Capabilities of perinatal healthcare institutions in primary and tertiary care of low birth weight infants in the Federation of Bosnia and Herzegovina: a cross-sectional multicentric study.

Introduction: Providing adequate healthcare for premature infants is an important issue in perinatal medicine. The aim of this study is to assess the level of the perinatal healthcare institution (PHI) where the newborns were delivered and the possibilities of transporting them to the cantons of the Federation of Bosnia and Herzegovina. The authors also aimed to examine the overall survival of low birth-weight infants (LBWI) in the Federation of Bosnia and Herzegovina and to compare the survival of newborns according to the PHI where they were born and the PHI where they were treated. Materials and methods: This cross-sectional study included newborns of both sexes that were born in the maternity wards in 10 cantons of the Federation of Bosnia and Herzegovina with a gestational age between 22 and 42 weeks, and a birth weight less than 2500 g. Result: From the PHI of the first and second level, 159 newborns were referred to the third level. A total of 159/669 (23.7%) were referred from a second level PHI to a third level PHI, and 127/669 (l8.9%) LBWI were definitely taken care of. A total of 513/669 (76.8%) LBWI were definitely taken care of in the third level PHI. Out of a total of 159 LBWI referred from other PHI, only 31 (19.5%) LBWI were transported in less than 4 h, and 128 (80.5%) newborns were admitted to the third level PHI within 4 h of birth (P<0.0001). In second level PHI, most LBWI died in the first 12 h after birth, while in third level PHI, 69.2% of LBWI died after 1 week of life. Conclusion: Based on world experience and assessment of the situation in Federation of Bosnia and Herzegovina, it is necessary to take measures to improve perinatal care and its regional organization.

Full trisomy 14 in one of bichorionic biamniotic twins.

We describe the case of the lethal full trisomy (T) 14 in a fetus from bichorionic biamniotic (BCBA) twin pregnancy. This is a case of a 28-year-old primigravida, with an unremarkable personal and family history, who just like her 30-year-old husband, was without consanguinity between spouses. She conceived spontaneously, without a burdened gynecological-obstetric history. By the 12th week of pregnancy, she had hyperemesis gravidarum and one episode of bleeding due to which progesterone supplementation was prescribed. Due to asymptomatic bacteriuria, she took cefuroxime axetil in the 13th week of pregnancy and azithromycin in the 15th week due to cervicitis with ureaplasma urealyticum.

Extraperitoneal Cesarean Section after two Medial Laparotomies, Anus Prater, and Surgical Treatment of the Rectovaginal Fistula in a Patient with Crohn's Disease: A Case Report.

The aim of this case report is to show the advantages of the extraperitoneal cesarean section (ECS) approach in a pregnant patient with multiple previous abdominal transperitoneal colon surgeries and Crohn's disease. A pregnant nulliparous woman with Crohn's disease was admitted for delivery. After delivery, a large rupture and lesion of the rectum was observed. Suturing of the vagina, rectum and sphincter was performed by an abdominal surgeon. Because of a very large and irregularly shaped rectum rupture, the patient underwent infraumbilical medial laparotomy and sigmoidostomy. After 18 months, the patient started to experience vaginal discharge and Y-shaped rectovaginal fistula was confirmed. Surgical reconstruction was performed. The patient's second pregnancy began one year later. At 38 weeks of pregnancy, elective extraperitoneal cesarean section was performed. A healthy newborn was delivered. Follow-up showed full and fast recovery after the ECS. In cases of pregnant women who have had multiple colon surgeries, gynecology surgeons can choose to perform an ECS to avoid transperitoneal entrance into the abdomen. ECS avoids lysis of postoperative adhesions after repetitive gastrointestinal surgeries, the formation of new adhesions by lysis of the old adhesions, and most importantly, the possibility of colon or small intestine lesions during lysis of dense or firm adhesions.

Artificial intelligence as a new answer to old challenges in maternal-fetal medicine and obstetrics.

