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.

Cesarean Section Rate Analysis in University Hospital Tuzla - According to Robson's Classification.

OBJECTIVE: For last decades, there has public concern about increasing Cesarean Section (CS) rates, and it is an issue of international public health concern. According to World Health Organisation (WHO) there is no justification to have more than 10-15% CS births. WHO proposes the Robson ten-group classification, as a global standard for assessing, monitoring and comparing cesarean section rates. The aim of this study was to investigate Cesarean section rate at University Hospital Tuzla, Bosnia and Herzegovina. METHODS: Cross sectional study was conducted for one-year period, 2015. Statistical analysis and graph-table presentation was performed using Excel 2010 and Microsoft Office programs. RESULTS: Out of 3,672 births, a total of 936 births were performed by CS. Percentage of the total number of CS to the total birth number was 25,47%. According to Robson classification, the largest was group 5 with relative contribution of 29,80%. On second and third place were group 1 and 2 with relative contribution of 26,06% and 15,78% respectively. Groups 1, 2, 5 made account of realtive contribution of 71,65%. All other groups had entirely relative contribution of 28,35%. CONCLUSION: Robson 10-group classification provides easy way in collecting information about CS rate. It is important that efforts to reduce the overall CS rate should focus on reducing the primary CS. Data from our study confirm this attitude.

Do growth hormone and insulin-like growth factor 1 affect prognosis in patients with killip I and II class acute myocardial infarction?

We investigated concentrations and roles of insulin-like growth factor 1 (IGF-1) and its binding protein (IGF1BP-3), growth hormone (GH), insulin, and markers of insulin resistance and inflammation in acute myocardial infarction (AMI). We aimed to assess any possible association between serum GH/IGF-1 axis following AMI and short-term survival rates. A follow up study was performed in 2010. Study group consisted of 75 patients with Killip I and II class AMI. There were 30 control subjects. Blood samples were obtained within 24 hours of admission and analyzed for the aforementioned hormones. Patients were followed-up during 6 months for new cardiac events. Median GH was higher in AMI (0.96; range 0.6-2.4) than in controls (0.26; p<0.001). IGF-1 was significantly lower in AMI (123 vs. 132; p<0.05), and so was the IGF-1/GH ratio (p<0.001) and IGF1BP-3. Insulin was higher in study group, but without statistical significance. However, we found significant between-group differences in other markers of insulin resistance (HbA1c, glycemia, HOMA-IR) and inflammation. Simple linear correlation showed positive correlation between GH and C-reactive protein. All patients with new cardiac events had IGF-1 below median and lower left ventricular ejection fraction. In conclusion, IGF-1 may affect outcome of AMI. GH resistance might be a result of inflammatory/immune response and therefore it could be a useful prognostic marker.

Angiomyofibroblastoma of the vaginal portion.

INTRODUCTION: Angiomyofibroblastoma is a tumor which is consists of two components: blood vessels and stromal cells, with always prominent vascular component. Angiomyofibroblastoma is benign tumor, but in literature is reported a case of recurrence and one case with sarcomatous transformation, which shoved that these tumors may rarely be associated with malignant component. CASE REPORT: A 78-year-old multiparous housewife was hospitalized at University Clinical Center because of painless, asymptomatic tumor of vaginal portion (posterior side). Tumor size was 7 millimeters in diameter. Internal genital organs did not present abnormalities. The patient underwent operative removal of the tumor and went to home at some day. At the histological examination the tumor presented as a angiomyofibroblastoma cervices uteri.

Comparison of Kegel exercises and a combination of Kegel exercises with the use of the KegelSmart biofeedback device in the treatment of static urinary incontinence.

