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.

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.

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.