Perimortem Caesarean section because of a live fetus: case report and literature review.

BACKGROUND: Perimortem Caesarean section (PMCS) is a rare surgical procedure that is potentially lifesaving for mother and child. AIM: To describes a live fetus 1 h after maternal cardiac arrest and a rare hospital surgical event, PMCS. CASE REPORT: We report on a 22-year-old gravida 1 para 1 woman who had a convulsive loss of consciousness at 31 weeks' gestation. A convulsive loss of consciousness was accompanied by profuse vomiting of gastric contents. Cardiopulmonary resuscitation was initiated. Fetal heartbeats were recorded and the patient was referred to the Clinic for Gynecology and Obstetrics. Perimortem Caesarean section was performed. Neonatal cardiopulmonary resuscitation was initiated, but the infant was pronounced dead after 60 min of attempted resuscitation. Maternal cardiopulmonary resuscitation was without success and it was abandoned following discussion with family members. CONCLUSION: A cooperative team approach is the key factor to producing a good perinatal outcome.

SHORT-TERM OUTCOME OF MASSIVE PULMONARY HEMORRHAGE IN PRETERM INFANTS IN TUZLA CANTON.

Massive pulmonary hemorrhage (MPH) in neonates is a severe condition followed by many complications and associated with a high mortality rate. The aim of this study was to present the incidence, possible risk factors, and short-term outcome of neonatal MPH in Tuzla Canton. We retrospectively analyzed data on neonates with MPH from January 2015 to December 2017. On statistical analysis, standard methods of descriptive statistics were used. During the three-year study period, 16 neonates developed MPH, 5 (31.25%) male and 11 (68.75%) female. Their mean gestational age was 29.48±2.21 weeks and mean birth weight 1276.69±387.65 grams. Seven (43.75%) neonates survived and 9 (56.25%) died. Significant differences between the two outcome groups (survivors/died) were found in gestational age, birth weight, birth length, 5-minute Apgar score, and length of treatment at the Neonatal Intensive Care Unit. In Tuzla Canton, MPH occurred mainly in preterm neonates requiring mechanical ventilation, with the incidence of 1.91% of total premature births. The short-term outcome was uncertain, with a high mortality rate of 56.25%. Lower gestational age, lower birth weight, lower birth length and lower 5-minute Apgar score were confirmed as risk factors for poor short-term outcome.

The relationship between C-reactive protein, anthropometric parameters and lipids in menopausal transition.

Aim To investigate the relationship between C-reactive protein, anthropometric parameters, and lipids in women in the menopausal transition. Methods This cross-sectional study included 150 women divided into three groups: premenopausal (n=50), perimenopausal (n=50), and postmenopausal (n=50). All women were interviewed, body mass index (BMI) and waist-hip ratio (WHR) values were calculated, and a blood sample was taken for laboratory analysis. The values of the lipids were determined including triglycerides, total cholesterol, and high-density lipoprotein (HDL) cholesterol, while low-density lipoprotein (LDL) and very-low-density lipoprotein (VLDL) cholesterol values were obtained through formulas. The concentration of CRP was determined by immunoturbidimetry on the Architect ci8200 device. Results The BMI of postmenopausal women was significantly higher than that of premenopausal (p=0.025) and perimenopausal women (p=0.010). The ratio of the waist-hip circumference of postmenopausal women was significantly higher than the ratio of the waist-hip circumference of premenopausal women (p<0.001), as well as that of perimenopausal women (p<0.001). A significant difference in CRP concentration was found only between the postmenopausal and premenopausal groups (p=0.009). CRP significantly positively correlated with BMI in all three groups. A significant positive correlation was found between CRP and WHR in the perimenopause and in the postmenopause group. No significant correlation was found between CRP and lipid parameters in any group. Conclusion An increase in body weight or obesity in the postmenopausal period, increase in CRP concentration, and positive correlation between these parameters suggest that entering menopause could mean a potential increase in the risk of developing cardiovascular and metabolic diseases.

Uncontrolled Acute Intermittent Porphyria as a Cause of Spontaneous Abortion.

