[Premature rupture of the fetal membranes--an active or expectant approach in management of this obstetrical problem]. / Rano prsnuce plodovih ovojaka--aktivni ili ekspektativni pristup resavanju opstetrickog problema.

INTRODUCTION: A prospective investigation and comparative analysis of clinical and microbiological results have been performed as to point to some facts of possible significance in solving the dilemmas concerning the problem of pregnant women with premature rupture of the membranes. MATERIAL AND METHODS: Intensive clinical monitoring of the course, methods and complications of the labor was undertaken in 75 pregnant women with premature rupture of the membranes and term delivery. Smears from the vagina, cervix, amnion and amniotic fluid were obtained from each pregnant woman, as well as nasal and throat smears from newborn infants in order to microbiological analysis. According to the method of labor treatment, the investigated patients (n = 75) were distributed into 2 groups. Early induction of labor was applied in 39 pregnant women (labor induction 6 h following rupture of the membranes) and expectatively treated 37 pregnant women (the control of pregnant women until initiation of the spontaneous contractions associated with antibiotic prophylaxis). RESULTS AND DISCUSSION: Duration of labor (period from rupture of the membranes to the delivery and from the initiation of regular contractions to the delivery) was significantly shorter (p < 0.01) in the induced labor group. Cesarean section was performed in 18.4% od labors in the first and in 13.5% of labors in the second group. Chorioamnionitis occurred in 7.9% in the first and in 21.6% in the second group during the labor (p < 0.05). The incidence of puerperal and neonatal infection was lower in the first investigated group (7.9% and 5.2%) than in the second group (18.9% and 16.2%). Positive microbiological finding was recorded in 13.2% of pregnant women from the first group and in 27.0% from the second group (p < 0.05). CONCLUSION: From the medical point of view it is reasonable to apply early induction of labor in pregnant women at more than 34 weeks' gestation. In pregnant women of less than 34 weeks' gestation, the expectant management of labor is recommended only in the next 48-72 hours.

[Prostaglandins in the induction of labor at term with premature rupture of fetal membranes]. / Prostaglandini u indukciji porodaja u terminu s prevremenim prsnucem plodovih ovojaka.

A prospective, randomized study included 389 pregnant women with normal pregnancy, gestational age of 37 weeks (259 days) in whom the delivery started by premature rupture of fetal membranes and without labor pains 6 or more hours after rupture of fetal membranes. The Bishop score was < or = 6 and there were no clinical or laboratory signs of infection before induction. The first group (n = 219) included pregnant women at term with premature rupture of fetal membranes and unfavourable pelvic score in whom labor was induced by intracervical dinoprostone. The second-control group (n = 170) included pregnant women at term with premature rupture of fetal membranes and unfavorable pelvic score in whom delivery was induced by oxytocin infusion. In a 6 hour interval from the beginning of induction 61.64% women from the I group and 40.00% from the control group had a pelvic score > or = 7, (p < 0.05). After 12 hours the Bishop score was > or = 7 in 89.94% of women from the I group and 61.18% from the II-control group (p < 0.03). 63.34% of women, in whom labor was induced by intracervical application of dinoprostone, had an additional oxytocin induction. 82.18% of women from the first group and 62.25% from the second group (p < 0.05) had vaginal delivery with reduced activity of the uterus (p < 0.05) and significantly decreased number of irregular labor pains (p < 0.05) with hypertonia, hypercontraction and frequent contractions. In the first group the mean time of induction was 8.12 +/- 5.51 hours, while in the second-control group it was 10.83 +/- 7.34 hours (p < 0.01). In the group of deliveries induced by dinoprostone incidence of puerperal induction was 1.01% and 5.93% in the control group. Neonatal infection occurred in 3.19% of newborns in the first group and in 11.18% in the second group. 5.05% of newborns from the first group and 9.41% from the control group suffered from perinatal trauma and anoxia. In the first group the total perinatal morbidity was 10.43% and 31.18% in the second group (p < 0.05).

[Delivery with vacuum extraction--indications, technique and complications]. / Porodaji vakuum ekstrakcijom--indikacije, tehnika i komplikacije.

