[Placenta percreta--surgical treatment and personal experience]. / Placenta perkreta--hirurski tretman i nase iskustvo.

This is a case report of a female patient with placenta percreta in whom pregnancy was terminated in the XXVII gestational week. The disease was not diagnosed during pregnancy which had a normal course; the suspicion appeared during the third stage of the delivery period and it was confirmed during the operation and subsequent histopathological finding. As profuse bleeding occurred, urgent laparotomy with hysterectomy and unilateral adnexectomy were performed. Thirteen hours after the delivery the infant died.

[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.

[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%).

[Induction of labor using endocervical administration of dinoprost in post-term pregnancy]. / Indukcija porodaja endocervikalnom aplikacijom dinoprostina u postterminskoj trudnoci.

The authors analyzed results of 295 labors induced with endocervical application of dinoprostin (152 term- and 143 postterm labors) in relation to 242 (125 term- and 117 postterm-) spontaneous labors. Delayed labor increases the occurrence of meconial amniotic fluid (21.96%:9.03% p < 0.01), and pathological and prepathological CTG records (23.85%: 11.97% p < 0.005). In addition, children show lower Apgar score (p < 0.001), and among them there are more hypertrophic (6.54%:2.53% p < 0.05), postterm (6.92%:0.0% p < 0.005), and dysmature children (11.92%:3.12% p < 0.01) when compared to children born between the days 274 and 287 of the gestational age. Perinatal morbidity of children born after 287 gestational days in rather high-32.31%. Induction of labor with endocervical application of prostine shortens the duration of the labor (p < 0.001). Large numbers of labors are finished with vacuum extraction-3.73% (3.29% of term- and 4.19% of postterm labors) and cesarear section-12.88% (10.53% of term- and 15.38% of postterm labors) usually due to dystocia of the uterus and hypoxion of the neonate. Labor trauma is the most usual trauma among perinatal problems of new born infants delivered by the induction with prostaglandins and high perinatal morbidity rate is due not only to the induction method but also to the incorrect assessment of the gestational age.