Causes of an Increased Rate of Caesarean Section.

INTRODUCTION: The increase in the percentage of the Cesarean sections has got an important place in determination of modern obstetrics. The evaluation of that needs actual, modern opinion for obstetrics and transformation actual obstetric science than investigating the best situation for the mother and child in the actual moment. All medical, organizational, economic and ethical capacities with support of modern diagnostic and therapeutic procedures present a reason for the access in modern obstetrics. It takes the descriptive and analytic method at work. In our country the percentage of the Caesarean section is 15% (according to WHO data), with large variations in frequency depending on the writer and the investigated time. AIM: To investigate the prevalence of Cesarean section in Bosnia and Herzegovina until 2017. PATIENTS AND METHODS: In our investigation made prospective and target analysis is investigated at 2017 as a target year. Sources are: patient charts, notes and charts of new born. Group A presents number investigated patients with made Cesarean section in time at one year (2017) in General hospital "Prim.dr A.Nakas". Group B presents control group with identical number of deliveries with Cesarean section in 2007 in General hospital "Prim.dr A. Nakas" with all variables who detected in investigation group. RESULTS: Analysis the number of deliveries finished Cesarean section in time from 2007 to 2017 in General hospital "Prim.dr Abdulah Nakas "Sarajevo presents augmentation frequency from 15,5 % in 2007 year to 21,7 % in 2011; smaller number in 2012 to 20,3% and finally 22.9% in 2017 for all deliveries. CONCLUSION: Our investigation shows an important number of Cesarean section and is still working because of clearer obstetric indication but they make a vital indication for the mother and baby. It worries percent of poorly described indications, that are something important for the comfort of doctor and any patients that wants natural delivery. It worries the public because the more important short term and long-term unwanted effects; Cesarean delivery in correlation with augmentation of this operation.

Use of Quantitative Fluorescent Polymerase Chain Reaction (QF PCR) in Prenatal Diagnostic of Fetal Aneuploidies in a 17 Month Period in Parallel with Karyotyping.

INTRODUCTION: QF PCR has recently entered diagnostic practice as a possible way to bypass culturing of the fetal cells, as well as to provide a rapid response following amniocentesis. MATERIAL AND METHODS: The effective value of the QF PCR remains a much debated issue, positions ranging from that it makes classic kayotyping obsolete except in special occasions, to that it is no more than a guideline for a mandatory karyotype. Current practices of the gynecology specialists generates samples in such fashion that kariotyping of samples quickly falls behind to the point of obsoleteness, because, by the time a karyotype has been finished, a window of opportunity for termination of pregnancy has closed. RESULTS: QF PCR provides a rapid response alternative, but it is necessary to establish its reproducibility, as well as an algorithm of its use along classic kariotyping. This study contains samples processed in a period from August 1, 2012 to December 31 2013 in both QF PCR and classic karyotype. Object of this study was compare results obtained by two methods, and establish confidence interval of the QF PCR testing. Overall, 661 amniotic fluid samples were processed and typed with QF PCR, out of which 221 were done in parallel with karyiotyping, as an confirmation of results.

Ultrasound evaluation of uterine scar after Cesarean section and next birth.

INTRODUCTION: Cesarean section (Sectio Caesarea) is a surgical method for the completion of delivery. After various historical modifications of operative techniques, modern approach consists in the transverse dissection of the anterior wall of the uterus. The rate of vaginal birth after cesarean section was significantly reduced from year to year, and the rate of repeated cesarean section is increased during the past 10 years. Evaluation of scar thickness is done by ultrasound, but it is still debatable size of thick scar that would be guiding "cut-off value" for the completion of the delivery method. GOAL: The aim was to examine the most accurate ultrasonic method for assessing thickness scar on the uterus after previous cesarean delivery and determine the threshold thickness of scar that would allow the completion of birth vaginally. MATERIAL AND METHODS: Conducted is prospective study of 108 pregnant women aged 20-42 years, who had previously had a Caesarean section. Diagnostic accuracy in assessing the success of scar scale by evaluation of delivery (spontaneous or caesarean section). Measurements were carried out by 2D and 3D ultrasound machines in the 20, 38-40 week of gestation and 48 hours after birth. RESULTS: Tests have shown that there is a statistically significant difference in the rates of specificity (0.04), sensitivity (0.05), PPV (0.01) and NPV (0.01) between 2D and 3D ultrasound. Ultrasound images of uterine muscle scar after prior cesarean section are better by 3D methods. The marginal value, "cut-off value" thick scar, which provides the possibility of vaginal birth after previous incision was 3.5 mm. CONCLUSION: The study showed that ultrasound measurement of 3D ultrasound thick scar on the uterus after previous cesarean section has practical application in determining the mode of delivery among pregnant women who have previously given birth by Caesarean section.