This study is a retrospective analysis of data on deliveries which ended up in vacuum extraction at the Clinic of Gynecology and Obstetrics in Novi Sad during two periods: 1983-85, and 1993-95. The aim of this study was to analyze indications, technique and complications of deliveries which ended up in vacuum extraction. Out of the total number of deliveries-17,110 in the period 1983-85, 4.86% ended up in vacuum extraction. The perinatal morbidity was 10.82%, the perinatal mortality 15.13/1000. In the period 1993-95, there were 18,599 deliveries, whereas 2.65% ended up in vacuum extraction. The perinatal morbidity was 8.93%, while perinatal mortality 11.12/1000. The risk of morbidity occurring in surgical procedures can be decreased if prompt vacuum extraction is performed.

[Cesarean hysterectomy im modern obstetrical practice from 1968 to 1993]. / Histerektomija cezarea u savremenoj opstetrickoj praksi u periodu 1968-1993. godina.

A retrospective study of cesarean hysterectomies at the Department of Obstetrics and Gynecology in Novi Sad was conducted for the period 1968-1993. There were 129,127 deliveries, whereas cesarean section was performed in 10,485 (8.12%) cases. There were 55 cesarean hysterectomies (0.042%), while in 0.52% they were performed during cesarean section. Elective hysterectomy was performed in 7 (12.73%) cases because of neoplastic process and uterine myoma, while in 48 (87.27%) cases it was performed for heavy bleeding. Most often bleeding occurred due to complications of placenta previa, uteroplacental apoplexy, premature placental ablation, uterine rupture and atony. Total hysterectomy was performed in 30 (54.54%) cases and subtotal hysterectomy in 25 (45.45%) cases. Bilateral adnexectomy was performed in 3 (5.45%) cases. Urinary bladder injury occurred in 4 (7.27%) patients, wound infection in 11 (20.00%) patients, urinary infection in 3 (5.45%) and pelvic peritonitis in 1 (1.82%) patient. One maternal death (1.82%) occurred due to DIC (disseminated intravascular coagulation). Out of 57 delivered newborns 20 (35.10%) died in the perinatal period. There were 13 stillbirths (22.80%), whereas 7 newborns (12.30%) died in the early neonatal period due to prematurity and RDS (respiratory distress syndrome).

[Nutritional status in women and estrogen production in surgical menopause]. / Uhranjenost zena i produkcija estrogena u hirurskoj postmenopauzi.

The objective of this study was to examine how nutritional status, in women with bilateral ovariectomy and after preservation of ovaries, influences estrogen production. After bilateral ovariectomy statistically significant low values of urinary estrogens were recorded (21.76 nmol) in regard to ovarian preservation (87.80 nmol). Urinary estrogen values correlated with obesity in women with bilateral ovariectomy: in undernourished they were 10.50 nmol, in normally nourished 21.05 nmol, and in obese women 25.05 nmol. These differences are statistically significant. This can be explained by a higher conversion of androstendione to estrone, in the massive tissue, which is the main source of estrogen in postmenopause. This correlation does not exist in women with preserved ovaries, because in that case they are the basic source of estrogen.

[Postoperative infection as an indication for hysterectomy after cesarean section]. / Postoperativna infekcija kao indikacija za histerektomiju nakon porodaja carskim rezom.

Even today infection is the most important cause of morbidity and mortality after cesarean section. The aim of this paper is to point to the significance of hysterectomy in treatment of puerperal infection in the contemporary obstetrics. During a 15- year period (1981 - 1995) 85231 deliveries were performed at the Clinic for Gynecology and Obstetrics in Novi Sad (Yugoslavia). There were 8609 (10.10%) cesarean sections. Hysterectomy was performed in 16 cases (0.186%) of women undergoing cesarean section due to dehiscence of uterine suture, endometritis, diffuse peritonitis or sepsis. Infection during delivery was diagnosed in 3 (18.75%) cases, the delivery itself began by amnion rupture in 5 (31.25%) cases, it lasted more than 12 hours in 6 (37.50%) cases. Elective cesarean section was performed in 3 (18.75%) cases, cesarean section during delivery in 13 (81.25%) and iterative cesarean section in 5 (31.25%) cases. Total hysterectomy was performed in 9 (56.25%) cases and subtotal in 7 (43.75%) cases. Postoperative treatment by antibiotics was carried out in all cases. There were postoperative complications after hysterectomy in 7 (43.75%) cases. According to results of microbiologic analyses in 7 (43.75%) cases one cause was determined, while in 9 (56.25%) cases two or more causes were determined. Gram-negative-bacteria were the most common cause (68.75%).