BACKGROUND: Following the latest trends in the development of artificial intelligence (AI), the possibility of processing an immense amount of data has created a breakthrough in the medical field. Practitioners can now utilize AI tools to advance diagnostic protocols and improve patient care. OBJECTIVE: The aim of this article is to present the importance and modalities of AI in maternal-fetal medicine and obstetrics and its usefulness in daily clinical work and decision-making process. METHODS: A comprehensive literature review was performed by searching PubMed for articles published from inception up until August 2023, including the search terms "artificial intelligence in obstetrics", "maternal-fetal medicine", and "machine learning" combined through Boolean operators. In addition, references lists of identified articles were further reviewed for inclusion. RESULTS: According to recent research, AI has demonstrated remarkable potential in improving the accuracy and timeliness of diagnoses in maternal-fetal medicine and obstetrics, e.g., advancing perinatal ultrasound technique, monitoring fetal heart rate during labor, or predicting mode of delivery. The combination of AI and obstetric ultrasound can help optimize fetal ultrasound assessment by reducing examination time and improving diagnostic accuracy while reducing physician workload. CONCLUSION: The integration of AI in maternal-fetal medicine and obstetrics has the potential to significantly improve patient outcomes, enhance healthcare efficiency, and individualized care plans. As technology evolves, AI algorithms are likely to become even more sophisticated. However, the successful implementation of AI in maternal-fetal medicine and obstetrics needs to address challenges related to interpretability and reliability.

Viable invasive cervical pregnancy treated with minimally invasive procedures.

With an incidence of 1% of all ectopic pregnancies, cervical ectopic pregnancy (CEP) is due to possible early misdiagnosis or bleeding and rupture can become a life-threatening condition with the need for urgent hysterectomy, which has been seen in clinical practice recently. We present a case of early diagnosed invasive CEP treated with combined minimally invasive procedure (MIP) due to acute pelvic pain and bleeding. In our case, we applied several of these methods to a primigravida with early invasive CEP with fertility preservation. By combining the self-described local medications with uterotonics and cervical anaemia treatment, intravenous tranexamic acid and MIP, we were able to preserve the uterus with minimal blood loss and the possibility of future conception.

Diode laser use in hysteroscopic surgery: current status and future perspectives.

Recent advances in surgical technology and innovative techniques have revolutionized surgical gynecology, including transcervical hysteroscopic procedures. Surgical lasers (Nd-Yag, Argon, diode, and CO2 lasers) have been promoted to remove a variety of gynecological pathologies. For hysteroscopic surgery, the diode laser represents the most versatile and feasible innovation, with simultaneous cut and coagulate action, providing improved hemostasis compared with CO2 laser. The newest diode laser devices exhibit increased power and a dual wavelength, to work precisely with reduced thermal dispersion and minimal damage to surrounding tissues. Their efficacy and safety have been validated both in the hospitals as well as in the office setting. Updated evidence reports that several hysteroscopic procedures, including endometrial polypectomies, myomectomies and metroplasties can be successfully performed with a diode laser. Therefore, this review aimed to give a deeper understanding of the role of laser energy in gynecology and subsequently in hysteroscopy in order to safely incorporate this technology into clinical practice.

The proposal of the novel fetal shoulder dystocia graduation: a clinical-based opinion.

BACKGROUND: Shoulder dystocia is a peracute mechanical dystocia and a prepartum, usually unpredictable, life-threatening entity with significant forensic implications due to significantly poor perinatal outcome, especially permanent disability or perinatal death. CONTENT: To better objectify the graduation and to include other important clinical parameters, we believe it is appropriate to present a proposal for a complete perinatal weighted graduation of shoulder dystocia, based on several years of numerous other and our own clinical and forensic studies and thematic biobibliography. Obstetric maneuvers, neonatal outcome, and maternal outcome are three components, which are evaluated according to the severity of 0-4 proposed components. Thus, the gradation is ultimately in four degrees according to the total score: I. degreee, score 0-3: slightly shoulder dystocia with simple obstetric interventions, but without birth injuries; II. degree, score 4-7: mild shoulder dystocia resolved by external, secondary interventions and minor injuries; III. degree, score 8-10: severe shoulder dystocia with severe peripartum injuries; IV. degree, score 11-12: extremely difficult, severe shoulder dystocia with ultima ratio interventions applied and resulting extremely severe injuries with chronic disability, including perinatal death. SUMMARY: As a clinically evaluated graduation, it certainly has an applicable long-term anamnestic and prognostic component for subsequent pregnancies and access to subsequent births, as it includes all relevant components of clinical forensic objectification.