Aim To determine which of the two methods, Kegel exercises or combination of Kegel exercises with the use of the KegelSmart biofeedback device, has better therapeutic effects on the symptoms of SUI in females. Methods Fifty female patients with SUI were randomly divided into two groups: 25 treated with Kegel exercises, and 25 with the combination of Kegel exercises with the use of the KegelSmart biofeedback device. Patients in both groups performed Kegel exercises 30 minutes daily for 30 days. Patients in the second group, in addition to Kegel exercises, applied the KegelSmart device intravaginally for 20 minutes daily for 30 days. All patients filled out a questionnaire based on 12 questions consisting of an objective and a subjective component. Results The basic characteristics of the patients from both groups were not statistically significantly different: age 55.16 vs 54.52 years; number of births 1.80 vs 1.96; body mass index 29.12 vs 28.40. There was a statistically significant reduction in the values of all analysed objective and subjective parameters in the group treated with combination of Kegel exercises with the use of the KegelSmart biofeedback device compared to Kegel exercises group. Conclusion Combination of Kegel exercises with the use of the KegelSmart biofeedback device has better therapeutic effects than Kegel exercises on the objective and subjective symptoms of SUI.

The Misgav-Ladach method of cesarean section: a step forward in operative technique in obstetrics.

OBJECTIVE: The objective of this study is to compare the intraoperative and short-term outcomes of two cesarean techniques: the modified Misgav-Ladach and the Pfannenstiel-Kerr. METHODS: We performed a prospective observational cohort study of women undergoing a primary cesarean at the Clinic for Obstetric and Gynecology Tuzla, Bosnia and Herzegovina, between January 2003 and December 2011. The two cesarean techniques were compared for intraoperative and short terms outcomes. RESULTS: A total of 4,944 women were included in this study, 4,336 allocated to the modified Misgav-Ladach and 608 to the Pfannenstiel-Kerr techniques. The rate of modified Misgav-Ladach increased from 74 % in 2003 to 99 % in 2011. The modified Misgav-Ladach technique was associated with a shorter operative time (13.3 min ± 7.4 vs. 19.1 min ± 6.8, p < 0.05), as well as significantly less surgical material (3.5 ± 2.5 vs. 7.9 ± 2.1, p < 0.05). The modified Misgav-Ladach technique was also associated with lower analgesic requirements, lower rates of febrile morbidity and wound infection compared to the Pfannenstiel-Kerr technique (p < 0.05). No significant differences were observed in the incidence of endometritis, wound dehiscence, bowel restitution, postoperative antibiotic use, and hospital stay. CONCLUSION: The modified Misgav-Ladach technique is associated with a shorter operative time than Pfannenstiel-Kerr and might lead to better postoperative outcomes.

Perinatal mortality during fifteen-year period in Tuzla Canton, Bosnia and Herzegovina.

THE AIM: To determine the incidence of perinatal mortality, as well as the frequency of premature deliveries. METHODS: We analyzed the data of birth protocol at the Clinics for Gynecology and Obstetrition at the University Clinical Centre in Tuzla in period 1992-2006. RESULTS: Perinatal mortality gradually declines in the period of 1992-2000. The decline owns mostly to early neonatal mortality more than to fetal which also shows the trend of decrease. During the first analyzed years (1992 and 1993) the incidence of premature deliveries was below 10% but that number increased during 1994 and 1995 (15.8%). The most interesting finding is that the highest level of incidence of premature deliveries was registered in the first postwar year--1996 (16.4%) when we also noted the largest number of deliveries for the analyzed period and most of which were finished between 32 and 36 weeks. The frequency of delivery of underweight babies (500-2499 g) was between 3.8 to 12.2%. The highest frequency was registered during the 1994 and 1995 when it reached 12.2%. The frequency of delivery of extremely underweight babies (500-999 g) for the analyzed period was about 0.1% with significant increase during the wartime (1995 even 0.6%). CONCLUSION: We found that during the period of 15 years a significant decline of perinatal mortality is registered, due to early neonatal death. Limited accessibility and quality of perinatal health care during the war period had detrimental effects on the healt and survival of newborns.

Risk of uterine rupture following locked vs unlocked single-layer closure.

