Clinical Manifestation and Obstetric Outcomes in Pregnant Women with SARS-CoV-2 Infection at Delivery: A Retrospective Cohort Analysis.

This retrospective cohort study aimed to analyze the clinical manifestations, complications, and maternal-fetal outcomes in patients affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during delivery. The cohort included 61 pregnant women positive for SARS-CoV-2 infection at the time of delivery. Patients were divided into two groups: symptomatic and asymptomatic. We found a significantly higher rate of leukocytosis (p < 0.00078) and lymphopenia (p < 0.0024) in symptomatic women compared with asymptomatic ones. Other laboratory parameters, such as CRP (p = 0.002), AST (p = 0.007), LDH (p = 0.0142), ferritin (p = 0.0036), and D-dimer (p = 0.00124), were also significantly more often increased in the group of symptomatic pregnant women. Overall, symptomatic pregnant women with SARS-CoV-2 infection at the delivery show more often altered laboratory parameters compared with asymptomatic ones; nevertheless, they have a slightly higher but non-significant rate of preterm delivery, cesarean section, as well as lower neonatal birth weight and Apgar score, compared with asymptomatic women.

Efficacy of transvaginal ultrasound versus magnetic resonance imaging for preoperative assessment of myometrial invasion in patients with endometrioid endometrial cancer: a prospective comparative study.

BACKGROUND: We compared the accuracy of preoperative transvaginal ultrasound (TVUS) versus magnetic resonance imaging (MRI) for the assessment of myometrial invasion (MI) in patients with endometrial cancer (EC), while definitive histopathological diagnosis served as a reference method. PATIENTS AND METHODS: Study performed at a single tertiary centre from 2019 to 2021, included women with a histopathological proven EC, hospitalized for scheduled surgery. TVUS and MRI were performed prior to surgical staging for assessment MI, which was estimated using two objective TVUS methods (Gordon's and Karlsson's) and MRI. Patients were divided into two groups, after surgery and histopathological assessment of MI: superficial (≤ 50%) and deep (> 50%). RESULTS: Sixty patients were eligible for the study. According to the reference method, there were 34 (56.7%) cases in the study with MI < 50%, and 26 (43.3%) with MI > 50%. Both objective TVUS methods and MRI showed no statistical significant differences in overall diagnostic performance for the preoperative assessment of MI. The concordance coefficient between both TVUS methods, MRI and histopathology was statistically significant (p < 0.001). Gordon's method calculating MI reached a positive predictive value (PPV) of 83%, negative predictive value (NPV) of 83%, 77% sensitivity, 88% specificity, and 83% overall accuracy. Karlsson's method reached PPV of 82%, NPV of 79%, 69% sensitivity, 88% specificity, and 80% overall accuracy. Accordingly, MRI calculating MI reached PPV of 83%, NPV of 97%, 97% sensitivity, 85% specificity, and 90% overall accuracy. CONCLUSIONS: We found that objective TVUS assessment of myometrial invasion was performed with a diagnostic accuracy comparable to that of MRI in women with endometrial cancer.

Preterm and term birth in twin pregnancies during a seven-year period: a call for obstetricians to declare about amnionicity and chorionicity.

Aim To compare maternal, foetal and neonatal characteristics, and perinatal outcome of preterm and term deliveries in twins pregnancies in order to improve perinatal care in Bosnia and Herzegovina. Methods This retrospective cohort study included pregnant women with twin pregnancy who delivered during the period between 1 January 2012 and 31 December 2018 at the Clinic for Gynaecology and Obstetrics, University Clinical Centre Tuzla. Results During the seven-year period 26 734 deliveries were recorded, out of which 362 (1.35 %) were twin pregnancies, 226 (62.4%) preterm and 136 (37.5%) term ones. In the preterm group 38 (16.8%) pregnancies were assisted medical reproduction, and 16 (11.7%) of those were in the term group. The average birth weight was significantly higher for the first twin in both groups (p<0.00001). Incipient intrauterine foetal asphyxia was more frequent in the preterm group (p<0.05). The most common indication for Caesarean section was abnormalities of foetal presentation and lie, 176 (68.2%) for the overall sample. Conclusion Cornerstone of twin pregnancy antenatal care is to get correct data about amnionicity and chorionicity. Since majority of prenatal data did not have this information we call all obstetricians to declare about amnionicity and chorionicity in twin pregnancies during the first trimester ultrasound examination.

Pregnancy outcome in women who survived genital or extragenital cancer.

