Misoprostol-induced abortions in Kosovo.

OBJECTIVE: To compile and compare data on the abortions performed surgically and medically between January 1, 2006, and December 31, 2008, at the Gynecology and Obstetrics Clinic of the University Clinical Center of Kosovo. METHODS: The information for this retrospective, descriptive study was collected from the abortion register and the register of operative protocols. The variables used were age, number of births, number of abortions, duration of the terminated pregnancy, method of abortion, complications during and/or after the procedure, and attendance at consultations about family planning. RESULTS: A total of 1329 abortions were performed during the study period in women with a mean age of 30.12 years (range, 15-46 years). Of these abortions, 923 were performed by curettage, 108 by vacuum aspiration, and 250 using misoprostol. The rates of retained products of conception were 6.39%, 23.15%, and 8%, respectively, in these 3 groups. Heavy bleeding occurred in the 3 groups and there was 1 case of postabortion endometritis in both the curettage and the misoprostol group. However, no transfusions were needed and no uterine perforations occurred in the misoprostol group, whereas there were 9 transfusions in the vacuum aspiration group and 2 uterine perforations in the curettage group-1 followed by a hysterectomy. CONCLUSION: Misoprostol was very successful in all cases, with no serious adverse effects. It is much easier to administer than to perform a surgical abortion, with less severe postabortion complications and lesser costs.

Colposcopy and cytodiagnosis in the prevention of cervical malignancies.

BACKGROUND: Worldwide, cervical cancer is the fifth most frequent malignant disease in women, ranking third, after endometrial and ovarian cancer, among malignant diseases of the female genitalia. Sexual activity early in adolescence and promiscuity have been confirmed as risk factors. The aim of this study was to establish the value of cytology, colposcopy, and pathohistology in the prevention of cervical malignancies. METHODOLOGY: The study population comprised 750 patients hospitalized for different reasons in whom cervical alterations were noted on speculum examination or who showed typical clinical symptomatology, performed at the Obstetric-Gynecologic Clinic in Prishtina, Kosovo during the period between January 2008 and January 2009. RESULTS: The symptomatology of the patients with pathological cervices varied, with 272 of the 750 patients (36.27%) showing clinical symptoms. Atypical epithelial changes, noted during colposcopy, were more frequent in patients 31-40 years of age (60 patients, 32.09%) and 41-50 years of age (59 patients, 31.55%). In addition to material collected during colposcopic examination, biopsy material (direct biopsy) was obtained from 117 patients. Histopathological findings from both sources were noted: 19 cases (16.24%) of cervical dysplasia at different stages, six cases (5.13%) of carcinoma in situ, and three cases (2.56%) of invasive carcinoma. CONCLUSIONS: The correct clinical evaluation of cervical epithelial alterations enables a prompt diagnosis and the timely implementation of appropriate therapeutic measures.

Missed abortion and application of misoprostol.

BACKGROUND: Spontaneous abortion is categorized as threatened, inevitable, incomplete, complete, or missed. Abortion can be further categorized as sporadic or recurrent. By definition, a missed abortion is an in utero death of the embryo or fetus before the 20th week of gestation with retained conception products. Missed abortions may also be referred to as blighted ovum or an anembryonic pregnancy. MATERIALS AND METHODS: A prospective-pathological analysis of 100 missed abortion pregnancies that were diagnosed and treated at the obstetrics-gynecology clinic in Pristina were included. Patients were analyzed based on age, parity, gestational age, method of misoprostol application, effective duration from the moment of application to abortion, and adverse effects from applying misoprostol. RESULTS: In 25 (25%) pregnancies (15 at the end of week 10 pregnant VIII and IX of the week until the end of the week XII) one tablet of misoprostol was applied to the rear vaginal fornix for 3 h, and the effect was achieved in a mean of 10 h for the first group, while it was achieved in 11 h in the second group. Thus, the average efficiency was 10.5 h. After applying three tablets of misoprostol to the rear vaginal fornix, 11 abortions occurred (44%), with the use of four tablets seven (28%) aborted, and with five tablets three (12%) aborted. There was average bleeding in 60 (67.41%) aborted pregnancies, and bleeding of the package in 15 (16.85%). CONCLUSION: Administration of misoprostol to women with a missed abortion produced spontaneous expulsion and reduced the need for surgical treatment.

Impact of parity and intrauterine fetal condition during vacuum extraction.

PURPOSE: The main goal of this study was to investigate the impact of parity and intrauterine fetal condition on vacuum extraction. MATERIAL AND METHODS: This study included 10742 newborns who were delivered during 2008 in obstetrics/gynecology clinics in Kosovo, Yugoslavia. One hundred fifty-eight of these were vacuum deliveries. Data were collected for indicators such as parity, maternal age, gestation duration, newborn vitality, and birth weight. RESULTS: Vacuum extraction was used in 158 cases (1.47 %), of whom 116 (73%) were nulliparous and 42 (27%) were multiparous. In 121 cases (76.5%), vacuum extraction was performed in women with no history of abortion, and 101 (64%) of the women were aged 21-30 years. The main reason for vacuum extraction in 115 women (72%) was arrest (stasis) in the second stage of labor. Vacuum extraction was carried out at a gestational age of 34-40 weeks in 94 cases (59.5%). Amniotic fluid was clear in 125 cases (80%), and meconial amniotic fluid was seen in three cases (1.8%). Birth weight was > 3.5 kg in 77 infants (48.5%) and < 2.5 kg in seven (4.5%). Apgar score (AS) was 0-3 in 19 (12%), 4-7 in 129 (81.6%), and 8-10 in eight (6.4%) infants. In 91 cases (57.6%), newborn resuscitation was necessary and neonatal complications occurred in 11 cases (6.96%). CONCLUSIONS: We conclude that vacuum extraction was performed mostly in nulliparous women aged 21-30 years. Most newborn infants had a birth weight of > 3.5 kg, the most frequent AS was 4-7, and newborn resuscitation was needed in most cases.