OBJECTIVE: To compare the rate of uterine scar disruption after a locked versus an unlocked single-layer closure of the hysterotomy incision at a previous cesarean. METHODS: A retrospective cohort study in a population where both locked and unlocked single-layer closure are commonly used. All singleton pregnancies at 24 weeks' gestation or more with a previous single cesarean were included. Rate of uterine scar disruption (complete uterine rupture and uterine scar dehiscence) were compared between women with a previous locked and those with a previous unlocked single-layer closure of the uterus. RESULTS: Out of 388 women included in the study, 272 had a previous unlocked single-layer closure and 116 had a locked single-layer closure. We found no significant difference in the rate of uterine scar disruption between the two groups (5.9% vs 8.6%, p = 0.32). CONCLUSION: Locking a single-layer closure was not associated with an increase rate of uterine scar disruption at the next pregnancy in our retrospective analysis. A randomized trial should be performed.

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.

Laparoendoscopic Ovarian-Sparing Surgery of Adnexal Tumors in Children and Adolescents by General Gynecologists: A 10-Year, Retrospective Cohort Study.

Background: In pediatric and adolescent gynecology, ovarian-sparing surgery (OSS) is an approach for preserving the ovaries affected by tumors and torsion during surgical treatment. Materials and Methods: We analyzed participants from a tertiary Gynecology and Obstetrics University Hospital. Participants were patients <19 years of age with adnexal tumors managed surgically with removal of pathologically confirmed ovarian tissue in the period from 2008 to 2017. Results: The average age of 38 patients who underwent surgery for adnexal tumors and were included in the study was 16.78 ± 2.15 years, from 12 to 19 years, with significantly younger patients in the salpingo-oophorectomy/oophorectomy and laparotomy group (P = .036 and P = .001). The laparoscopic approach was performed in 28 (73.68%) patients and laparotomy in 10 (26.31%) patients (P < .0001). Cystectomy was performed in 29 (76.31%), oophorectomy in 1 (2.63%), and salpingo-oophorectomy in 8 (21.05%) patients. A significantly higher number of patients underwent OSS with laparoscopy in scheduled surgical procedure and emergency surgery groups (P = .021 and P = .028). Benign ovarian tumors were found in 31 (81.57%), borderline in 3 (7.89%), and malignant in 4 (10.52%) patients. Conclusion: Our study has shown a high trend in OSS using the endoscopic approach in management of adnexal tumors despite the fact that the management was done by general gynecologists.

Progesterone induced blocking factor (PIBF) taken in early pregnancy predicts the pregnancy outcome in women undergoing in vitro fertilization procedure.

Earlier data suggest a relationship between PIBF concentrations and the outcome of pregnancy. The aim of the study was to compare serum and urine concentrations of PIBF in women with successful pregnancy after IVF with those of women without pregnancy after IVF procedure, and to evaluate the potential relation between PIBF and the outcome of pregnancy. Urine and serum were collected from 120 women, undergoing IVF. 87.5% of patients had primary infertility. 69.2% faced female causes of infertility: 10.8% tubal cause, 11.7% ovulation disorder, and 46.7% other causes of infertility. 30.8% of patients had male factor of infertility. Among non-pregnant women (42) mean concentrations of PIBF in urine and serum were significantly lower (15.8 ng/mL; 148.4 ng/mL) than in women with positive beta HCG value (78) (19.1 ng/mL; 225.9 ng/mL). In 49 patients pregnancy terminated with a term delivery, in 10 patients with pretem delivery, while in 19 patients the pregnancy terminated with a miscarriage. PIBF concentrations in urine (13.9 ± 2.8 ng/mL) and serum (124.6 ± 46.7 ng/mL) samples of women with miscarriage were significantly lower of those with preterm delivery (180.6 ± 54.4 ng/mL; 18.1 ± 4.4 ng/mL) and of those with term delivery (20.4 ± 8.5 ng/mL; 208.7 ± 114.3 ng/mL). Successful pregnancy after IVF procedure is predictable by measuring of urine and serum PIBF concentrations and could be important for predicting of early implantation and pregnancy outcome after IVF procedure and maybe to protect the risk pregnancy.