Aim To investigate clinical and obstetrical characteristics, an outcome and a prognosis for pregnant women with diagnosed and treated genital or extragenital cancer and their newborns. Methods This retrospective cohort study included pregnant and childbearing women with a history of cancer diagnosed before pregnancy during the period between 1 January 2014 and 31 December 2018. Data related to the course of pregnancy and childbirth were collected from medical records (mothers' disease history and partogram). The analysis covered clinical and histopathological characteristics of cancers, type of the treatment (surgery, chemotherapy, radiotherapy), demographic data, obstetric characteristics, comorbidities of women, and outcome of the newborns. Results The study recorded 18 414 deliveries, of which 30 (0.16%) were pregnancies in women who had been diagnosed and treated earlier for genital or extragenital cancer. The average age of the women at the time of delivery was 29.43±5.97 years. There were six (20%) women with genital and 24 (80%) with extragenital cancer. The most frequent extra genital cancer was Hodgkin lymphoma, in eight (26.6%) cases; ovarian cancer was the most frequent genital cancer, in four (13.3%) cases. The average time span from the cancer diagnosis and start of the treatment to the delivery was 59.2±44.4 months (5 years) (range 12 months - 15 years). Two (6.6%) women died. Conclusion Our data demonstrate a favourable obstetric and neonatal outcome for women who have survived cancer.

Perinatal characteristics and prevalence of low birth weight infants in the Federation of Bosnia and Herzegovina: prospective multicentric study.

Aim To investigate the prevalence and obstetrical characteristics of low birth weight infants (LBWIs) in ten Cantons of the Federation of Bosnia and Herzegovina (FBiH). Methods The prospective study included newborns of both genders, gestational age (GA) of 22 to 42 weeks and birth weight(BW) of less than 2,500 grams in the period 1 January 2009 to 31 December 2009. Results In the observed period, 22897 neonates were born, out of whom 669 (2.9%) had a BW less than 2500 grams (average BW was 1295 grams; SD ± 234.2; a coefficient of variation of 0.58). The average GA was 31.4 weeks of gestation. The average lifespan of mothers was 27.7 years (SD ± 1.2). The average Apgar scor (AS) in the first minute was 4.6 (SD ± 2.1) and in the fifth minute it was 6.6 (SD ± 1.9). The LBWIs were most commonly delivered by primiparas, 317 (47.5%). Of the 669 LBWIs, 411 (61.4%) were born per vias naturalis, with cephalic presentation. The highest number of LBWIs was born in Sarajevo Canton, 3.7%, and Central Bosnia Canton, 3.7%. The lowest prevalence was in Posavina Canton, 1.1%. The largest late fetal mortality was in Central Bosnia Canton, 7.7 ‰. Conclusion This study has determined a relatively low prevalence of LBWIs and other examined obstetrical characteristics that are in correlation with European and Global World data.

Pregnacy and Delivery in a Patient After Tetralogy of Fallot Surgery Being Undergone.

AIM: The aim of the paper is to present the risk of pregnancy for mother and her child in a young patient who had a surgery to repair Tetralogy of Fallot (ToF), who gave a birth to her firstborn by having a cesarean section. CASE REPORT: 23 years old patient, in 28 weeks of pregnancy was admitted to the clinic due to her medical record. She did not have any subjective complaints. She had two surgeries to repair ToF. After the surgery, she had residual ventricular septal defect (VSD). She had her first surgery 20 years ago (she was 3 years old), and second 7 years ago (she was 16). She had regular check-ups since, and her heart condition was unchanged. Due to her heart surgeries and VSD, a cardiologist indicates that she should deliver by having a c-section when she is 36 weeks pregnant. The patient's heart condition was stabilized and the patient was sent home. She was recommended to have her cardiologist check up on her as she leaves the hospital and to have a gynecological examination in 6 weeks. CONCLUSION: It can be concluded that team work and prenatal care, in most cases, lead to delivery without complication, both for mother and fetus.

Cardiotocography in the prognosis of perinatal outcome.

