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Recurrent foetal loss is a significant clinical problem, occurring in 1-5% of reproductive females. Inherited or acquired thrombophilia has been diagnosed in 50-65% of women with history of unexplained foetal loss. The low molecular weight heparin was applied in 24 women with inherited thrombophilia and previous recurrent foetal loss and in 6 women with primary antiphospholipid syndrome throughout their following pregnancies. The dose of low molecular weight heparin for the majority of women was 35-75 u/kg. Women with primary antiphospholipid syndrome received both low molecular weight heparin and aspirin 50-100 mg daily. Implementation of thromboprophylaxis resulted in successful pregnancy outcome in 29 out of38 pregnancies, which represents a significant improvement of pregnancy outcome in comparison to previous 81 pregnancy losses. The number of treated pregnancies in our study is small, but the rate of successful pregnancy outcomes is high (76%), indicating that low molecular weight heparin may be a promising approach to women with thrombophilia and recurrent foetal loss.

Introduction: Respiratory distress syndrome (RDS) of the newborn infant caused by immaturity of fetal lung is a very serious clinical problem. Surfactant is stored in the form of lamellar bodies. They are secreted into alveolar space and passed into amniotic fluid where they can be found. The similarity of lamellar body size to platelet size permits the use of a standard automated hematologic cell counter to estimate the number of lamellar bodies in amniotic fluid., Material and Methods: We conducted a prospective clinical study from 2005-2006 on amniotic fluid samples. Amniotic fluid samples were collected near delivery by transvaginal amniotomy, amniotomy during Cesarean section and 72 hours before delivery by amniocentesis. A hematology analyzer (Nikon-Kohden) was used to determine the lamellar body counts. After birth of newborns we compared their complete clinical examination results particularly emphasizing the prediction of the method of RDS by lamellar body count. Maximally specific lamellar body cutoffs for maturity and immaturity were determined using ROC curves., Results and Discussion: Of 232 amniotic fluid samples which were tested, 112 samples were collected by transvaginal amniotomy, 88 were taken during Cesarean delivery and 32 samples were collected by amniocentesis. The incidence of RDS was 14.6%. ROC curves were used to identify cut points for the test. We found that LBC is a good screening test for predicting fetal lung maturity with the area under the curve of 0.751. LBC cutoff of 42 x 10(3)/microl, with sensitivity of 82.4% and specificity of 64.6%, proved best for predicting fetal lung maturity., Conclusion: LBC is a good screening test for predicting fetal lung maturity. The advantages of LBC are speed, objectivity, low price, low sample volume required and universal availability.

Even though artificial surfactant is now available, respiratory distress syndrome still remains a serious problem in neonatology. Prenatal analysis of the amniotic fluid can provide data giving insight into the fetal lung maturity, which enables planning of the further outcome of high-risk pregnancies. Surfactant prevents atelectasis by forming a layer rich in phospholipids between the air and liquid phase in alveoli thus leading to increased surface tension in them, which is a precondition for a good lung function after birth. Lamellar bodies are a form of stored surfactant, and their count in the amniotic fluid can be determined simply by a standard hematology analyzer. The method of determining lamellar body count has found an important place in prenatal diagnostics and is recommended as an initial method of a "cascade" procedure of testing fetal lung maturity. However, considering the importance of procedure of sample collection, storage and centrifugation, which can significantly affect the results obtained for the lung maturity, the amniotic fluid samples must be absolutely free of contamination with blood, meconium, mucus, bacteria and leucocytes.

Ultrasonography of the central nervous system is an integral part of a prenatal scan, and the development of imaging technologies has led to better diagnostic possibilities. Posterior fossa anomalies have traditionally been divided into Dandy Walke malformation, Dandy Walker variation and megacisterna magna, but this approach, due to diversity of the extensive number of possible disorders covered by this classification, unables accurate prognosis and therefore adequate counselling. An alternative approach to the classification of posterior fossa anomalies is to divide them into agenesis of the vermis, which could be partial or complete, cerebellar hypoplasia, pontocerebellar hypoplasia and cerebellar atrophy. Different ultrasonographic and magnetic resonance imagining of appearances of the posterior fossa anomalies in prenatal period are discussed in the article, as well as possible syndromes and prognosis of different entities. Diversity of anomalies of the central nervous system, and in particular, subtle differences in prenatal appearances of posterior fossa anomalies, which may have major impact on the prognosis, demand a multidisciplinary approach that encompasses two-dimensional and three-dimensional ultrasound scan, magnetic resonance imaging, infectious diseases and metabolic disorders work-ups as well as individual approach to every case involving of a team of experts in the field of perinatology, radiology, paediatrics, neurology and genetics.

