Gynaecology and Obstetrisc in Tuzla in the period from 1st January 2002 to 31st December 2005 includes all live-borns with body weight below 2000 grams and gestation age between 28. and 34 weeks, of both sexes, from single pregnancies and without visible anomalies (n=418). The children were then divided into two groups: the study group (sample) whose mothers received antepartum administration of dexametazon (n=279), and the test group whose mothers did not receive antepartum administration of dexametazon (n=139). Multiple ultrasonic examination of the cranium was used to look for intracranial bleeding which was graded according to Papile into four degrees. Intracranial bleeding was found in 203 of 418 pre-terms (48.6%. The incidence of bleeding among 279 examined babies was 108/279 = 38.7%, and in the test group of 139 there were 95/139=68.3% bleedings. The relative risk of bleeding among the sample babies compared to the risk from bleeding in the test group was considerably smaller (29.2%). The increased relative risk for the occurrence of bleeding was found in low body weight(64.2%), and reduced in higher body weight(10.3%). Comparing the time of the beginning of bleeding, the risk for the occurrence of bleeding in the first three days is considerably lower in the study group (20.1%) when compared to the risk of the beginning of bleeding in the test group. Considering the degree of bleeding, the study group shows less profuse bleeding (59.2%) when compared to the test group (49.5%), but the difference is not statistical significant. In the total number of 418 studied preterm babies (both study group and test group) there were 57 lethal outcomes in the studied period, so the mortality was 13.6%. The relative likelihood of survival of all studied patients (with and without bleeding) was 4.69 times higher compared to the likelihood of survival of all babies in the test group. The likelihood of survival of the babies with bleeding is the same as the likelihood of survival of babies with bleeding from the test group [RR = 1,078 (95% CI= 0.501-2.318)] while the likelihood of survival of babies without bleeding from the study group was considerably higher than the ones in the test group [RR=41.75 (95% CI= 13.161-132.433)]. In conclusion antepartum administration of corticosteroids to the mother decreases the risk of intracranial bleeding in pre-term babies compared to the risk of pre-term babies whose mothers were not given antepartum corticosteroids. When bleeding develops in spite of steroids, the risk of the beginning of bleeding moves in prenatally treated pre-term babies compared to test group from the first three days to the period between the 4th and 7th day of life. In preterm baby when bleeding develops in spite of steroids, the likelihood of survival is the same in both groups, which leads to the conclusion that corticosteroids received antepartum do not have any impact on survival. Despite this, our investigation showed that the likelihood of survival of the study group who received antepartum corticosteroids without intracranial bleeding was higher compard with the test group without bleeding, because of corticosteroids received antepartum may have some other good impact for survival apart from stopping bleeding.

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.

Influence of perinatal complications on serum levels of alpha 1-antitrypsin was investigated in preterms newborns. Investigation was performed on two groups of newborns: first group consisted of 40 preterm newborns (gestation below 37 weeks) with perinatal complications, and second group consisted of 40 newborns without perinatal complications (gestation 37-42 weeks). Values of al-AT in serum preterm newbornswere 1,76+/-0,48 g/l, and in health newborns 1,88+/-0,31 g/l. Statistically significant difference was noted between two investigated serum values (p<0,0008). There was not a statistically significant influence of sex of investigated newborns in serum levels of alpha1-AT. From all investigated perinatal complications (RDS, brain damage, infection, deviation of intrauterine growth, ruptura vela filamentorum, vitium cordis congenita and more complications) variable "infection" has had only statistically significant influence on serum levels alpha1-AT (p< 0,02). T he opinion o f authors of th is investigation is that serum levels of this protein could be usefull in a diagnostic purposes, even if antibiotic treatment was started, and it will be a usefull as an early marker of pure treatment some of diseases.

AIM of this work is to show epidemiological and clinical characteristics of congenital anomalies in Tuzla Canton, Bosnia and Herzegovina. MATERIALS AND METHODS Retrospective analysis of 41 395 labours in Ob & Gyn Clinic University Clinical Centre, Tuzla, from Jan 1995 to Dec 2003. Diagnosis of congenital anomalies was performing on the basis of clinical, ultrasound examination, CAT scan and cariotype. RESULTS In the eight years period we have registered 647 live born both genders with congenital anomalies on the birth, with incidence 1:63.97 and prevalence 15.62 on 1000 live born. Most frequently we had hearth congenital anomalies (22.10%) with prevalence of 3.45%. Chromosomal aberrations--Sy Down we had in 83 cases with incidence 1:498.7. Age structure of mothers was between 16 to 42 years, with average age 29,85 (SD +/- 2). Sufficient but not optimal number of controls during pregnancy (8-10) we have only in 8.19% of mothers. Rate between genders was 1:1,27 in favour of female newborns which is significantly different from general population with rate 1,08-1 in favour of male newborns in Tuzla Canton. We have a few options for operative treatment (5.71%) especially in centres with low possibilities for postoperative care and therapy and consequently high mortality (25.96%). CONCLUSION Congenital anomalies are great problem for health care in Tuzla Canton, so we urge to salvation of this problem at the state level.

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.

Respiratory distress syndrome (RDS) is a syndrome of respiratory malfunction occurring in pre-term newborns. Twin pregnancy is a risk factor for the occurrence of RDS. The objective of our study is to analyse RDS incidence in pre-term twins and to determine the mortality in this group of newborns compared to single pregnancy pre-term babies. The study is based on the data collected in Clinic for Gynaecology and Obstetrics, Neonatology Department in the year 1999. RDS was diagnosed on the basis of clinical status and radiology findings. In the course of the test period, 544 pre-terms were born, 91 (16.7%) of them being from twin pregnancies. RDS developed in 132 newborns from single pregnancies (29.1%), in 28 newborns from twin pregnancies with RDS developed in both twins (30.7%) and in 19 babies whose twin siblings did not have RDS. If we consider gestation age, RDS developed in 28.6% twins born between 32nd and 36th gestation week and in 20.45% single newborns of the same age. The results were similar in younger gestation age. Mortality rate in the tested group was 17.8% and 9% in the control group. These results lead us to the conclusion that pre-term newborns from twin pregnancies tend to develop RDS, a more difficult clinical status, have more complications and higher mortality rate than the newborns from single pregnancies.

Convulsions are relatively frequent in neonatal population. They are also the most dramatic sign of a disorder of the central nervous system. Clinical signs of convulsive seizures in neonatal period differ greatly from those occurring in a later stage. Our study involves a five year period, in the course of which we analysed all newborns with convulsions occurring in the early neonatal period. The objective of the study was to determine the incidence, aetiology and time of occurrence of convulsions, to determine the mortality rate in this group of newborns and to assess risk factors for the development of convulsions. In 29.423 newborns tested in the course of the study at our Clinic, convulsions were found in 38 (0.13%) of them. Regarding the gestation age, 68.4% of the cases of convulsion occurred in at term newborns. The most frequent aetiology factor was a perinatal damage, in 60.4%, and the majority of convulsive seizures occurred in the period between the 2nd and 7th day (84.3%). Five of the tested newborns died (13.5%), three of them having suffered from convulsions in the first 24 hours. The authors came to the conclusion that many factors influence the development of convulsions, and that the occurrence of convulsions in the first 24 hours and heavy perinatal brain damage give bad prognostics for survival.