AIM: The objective of the study was to examine whether cardiotocography can (CTG) predict asphyxia of the embryo, manifested as hypoxic-ischemic encephalopathy (HIE), and to what extent one can rely on CTG record. MATERIAL AND METHODS: Retrospective research was carried out at the Clinic for Gynecology and Obstetrics UKC Tuzla and medical documentation from the history of mothers and newborns was used. The study group consisted of 68 pregnancies and newborns who developed HIE. The control group consisted of 40 pregnancies, which resulted in birth of healthy newborns--without signs of asphyxia. CTG records were analyzed, Apgar score, the ways of finishing delivery. RESULTS: Pathological CTG records (bradycardia 100, tachycardia 180, silent type of curve, late decelerations) were found in 45 (66.17%) cases of the study group in comparison to 11 (27.5%) in the control group. In the study group Apgar score in 5th minute lower than 7 had 17.46% newborns and the highest incidence of the normally finished deliveries. We conclude that cardiotocography is one of the reliable methods of fetal monitoring in pregnancy and delivery, and that pathological CTG record very likely indicates the possible presence of perinatal asphyxia. CONCLUSION: Achieving a low degree of correlation between pathological intrapartum cardiotocography findings and long-term outcome of children can be achieved by rapid and adequate obstetric intervention and the relatively short duration of fetal acidosis, and optimal procedures during intensive care of newborns.

C-reactive protein as a biochemical marker of idiopathic preterm delivery.

Each birth which has happened before gestation period of 37 weeks of gestation and which is not related to a degree of birth difficulty is called premature birth. Different researches pointed out that C-reactive protein (CRP) can be used as a possible marker of idiopathic preterm delivery. RESEARCH GOALS WERE: To examine reliability of CRP in mothers serum as a marker of premature birth among pregnant women who had no of the known risks for premature birth. To determine critical value of CRP in pregnancies this ended up as a premature birth. To determine connection between value of CRP and low birth weight of the newborn. The research is done in a form of prospective study on 200 pregnant women. Research included pregnant women without known risks factors for premature birth with condition that those women had suitable antenatal protection. All pregnant women were divided in into two groups, experimental and control group. Experimental group is consisted of 150 pregnant women who were regularly controlled in ambulance. Control group consisted of 50 pregnant women who were hospitalized at the Department for Pathology of pregnancy due to threatening miscarriage symptoms of condition that tocolytic index were less than 4. The value of CRP in serum of all pregnant women was determined in period from 20 to 24th week of gestation. In further course of pregnancy we followed those pregnant women with more often premature birth and if premature birth occurred more often in pregnant women with increased value of CRP in relation to women who had normal values. As a critical value for CRP was taken > 2 median value. Besides descriptive statistic methods in evaluating data processing were used (see text for symbols) test, student's t-test, Fishers test and Mann-Whitney test. RESULTS: Mean value of CRP in experimental group was 3.913 and in control group 14.92 (t = 4.72, p < 0.0001). Mean value of CRP was 18.17 in group of prematurely births and in women who gave birth on time 3.87 (t = 5.72, p < 0.0001). Value of CRP > 2 had 33 women who gave birth prematurely (16.5%). CONCLUSIONS: CRP can be used as a reliable marker of idiopathic premature birth. CRP value which is connected with development of premature birth is 4 mg/l. There is connection between the value of CRP > 2 and low birth weight of the newborn.

[Rupture of the uterus as a complication in delivery after cesarean section]. / Ruptura uterusa kao komplikacija porodaja kod porodilja koje su prethodno imale carski rez.

INTRODUCTION: In present clinical practice there is an increasing number of patients with delivery with previous cesarean section which is frequent reason for the repeated one. The most serious complication in labour with previous cesarean section is the rupture of the uterus which is as frequent in labour by natural way as in repeated cesarean section. This is a reason that many of obstetricians do not support attitude "Once cesarean section, always a cesarean". THE AIM: In a retrospective study in five years period beginning January 1, 1998, we analyzed total number of deliveries, total number of cesarean section, way of deliveries with previous cesarean section and frequency of complications. METHODS: We used Chi2 test and Contigency table. RESULTS: In analyzed period from January 1, 1998 through December 31, 2002, we completed 24,194 deliveries at Ob/Gyn Clinic in Tuzla. Out of this number we performed 4073 cesarean sections or 16.83%. Out of 24,194 deliveries we had 1328 (5.49% of all deliveries) deliveries after performed cesarean in previous pregnancy. Out of 1328 deliveries following cesarean we completed by natural way 323 pregnancies or 24.33% and by repeated cesarean 1005 or 75.67%. Previous one cesarean had 1191, previous two cesarean 126, and previous three cesarean had 11 women. Out of 1328 deliveries by previous cesarean we had 12 (0.90%) or 1:111 cases, complicated by intrapartum rupture of the uterus. It was significantly more than in group of deliveries by unscarred uterus (1:16,849 deliveries). Three of 12 ruptures of the uterus were in group by natural way of delivery and 9 cases in group by repeated cesarean, no statistical difference (p>0.05). Out of 12 cases complicated by rupture of the uterus, ten cases were incomplete and two complete rupture of the uterus. CONCLUSION: Repeated cesarean section by his complications imposes the careful choice of indication for primary cesarean section and by this way make maternal mortality and morbidity significantly lower, specially in the light of the fact that only 24.33% deliveries following cesarean is completed vaginally. The most frequent complication was rupture of the uterus in relation 1:111 deliveries.