Focal increta placentomegaly of the posterior nonscarred uterine wall and posterior asynclitic presentation.

BACKGROUND: Fetal malpresentations and malpositions are more common in placenta previa and uterine cavity abnormalities. AIM: To show successful management of focal increta placentomegaly and uterine preservation in primiparous woman. CASE REPORT: We describe posterior low-lying focal increta placentomegaly verified during cesarean section, which is a possible risk factor for persistent posterior asynclitism and consequent mechanical dystocia. In addition to antifibrinolytics and uterotonics, hemostatic compression sutures of the posterior uterine wall were performed with an applied intrauterine balloon, and thus the uterus was preserved in primiparous woman as a definitive therapy. CONCLUSION: Timely identified malplacentation as well as adequate medical and surgical measures taken by an experienced team of obstetricians and anesthesiologists can contribute to preservation of the uterus and thus the life of mother and neonate.

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.

Sudden death of a pregnant woman because of massive aspiration-case report and review of literature.

INTRODUCTION: Massive aspiration of gastric contents as a cause of death in pregnancy without anesthesia is possible, but is not documented in the available literature as a separate case report. AIM: To describe sudden death of a pregnant woman because of massive aspiration of gastric contents. CASE REPORT: The presence of a valvular anomaly in a 26-year-old woman had been known since childhood: the prolapse of both mitral cusps. In the 34th week of her second pregnancy, after dinner, she went to take a shower when she collapsed with abundant vomiting of stomach contents. The ambulance came in 20 min and started a resuscitation procedure which was unsuccessful, and the death of the pregnant woman was established in the 34th week of pregnancy. Autopsy revealed massive aspiration of gastric contents into the trachea and bronchi, pulmonary edema, and generalized cyanosis. Left ventricular dilatation was found in the heart, with prolapse of both mitral valve cusps. CONCLUSION: Sudden deaths in pregnancy are rare and dramatic conditions in emergency medicine. Cardiac checkups are very important for pregnant women with heart failures or heart anomalies, and must be recommended by gynecologists.

Pelvic packing in the treatment of severe postpartum posthysterectomiam hemorrhage.

INTRODUCTION: Pelvic packing (PP) as a simple method of "damage control surgery" in severe abdominopelvic hemorrhage in gynecological and obstetric surgery after emergency obstetrics or gynecological hysterectomy. OBJECTIVE: To present the case of successful PP as a simple and effective method in refractory pelvic bleeding after emergent peripartum hysterectomy and severe obstetric shock with consumptive coagulopathy. CASE REPORT: Acording to laboratory findings and clinical condition in a 30-year-old (G2 P2) parturient, it was most likely an obstetric embolism with uterine rupture as the cause of severe postparum hemorrhage with disseminated intravascular coagulopathy and obstetrics hemorrhagic shock development in the described case. Pelvic packing after postpartum hysterectomy was the definitive minimally invasive and simple hemostatic procedure. CONCLUSION: The use of pelvic packing and obstetrics skills should be included in the protocol as a necessary, life-saving, and uncomplicated vital indication procedure.

The influence of body mass index and smoking on the age of onset of menopause in women in Bosnia and Herzegovina: a cross-sectional multicentric study.

Introduction: Menopause is the last physiological menstrual period and is a complex process involving the following: endocrine, genitourinary, cardiovascular, and locomotor system, and it leads to vasomotor symptoms and psychological complaints. This study aims to investigate the influence of smoking and body mass index (BMI) as risk factors on the age of onset of menopause in women in Bosnia and Herzegovina. Material and methods: This study included 460 women in natural menopause. The study was conducted in 2 phases: interview and measurement of BMI. Each patient underwent an interview based on the questionnaire, following the verbal consent of the patient, who had previously been explained the nature of the research. Results: The age at which menopause occurs increases with the BMI increase, and it can be described by the regression equation: age = 0.096 × BMI + 45.7, which has statistical significance. The mean age of menopause occurrence in current smokers was lower (47.5 ±0.4 years) than in non-smokers (48.8 ±0.2 years) (p = 0.010). Conclusions: Our study confirmed the statistically significant correlation between smoking, BMI, and age of onset of menopause.

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.