[Operative deliveries in Clinic of Gynecology and Obstetrics Tuzla, Bosnia and Herzegovina, during 1986-2005]. / Operativno zavrseni porodi u Klinici za ginekologiju i akuserstvo u Tuzli, Bosna i Hercegovina u razdoblju 1986.-2005. godine.

UNLABELLED: The aim of this paper was to determine the incidence of operative deliveries and to make a comparison between the incidence rate in the pre-war (1986-1991), war (1992-1995) and post-war (1996-2005) periods. METHODS: We retrospectively collected data from the databases of University Clinic of Gynecology and Obstetrics Tuzla for the period of twenty years (January 1st, 1986 - December 31st, 2005). RESULTS: The frequency of Cesarian section was in constant rise since 1990 when it surpassed 11%, with the exception of two war years 1992 and 1993 when it was 9.5%. The highest frequency was registered in 2004 - 20.7%. Statistically significant difference in Cesarean section was found between period 2001-2005 (18.5%) and other analysed periods. Vacuum extraction methods were most used in 1989 - 3.7%, and least in 2004 - 1.1%. In 1991, 50 - 0.8% of deliveries were finished with forceps, and since 2000 this method has not been used in any delivery. The frequency of pelvic presentation for the analyzed period varied less and was between 2.9% and 5.1%. CONCLUSION: During the period of twenty years at the Clinic of Gynecology and Obstetrics in Tuzla a significant increase in the incidence of deliveries finished with Cesarean section was found.

Correlation between interleukin 6 and interleukin 10 in acute myocardial infarction.

The aim of this study was to analyze (i) ratios between pro-inflammatory cytokines interleukin 6 (IL-6), interleukin 1 (IL-1), tumour necrosis factor alpha (TNF-alpha) and anti-inflammatory cytokine interleukin 10 (IL-10) in patients with acute myocardial infarction (AMI) and stable angina pectoris (ii) as well as correlation between IL-6 and IL-10 in AMI and (iii) correlation between IL-6 and lipoproteins in AMI.The total of 71 patients were enrolled in this study, 41 of them with AMI (study group) and 30 with stable angina pectoris (control group). The concentrations of cytokines and lipoproteins were measured from blood samples. Pro-inflammatory to anti-inflammatory cytokine ratios were calculated by dividing concentrations of pro-inflammatory cytokines with IL-10. In statistical analyses we used descriptive statistics, normality tests and analysis of correlation.IL-6: IL-10 ratio is significantly higher in AMI than in stable angina (P < 0,001), TNF-alpha: IL-10 is also higher in study group but the difference is not significant. We found positive linear correlation between IL-6 and IL-10 (r =0,43; p = 0,015) and negative linear correlation between IL-6 and high density lipoprotein HDL (r = -0,47; p= 0,008) in AMI.IL-6: IL-10 ratio is higher in AMI than in stable angina. There is linear correlation between IL-6 and IL-10 and IL-6 and HDL in AMI.

Complete Molar Pregnancy in Posmenopausal Woman-a Case Report.

INTRODUCTION: Gestational trophoblastic desease (GTD) is disease typical for reproductive period of women and is extremly rare in postmenopausal period of woman's life. AIM: To present a rare case of mollar pregnancy in 57 years of age postmenopausal woman. CASE REPORT: A multiparous woman aged 57 years, and two yars after last menstrual bleeding, was admitted at Clinic, due to hyperplastic endometrium findings and moderate prolonged postmenopausal uterine bleeding. Due to clinical simptoms we performed diagnostic exploratice curettage. During that intervention heavy bleeding was developed resulting in spontaneous expulsion of tumorous mass wich macroscopic looked as a mollar tissue. Imediatelly after intervention level of ß HCG was 193,057mlU/mL. Due to very high level of ß HCG patient was taken to laparotomy and during the surgery dicision was made to perform total abdominal hysterectomy with bilateral adnexectomy. Eight day after surgery patient was discharged from Clinic in good condition. Hystopathological examination of material obtained by explorative curettage and uterus showed complete mollar pregnancy. Controlled level of ß HCG was 1,996 mlU/mL fifth day after surgery. CONCLUSION: Although molar pregnancy in postmenopausal period of woman's life is very rare disorder, because of potentialy heavy complications it is very important to recognise this disorder at time, to prevent delay of treatment.