[Stimulation of labour with premature rupture of membranes]. / Stimulacija porodaja sa prijevremenim prsnucem plodovih ovoja.

INTRODUCTION: The objective is to examine the efficiency of the application of prostaglandins (PgE2) in labours with the complications of premature rupture of membranes (PRM) for the purpose of their more frequent use. STUDY DESIGN: Two groups of term labours with the complications of PRM were observed in Gynaecology and Obstetric Clinic in Tuzla, in 2002. In the examination group No=59 (46.82%), we used vaginal suppositories prostin E2 (3 mg) for stimulation of labour. In the second group of pregnant women, No=67 (53.17%) we used oxytocin for stimulation. The following was observed: the age of pregnant women, parity, Bishop score, latent period (time from application of the medicine until delivery), manner in which the labour was ended, birth weight, Apgar score after the first and the fifth minute, incidence of complications (infections and bleeding) in the period of confinement/puerperium). RESULTS: PgE2 were applied in pregnancies in earlier gesational age (37.31 versus 39.13), more often in nulliparous women (86.46%), in the case of immature cervix (Bishop score 3.70 versus 5.95). There were 80.45% successful stimulation, the same incidence of Cesarean sections, with no difference in the condition of newborns at birth (average Apgar score in the group with Pg 8.63), without difference in the incidence of complications in the confinement puerperium. In the group with Pg, there was a small percentage of infections, although the latent period was in 5.67% pregnancies longer than 24 hours. CONCLUSION: The application of PgE2 vaginal suppositories for maturing and stimulation of labour is a modern, efficient and easy to use method in obstetrics which is very acceptable.

[Stimulation of fetal lung maturation with dexamethasone in unexpected premature labor]. / Stimulacija plucne maturacije ploda deksametazonom kod ocekivanog prijevremenog porodaja.

INTRODUCTION: Preterm labour is most common complication of second half of pregnancy, incidence is 7 to 10% of all delivers. One of most important causes of increased mortality and morbidity of neonates is respiratory distress syndrome. Numerous studies prove that corticosteroids given antenatal to mother decrease the incidence of preterm delivered neonates. AIM OF THIS STUDY IS: To determined influence of dexamethasone given prepartal on maturation of neonatal lungs in correlation with gestational age. METHOD: This study include 150 pregnant women which delivered before 37 week of gestation. They are divide in three groups: two experimental and one control group. Group E1 consists of the pregnant women which received dexamethasone for five days in a single dose of 12 mg. Group E2 consists of the pregnant women which received dexamethasone less then five days, in a single dose of 12 mg. In the control group consists of the pregnant women which did not received dexamethasone. In this work we used gestational age in the moment of delivery. State of neonate is determined on the base of presence of clinical signs of respiratory distress syndrome after birth. Statistical method used in this work was test of proportion. RESULTS: In this work we find that there is a less number of neonates who has respiratory distress syndrome in group consists of the pregnant women which received dexamethasone for five days, 5 (10%). In group consists of the pregnant women which received dexamethasone less then five days, number of neonates with respiratory distress syndrome was 12 (24%). The number of neonates with respiratory distress syndrome in control group was 21 (42%). The value of test of proportion: K/E1 (the pregnant women received dexamethasone for five days)-z = 1.95, p < 0.05; K/E2 (pregnant women received dexamethasone less than five days)-z = 3.92, p < 0.05. In all three groups largest number of neonates with respiratory distress syndrome was between 31-34 week of gestation. Highest mortality of neonate with respiratory distress syndrome was in control group, 7 (14%), than in group consists of the pregnant women received dexamethasone lass then five days, 4 (8%). In group consist pregnant women received dexamethasone for five days, there were not cases of mortality caused by respiratory distress syndrome. The value of test of proportion was z = 2.85 (p < 0.05), between control group and group consists of the pregnant women received dexamethasone for five days. CONCLUSION: Dexamethasone accelerates maturation of fetal lungs, decrease number of neonates with respiratory distress syndrome and improves survival in preterm delivered neonates. Optimal gestational age for use of dexamethasone therapy is 31 to 34 weeks of gestation.