Ultrasound evaluation of uterine scar after cesarean section.

INTRODUCTION: The rate of attempted vaginal birth after previous cesarean delivery has decreased, while the success rate of such births increased. Advances in surgical techniques, the development of anesthesiology services, particularly endotracheal anesthesia, very quality postoperative care with cardiovascular, respiratory and biochemical resuscitation, significantly reduce maternal mortality and morbidity after cesarean section. Progress and development of neonatal services, and intensive care of newborns is enabled and a high survival of newborn infants. Complications after cesarean section were reduced, and the introduction of prophylaxis and therapy of powerful antibiotics, as well as materials for sewing drastically reduce all forms of puerperal infection. GOAL: Goal was to establish a measurement value of the parameters that are evaluated by ultrasound. MATERIAL AND METHODS: Each of the measured parameters was scored. The sum of points is shown in tables. Based on the sum of points was done an estimate of the scar on the uterus after previous caesarian section and make the decision whether to complete delivery naturally or repeat cesarean section. We conducted a prospective study of 108 pregnant women. Analyzed were: shape scar thickness (thickening), continuity, border scar out, echoing the structure of the lower uterine segment and scar volume RESULTS: The study showed that scar thickness of 3.5 mm or more, the homogeneity of the scar, scar triangular shape, qualitatively richer perfusion, and scar volume verified by 3D technique up to10 cm are attributes of the quality of the scar. CONCLUSION: Based on the obtained results we conclude that ultrasound evaluation of the quality of the scar has practical application in the decision on the mode of delivery in women who had previously given birth by Caesarean section.

Conization as treatment of choice for precancerous changes and university cervical cancer at the Department of Obstetrics and Gynecology of Clinical Center of Sarajevo University in 2009.

UNLABELLED: According to the Public Health Institute of the Federation of Bosnia and Herzegovina there were 132 newly diagnosed patients with cervical cancer in 2008. AIM: The aim of this article is to present the incidence of precancerous changes on the cervix and cervical cancer as well as the incidence of the use of conization as the type of treatment for cervical patients. METHODS: The number and type of surgical procedure was analyzed using the protocols from the Clinic of Gynecology and Obstetrics and Clinical Pathology and Cytology. At the Clinic of Gynecology and Obstetrics cold-knife conization with application of Sturmdorf sutures. RESULTS: In 2009 at the Clinic of Gynecology and Obstetrics there were 72 newly diagnosed women with cervical cancer, out of which 16 had in situ carcinoma, 158 CIN I lesions, 64 CIN II lesions, and 46 CIN III lesions. Planocellular carcinoma was diagnosed in 59 patients (82%), cervical adenocarcinoma in 13 patients (18%). 114 patients were treated with conization with the application of Sturmdorf sutures. The most common diagnosis made with pathohistological analysis of the conization was CIN III/CIS, which was found in 48 (29%) patients. CIN II and CIN III were diagnosed in 33 (29%) and 27 (24%) patients, respectively. CONCLUSION: Surgical method of treatment of precancerous changes as well as cervical cancer using the cold-knife conization with Sturmdorf sutures has shown high efficacy but with certain disadvantages such as the formation of scars, cervical stenosis, postoperative bleeding and others. Therefore, there is a need for the introduction of new protocols and newer methods of treatment. In order to decrease the number of women with precancerous changes, screening program is needed as the required part of women's health care plan as well as the introduction of HPV vaccination program.