Cesarean Scar Pregnancy Complicated with Placenta Percreta.

INTRODUCTION: Cesarean scar pregnancy is potentially life-threatening condition because of heavy complications and includes adherent placenta: accreta, increta or percreta as a result of deep placental invasion. AIM: To present a rare case of ectopic cesarean scar pregnancy combined with placenta percreta in 38-year old woman who undergone previous cesarean section delivery. CASE REPORT: A multiparous woman aged 38 years with prior cesarean section delivery, admitted first time to the Clinic in 7th week of gestation, due to her medical record (light bleeding). Diagnosis was: graviditas hbd 7, gemellar pregnancy, blighted ovum gemellus I, graviditas isthmico-cervicalis gemellus II. Due to diagnosis it was performed vacuum aspiration et curettage and woman leaved hospital same day. One month later same woman was admitted again to the Clinic due to bleeding and ultrasound finding suspicious to residual trophoblastic tissue. Beta human chorionic gonadotropin serum concentration at the day of admittance was 8,419 IU/ml. Ultrasound finding showed inhomogeneous supracervical formation with dimension 2,73x1,89 cm with increased vascularity and resistant index 0.36 and suspicious placenta increta. We made decision to surgery, and performed hysterectomy in view of heavy intraoperative haemorrhage. Woman was discharged at fifth day after surgery in good condition. Histological finding showed cervical pregnancy complicated with placenta percreta parietis isthmicocervicalis of the uterus. CONCLUSION: We showed the importance of early and opportune diagnosis of cervical pregnancy specially complicated with one of kind of throphoblastic disease, to prevent life-threatening complication.

Insulin-like growth factor-binding protein-1 (IGFBP-1) in cervical secretions as a predictor of preterm delivery.

OBJECTIVE: The objective of this study was to investigate the level of insulin-like growth factor-binding protein-1 (IGFBP-1) in cervical secretions and Bishop score as predictors of preterm delivery in asymptomatic pregnant women. METHODS: This was a prospective study at the Clinic for Gynecology and Obstetrics at the University Clinical Center in Tuzla, on a sample of 80 healthy pregnant women at between 24 and 34 gestational weeks. After interview every woman underwent IGFBP-1 concentration measurement by the 'Actim Partus' test. The Bishop score was determined by the author (A.L) during vaginal examination. Rates among groups were compared using arithmetic mean and standard deviation, Student's t-test, Mann-Witney U-test, and Spearman-Rank correlation test. Statistical importance was determined at the variation levels of 5% and 1%. RESULTS: Eight (10.00%) women in the study group had a positive Actim Partus test and six (7.50%) of them had a preterm delivery. The positive predictive value was 44.44% and negative predictive value was 98.59%. The specificity of the Bishop score in the study group was 83.78% and the sensitivity was 50.00%. The positive predictive value of the Bishop score in this group was 20.00% and the negative predictive value was 95.36%. There was no correlation between the Bishop score and Actim Partus test (p = 0.15). CONCLUSIONS: If the concentration of IGFBP-1 is <10 microg/L (negative Actim Partus test) in asymptomatic pregnant women, the risk of preterm delivery is low. The Actim Partus test could be used as a screening test for preterm delivery in asymptomatic pregnant women.

Etiological risk factors for brachial plexus palsy.