[Diagnostic significance of preoperative determination of CA-125 serum levels in the differentiation of malignant and benign pelvic masses]. / Dijagnosticki znacaj preoperativnog odredivanja koncentracije CA-125 u serumu u diferencijaciji malignhin i benignih karlicnih tumefakcija.

Preoperative estimation of serum C-125 tumour marker was performed in 45 patients with adnexal malignancies, 50 patients with benign pelvic masses and in 30 healthy women who underwent plastic surgery for disturbed statics of genital organs. Elevated serum CA-125 values (above 65 U/ml) were observed in 38 (84.5%) patients with ovarian malignancies (chi = 355.93, SD +/- 251.86) and in 7 (14%) patients with palpable benign pelvic masses (chi = 48.09, SD +/- 77.08). Preoperatively evaluated serum CA-125 values were not evident in the control group (chi = 7.20, SD +/- 6.98). There were statistically significant differences (T = 8.13, p < 0.05) between preoperative mean serum CA-125 values in the patients with malignant and benign pelvic masses. Also, there was statistically significant difference between the control group, the group with malignancies (T = 7.48, p < 0.05) and the group with benign pelvic masses (T = 2.86, p < 0.05). Preoperative assessment of the serum CA-125 values proved to be significant but not absolutely reliable laboratory-diagnostic parameter in differentiation of malignant and benign pelvic masses in the female.

[Breech presentation terminated by cesarean section]. / Porodaj zatkom zavrsen carskim rezom.

The prospective study was carried out in 86 mothers and their newborns born in breech presentation; 41 were delivered by cesarean section, 45 vaginally. The incidence of prepathologic and pathologic CTGs was rather high in both groups (34.14% and 24.34%) as well as the presence of meconium in the amniotic fluid (34.15% and 22.22%). The infants delivered by cesarean section have significantly (p < 0.05) higher pH levels (7.28 +/- 0.068) than those delivered vaginally (7.25 +/- 0.093). The acidosis incidence (pH +/- 7.20) is significantly (p < 0.01) lower in the first (9.76%) than in the second (26.66%) group. In the early neonatal period 24.35% of the children in the first group and 35.55% of the children in the second group developed a disease (p < 0.05). The difference in the morbidity rate can also be found in the fact that in the studied group no intracranial hemorrhage was diagnosed while in the control group it was found in 17.77% of the children. Manifest cerebral disfunction syndrome was detected in 2.44% of the children delivered by cesarean section and in 8.88% of the children delivered vaginally. One child (2.22%) delivered with manual help has died. The morbidity of the mothers was significantly (p < 0.05) higher in women who gave birth abdominally (17.68%) than in those who gave birth vaginally (8.88%).

[Risks for neonates born in the breech presentation]. / Rizik za novorodence u porodaju zatkom.

A prospective study included 106 females and their newborns, 45 of them born in breech presentation and 61 delivered normally. The incidence of prepathologic and pathologic CTG records and meconial amniotic fluid is significant (0.01), more frequent in breech presentation (24.44% and 22.2%) than in normal deliveries (8.20% and 9.84%). Children born in breech presentation have significantly (p < 0.005) lower Apgar score values after the 1st and 5th minute than the control children. Infants born in breech presentation have significantly (p < 0.01) lower pH values (7.25 +/- 0.093) than those delivered normally (7.30 +/- 0.056). The acidosis incidence (pH < 7.20) in the studied group was 26.66% and 3.38% in the control group. In early neonatal period the disease occurred in 35.55% of the breech presentation group and 9.83% of the normal group (p < 0.01). In the control group there was no intracranial hemorrhages and manifest cerebral disfunction--complications most frequently involved in perinatal morbidity of children born in breech presentation (17.77% and 8.88%). One (2.22%) child born in breech presentation died in the early neonatal period.