INTRODUCTION: The association of acute intermitetn porphyria (AIP) with pregnancy and as a cause of spontaneous abortion is rare. AIM: To show a case of AIP known before pregnancy in a patient who had a spontaneous abortion. CASE REPORT: A gynecologist examined 26-year-old patient in the 8th week of gestation, due to initial spontaneous abortion, abdominal pain, constipation, muscle weakness, vomiting and dark colour of urine. Her therapy was dydrogesterone. In consultation with an anesthesiologist, a short intravenous anesthesia, vacuum aspiration, and curettage were performed.During hospitalization, the patient ceased to take harmful drugs and she was given haemarginate, glucose and symptomatic drugs, and she recovered completely. CONCLUSION: Treatment of threatened spontaneous abortion in AIP remains the subject of dilemma and controversy, and future research is needed.

Epidemiology of neonatal sepsis caused by multidrug resistant pathogens in a neonatal intensive care unit level 3.

Aim Steady progress in intensive treatment worldwide has increased the survival of immature neonates, but with multiple invasive procedures, which have increased the risk of infection, thus the bacterial resistance to antibiotics. The aim of this study was to analyse the epidemiology of multidrug resistance pathogens as causative agents of neonatal sepsis in the neonatal intensive care unit. Methods A retrospective cohort study conducted at the Intensive care unit of the Paediatric Clinic of Tuzla over a three-year period (2016-2018) analysed epidemiology of neonatal sepsis caused by multidrug resistance pathogens. Statistical analysis applied standard methods, and the research was approved by the Ethics Committee of the institution. Results Of the total of 921 treated neonates, multidrug resistance (MDR) pathogens among causative agents of neonatal sepsis were found in 22 neonates (2.38%) with no gender difference. Prematurity and low birth weight were confirmed as the most significant risk factors. From the maternal risk factors a significant difference was found in the first birth and in vitro fertilization. Clinically, MDR sepsis manifested frequently as late onset sepsis, with longer hospital stay and higher mortality. The findings of leukopenia, thrombocytopenia and coagulation disorders were significant. Gram negative bacteria were frequently isolated, in particular Acinetobacter, which showed the greatest resistance to antibiotics. Conclusion Neonatal MDR sepsis is a threat to life, it complicates the treatment, increases costs and mortality. Outcomes can be improved by preventive strategies, earlier and more accurate diagnosis and rational use of antibiotics.

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.

Risk Factors and Outcome of Neonatal Pneumothorax in Tuzla Canton.

AIM: The aim of this study was to analyze risk factors and outcome of neonatal pneumothorax in Tuzla Canton. METHODS: Neonates with chest X-ray confirmed pneumothorax in University Clinical Center of Tuzla, within a three-year period, from January 2015 to December 2017, were retrospectively studied. Participants were evaluated for baseline characteristics, predisposing factors of neonatal pneumothorax, accompanying disorders and mortality. RESULTS: During the observed three-year period 11425 neonates were born in Tuzla Canton, with 7.33 % of preterm births, and 604 neonates were treated in NICU, with 265 neonates who required mechanical ventilation. Neonatal pneumothorax (NP) was diagnosed in 22 patients (9 term, 13 preterm), 12 (54.5%) were male. The incidence was 0.20% of total births, respectively 3.64% of those treated in NICU. The mean gestational age were 35.1 ± 3.0 weeks and birth weight 2 506.8 ± 727.7 grams. NP was mostly unilateral (72.7%) and right-sided. The most commonly associated diseases were: respiratory distress syndrome, intracranial haemorrhage, pneumonia, transient tachypnea and sepsis. In 8 (36.4%) neonates, the underlying cause of NP could be mechanical ventilation (secondary), whereas in 14 (63.6%) NP was spontaneous, without previous mechanical ventilation, although 11 of them required mechanical ventilation after pneumothorax. CONCLUSION: All perinatal risk factors were investigate, and significant differences in two observed groups related to mechanical ventilation were found for birth weight, gestational age, Caesarean section, length of mechanical ventilation, surfactant replacement therapy and outcome. Three (13.64%) neonates with NP died, and among risk factors with poor outcome, significant was only Apgar score in the first minute ≤ 5.