Ruptured rudimentary horn pregnancy at sixteen weeks.

Pregnancy in a non-communicating rudimentary horn is very difficult to diagnose before it ruptures, leading to life -threatening intraperitoneal hemorrhage. A 22-year-old second gravida patient presented at the Emergency Center of the University Clinical Center of Kosova with a 16-week history of amenorrhea and acute onset of severe abdominal pain. She was resuscitated and taken for an emergency laparotomy under general anesthesia. Intraoperatively, there was a massive hemoperitoneum with a ruptured right rudimentary horn Given their rarity, ruptured rudimentary horn pregnancies are of interest.

Colposcopy and cytodiagnosis in the prevention of cervical malignancies.

BACKGROUND: The aim of this study was to establish the value of cytology, colposcopy, and pathohistology in the prevention of cervical malignancies. METHODOLOGY: A prospective study involving 750 patients hospitalized in the Obstetric-Gynecologic department during the period between January 2008 to January 2009 for different reasons in whom cervical dysplasia were noted on speculum examination or who showed typical clinical symptoms, direct biopsy was also obtained from 117 patients. RESULTS: 272 of the 750 patients (36.27%) showed clinical symptoms of cervical pathology. Atypical epithelial changes noted during colposcopy were more frequent in patients 31-40 years of age (60 patients, 32.09%) and 41-50 years of age (59 patients, 31.55%). Histopathological changes were noticed in 19 cases (16.24%) of cervical dysplasia at different stages, six cases (5.13%) of carcinoma in situ, and three cases (2.56%) of invasive carcinoma. CONCLUSIONS: The correct clinical evaluation of cervical epithelial alterations enables a prompt diagnosis and the timely implementation of appropriate therapeutic measures.

The study of volume density of tracheal ganglions in vitro in new born babies with respiratory distress syndrome.

Volume density of respiratory organs was studied in vitro in newborn babies at different age of gestation (abort, immature, premature and mature) using stereometric method. The total of 23 cases was subject to this study. The respiratory organs (trachea, lungs) were taken from autopsies of newborn babies exited from different causes. For this purpose the tissues were fixed in formalin (10%) solution, cut serially in 7micro and 10micro slabs. Volume density of the respiratory system was assessed stereometricaly using Universal testing system Weibel M 42. We observed that volume density of epithelia, musculature and glands were proportionally present in the tracheal tissue. Cellular interstitial tissue is consistently increasing and corresponds to the developmental stages of the newborn babies. The density of tracheal ganglions is greater in premature ages of immature and premature newborns (p<0,05). Decreased number of ganglion cells is observed in mature ages (p<0,05). This is caused by intensive ramification of ganglions from serosa to deeper layers of trachea right to epithelium. Medium diameter of tracheal ganglions is greater in mature newborn babies and corresponds to developmental ages of babies.

Role of meconium in the reaction of airways smooth musculature in the newborn with meconium aspiration syndrome (MAS).

The role of meconium in the respiratory system was studied in newborns, who died from various causes (250 up to 3000 g of weight). We monitored tracheal rings response to dopamine, serotonin and ethanol in different concentrations (dopamine: 0,05 mg/ml, 0,5 mg/ml, 5 mg/ml; serotonin (5-HT): 10-4, 10-3, 10-2, 10-1 mol/dm3; ethanol: 0,02 ml, 0,5 ml, 1,0 ml; 96%). Tracheal smooth musculature tonus (TSM) was examined in 48 tracheal preparations taken after the newborn exitus due to different reasons. Based on functional researche of isolated preparations of tracheas, it may be concluded that: aspiration of meconium has not changed the response of TSM to dopamine, serotonin and ethanol (p>0,1) in comparison with the control group, which have died due to different lung inflammatory processes (e.g. pneumonia, bronchopneumonia, atelectasis, cerebral hemorrhage). The results suggest that meconium does not potentiate the constricting action of dopamine, serotonin and ethanol in tracheobronchial system. Meconium causes mild relaxation of the TSM through a mechanism that is not intermediated by the products of cyclooxygenases (prostaglandins, prostacyclins) from the tracheal epithelium or proteins. Also, as it seems, the direct activity of many tested acids in the smooth musculature has no significant impact on increase of the airways tonus in MAS syndrome.

Analysis of contraception using IUDs in Kosova.

INTRODUCTION: Family planning involves couples taking responsibility for their own fertility and making decisions about when and how many children to have. AIM: The aim of this study was to establish the value of use of IUD as a contraceptive method. MATERIAL AND METHODS: This study enrolled 1874 patients in whom an IUD was inserted as a method of contraception during the period 2003-2008. All of the patients were from Kosova and the method was retrospective. Data were collected from the medical charts of both public and private health institutions licensed by the Ministry of Health. RESULTS: The data analysis indicated that 69.42% subjects lived in the city, while 30.57% lived in villages. Of the subjects, 82.12% carried the IUD for more than 3 years without any problems. In 6.56% subjects, the IUD was removed within 6 months after insertion. Of these 21.95% had the IUD removed because they felt emotionally uncomfortable with having a foreign body inside their uterus. Of the 1874 women 3.04% became pregnant while using the IUD. CONCLUSIONS: The use of an IUD as a method of contraception in Kosova is increasing steadily.