AIM: To investigate risk factors for brachial plexus palsy in newborns. We analyzed 45 544 live-born children, born over a nine-year period from January 1, 1996 to December 31, 2004. METHODS: The analysis was retrospective and based on the medical documentation of the Clinic for Gynecology and Obstetrics, Clinic for Neurology, and Clinic for Physical Medicine and Rehabilitation of the University Clinical Center Tuzla. We compared study and control groups of newborns. Rates among groups were compared using Chi-square, with significance at p < 0.05, and with significance at p < 0.01. RESULTS: Examining epidemiological characteristics, 86 newborns with brachial plexus palsy had been recorded, thus, the prevalence was 1.86 per 1000 live-born children. Analyzing maternal and neonatal factors, and the labor pattern itself, it was found that the highest factors of risk for brachial plexus injury were birth weight of over 4000 g, a precipitous second stage of labor (<15 minutes), and vacuum-extractor assisted labor. Brachial plexus palsy was more frequent when the mothers were overweight, with a body mass index >or=29 kg/m2. None of the parturient women, whose newborns were diagnosed with brachial plexus palsy, had external conjugate diameter <18 cm. Newborns delivered vaginally were not diagnosed with a higher frequency of brachial plexus palsy when compared to newborns who were delivered by cesarean section, but newborns who were vaginal breech-delivered were diagnosed to have a higher incidence of brachial plexus palsy. Newborns whose mothers were older than 35 years were diagnosed to have brachial plexus palsy more frequently, but a statistically significant difference between primiparas and multiparas was not found. A total of 39 newborns (45.2%) were diagnosed with a fracture of the clavicle, which was the most frequently combined damage with brachial plexus injury. Forty-two newborns (48.8%) had an Apgar score of

Dydrogesterone and pre-term birth.

Progestin supplementation appears to be a promising approach to both preventing initiation of pre-term labor and treating it once it is already established. Successful pregnancy depends on maternal tolerance of the fetal "semi-allograft". A protein called progesterone-induced blocking factor (PIBF), by inducing a Th2 dominant cytokine production mediates the immunological effects of progesterone. Over time, various attempts have been made to clarify the question, whether progestogens can contribute positively to either prevention or treatment of pre-term labor and birth. Dydrogesterone treatment of women at risk of pre-term delivery results in increased PIBF production and IL-10 concentrations, and lower concentrations of IFNγ and could be effective for prevention or treatment of pre-term labor. Further randomized studies are needed.

LOW PRETERM BIRTH RATE WITH DECREASING EARLY NEONATAL MORTALITY IN BOSNIA AND HERZEGOVINA DURING 2007-2014.

THE AIM: of the study was to determine the situation of preterm births and early neonatal mortality during 2007-2014 in Tuzla Canton, Bosnia and Herzegovina. METHODS: The study covers a 8-year period and is based on the protocols at the Tuzla Clinic for Gynecology and Obstetrics that covers all birth in Tuzla Canton area. We analyzed the gestational age of all newborns and recorded the number of neonatal deaths in the first week after birth. Demographics, pregnancy and birth characteristics were collected from the maternal records. RESULTS: The total number of births in the period was 32738. Preterm birth was identified in 2401 (7.3%) cases with 12,5% occurring before 32 gestational weeks and 64% in 35-36 gestational weeks. The mothers of the 24-31 gws preterm group were significantly younger that those in the 32-36 group. In the 32-36 group there were significantly greater proportions of mothers with assisted reproductive technology and pre-eclampsia and 16.7% was medical induced preterm births versus 11.4 % in the 24-31 PTB group, p<0.05. The incidence of PTB did no vary significantly during the period, the lowest rate was found in 2010 (6.4%). A total of 221 children died giving a early mortality rate of 6.8 per 1000 live born over the 8 years. The majority 156 dying infants (70.6%) were preterm, only 5.7% died being born in the 35-36 gestational week (5.9 per 1000). Overall the preterm early mortality (7.3 per 1000) has shown a decreasing tendency during the latter years. CONCLUSION: During the last 8 years there have been no significant decline in preterm birth in the Tuzla region while a decline in early neonatal death has been registered.