Vaginal delivery through annular placenta -- case report.

Annular placenta is an extremely rare morphological type of human placenta. It is commonly related to placental vessel abnormalities frequently causing antenatal and postnatal hemorrhage and operative delivery. Gravida 4 para 1 had an uneventful course of pregnancy and normal vaginal delivery followed by moderate postpartum hemorrhage. Hemorrhage was found to be local in origin but the placenta was annular in shape and the newborn was delivered through one of the openings. Annular placenta was not recognized before delivery. Its implantation site was in the lower uterine segment but high enough to allow the passage of the fetus through its annular defect and vaginal birth. To our knowledge, this is a first report of annular placenta ending in normal vaginal delivery.

Delivery of medical services to different national groups during the war: an example from Bosnia and Herzegovina, 1991-2000.

OBJECTIVE: To investigate the delivery of health services to different ethnic groups in the war and postwar periods in the area of Livno, Bosnia and Herzegovina. METHODS: The total population, percentages by nationality, and numbers of persons medically or surgically treated at the War and General Hospital of Livno between January 1991 and October 2000 were retrospectively analyzed. Demographic data from church, military, and local government archives of the Livno region were used. RESULTS: In the prewar period (1991-1995), there had been living approximately 40,000 inhabitants (Croats, 75%; Moslems, 17%; Serbs, 8%) and 685,361 patients were treated (Croats, 46%; Moslems, 33%; Serbs, 21%). In the war period, 1590 patients were treated surgically (Croats, 78.5%; Moslems, 16.8%; Serbs, 4.7%). In the postwar period (1996-2000), surgery was performed for 3217 patients (Croats, 76.8%; Moslems, 19.3%; Serbs, 3.9%). CONCLUSION: The constant numbers of patients of different nationalities treated during and after the war reveal that the medical staff worked in an ethical and highly professional manner.

[Perinatal outcome of multiple pregnancies in maternity wards in Knin and Livno in 1990-2002]. / Perinatalni ishod viseplodnih trudnoca u rodilistima Knin i Livno 1990-2002. godine.

The aim of this study was to examine perinatal outcome of twin pregnancies in maternity wards in Livno and Knin. The perinatal outcome in these two maternity wards was examined retrospectively during the period 1990-2002. The incidence of twin births, the month with the highest incidence of twin births, the age and parity of the women with twins and their gestational age were examined. Also, we compared the perinatal outcome of twins with singletons, distribution according to sex, lie and presentation at birth. During 13 years 10,856 newborns were delivered, and 127 (1.2%) of them were twins. The incidence of twins in maternity wards in Knin and Livno during the war and after the war was not significantly different (p = 0.89). The month with the highest incidence of twin births was May (14.8%). The avarage age of women with twins was 28.9 +/- 9.7. Twins were born mostly by multiparas (2-4 deliveries). 94 (74%) twins were born on term and 33 (26%) twins before term. 74 newborns (7% per hundred) from singletons and 11 (43% per hundred) from twins died during perinatal period. Twins were delivered by cesarean section (27%) three times more often than singletons (8%). Hypertension in twin pregnancies (7%) was twice as frequent as in singletons (4%). 132 (51.6%) male and 122 (48.4%) female newborns were born. The distribution according to sex was: 58 pairs "male-females", 37 "male-male" and 32 pairs "female-female". The distribution according to presentation at birth was: 49% "cephalic-cephalic", 29% "cephalic-breech", 12% "cephalic-transverse", 5% "breech-breech" and all other combinations got 5%. In conclusion, our results during the war and after the war were not different from other centers and studies thanks to good antenatal care and selection of twin pregnancies for transportation on time to the center with higher level of health care.

[Perinatal care in Livno immediately after the war from 1995 to 1999]. / Perinatalna skrb u Livnu u neposrednom poracu 1995.-1999. godine.

The paragraphs of statistics for maternity hospital of county hospital in Livno for period 1995-1999, year are presented and describe perinatal, fetal and early neonatal mortality, newborns to birth-weight, the frequency of caesarean section, eclampsia, vacuum extraction, antenatal care and equipment maternity hospital and morbidity of the infants. Perinatal mortality in 1995 was 5.6@1000, but for 4 years 6.9@1000. Early neonatal mortality was appearing till 1996 year only with one death of newborn (1.1@1000). Fetal mortality was increased to 12.3@1000 in 1997; but the years before was 6.2@1000. According to the weight of newborns, 3.5% were no more than 2.500 g, but 93.5% were between 2.500-3.000 g, while newborns over 4.000 g where 3.0 percent. Watching and closely looking statistics for years in the classified groups does not fortify the major differences, except 1995 when was 1.7% newborns less than 2.500 g, but over 4.000 g 7.9%, that is under average and explaining to the minimum numbers of birth that year, and orienting refugees and exilied pregnant women to the centres with stronger obstetric and neonatal care Eclampsy were 9 and it was 2.2@1000. The number of antenatal visits of pregnant women increase during all these years, so that total number of visits was 20.905, that means 5.2 was the middle number of visits. There are much more without 2.0% or less than 3 visits 5.0%; with 9 or more 29.0%; the average number ultrasound examination is 3.4, and total 13.748, 37.0 percent of pregnant women is with 3 examples and 10.0% with 4 or over it, but 7.0% without ultrasonographc. It is obviously, that the number of the pregnant women without ultrasound examination is falling, so in 1995 there was 14.0% but 2.0% in 1999. Very important is increase those with 3 examination according to 1995 when there was 27.0%, but 47.0% in 1999. The usage of caesarean section is 7.7% but the major increase was in 1998 and it was 9.4% and 1999 is 10.1%. Vacuum extraction was used in 67 (1.7%) of newborns but in 1995 was 3.2%, the obstetric activity does three gynecologists. For perinatal mortality is important to say, that, during the war time, about 6.9@1000 in maternity hospital Livno was ranged into the group with low perinatal mortality. According to, the number of vacuum extraction belongs to the number of maternity hospital with vacuum extractions below 2.0%. Maternity hospital has two incubator after 1997 year and cardiotocographic intrapartal monitoring was used in about 55-65% of all deliveries.