The cervical length is an important factor in the risk evaluation of preterm delivery. The aim of this work was to determine the correlation between the cervical length and the demographic characteristics. A transversal type prospective study was done on a sample of 579 pregnant women at various gestational age of low risk mono-fetal pregnancy. The cervical length was measured by trans-vaginal ultrasound procedure within the regular pregnancy monitoring process. The following data were taken into consideration: the woman's age, her body mass at the beginning of the pregnancy and her height in order to calculate the body mass index as well as her smoking habit at the moment of conception. The mean cervical length was 34.3 mm and 35 mm in the group of women aged 30 and less and 31 and over, respectively. The cervix was insignificantly shorter in younger women (being 34.9 mm/35.9 mm in the 1st trimester, 34.5 mm/35.1 mm in the 2nd one and 33.9 mm/34.7 mm in the 3rd trimester). The sample of 579 pregnant women consisted of 448 non-smokers and 131 smokers. The difference in the length of the cervix in smokers and nonsmokers was not significant (being 32.2 mm/35.9 mm; 35 mm/34 mm and 34.4 mm/33.5 mm in the 1st, 2nd and 3rd trimester, respectively). The correlation between the body mass index and the cervical length was analyzed by trimesters. In the first trimester the increase in the body mass index was followed by the shortening of the cervix; the cervical length was not affected by the BAI in the second trimester, whereas the higher the body mass index the longer the cervix in the third trimester. Our study has shown that the cervical length is affected neither by the age of the woman nor her smoking habit but it is affected by the body mass index at the moment of conception, that linear trend being negative in the 1st trimester but positive in the 3rd one. Since the cervical length may be affected not only by the socio-demographic characteristics but the gynecologic obstetric history of the woman as well, we strongly suggest further investigations in this field.

Varix of intraabdominal part of fetal umbilical vein is during a prenatal ultrasound scan seen as a hypoechogenic mass between anterior abdominal wall and lower edge of liver, and the diagnosis is confirmed when blood flow is seen during color Doppler examination. A case of prenatal diagnosis of this abnormality is presented, with review of contemporary literature regarding diagnosis and management as well as the outcome of such pregnancies.

DEPARTMENT OF OBSTETRICS AND GYNECOLOGY: Department of Obstetrics and Gynecology of the Clinical Center of Vojvodina, as a tertiary care center, is going through constant innovation and improvement which are results of constant development of medical sciences, as well as of the increasing demands and needs of patients. New methods are being introduced, conditions of stay and treatment are improved, medical staff are required to participate in continuing medical education. Through the mutual efforts and achievements of the medical staff of the Department of the Clinical Center of Vojvodina and Provincial Secretary of Health and Social Welfare, the Department of Obstetrics and Gynecology of the Clinical Center of Vojvodina has become a department for the 21st century.

Introduction: Screening for chromosomal abnormalities identifies the group of women at higher risk for having a fetus with chromosomal abnormalities and the need for fetal karyotyping. In order to provide high quality screening, strict criteria Jbo certification of operators are introduced, issued by the Fetal Medicine Foundation (FMF), which enables annual external control of results. The aim of this study was to review the results of five-year prenatal screening for chromosomal abnormalities in Novi Sad, Serbia., Material and Methods: Ultrasound screening at 11-15 weeks gestation was performed, assessing fetal morphology, crownr-rump length and nuchal translucency (NT) according to the FMF guidelines. Risk for chromosomal abnormalities included the initial risk, based on maternal age, gestational age and anamnestic data, and corrected risk, which took into account the initial risk and the value of the nuchal translucency. The corrected risk was issued by the computer program issued by the FMF., Results: During the period 1999-2004, 4580 pregnant women were scanned. The risk for chromosomal abnormality was calculated using the FMF program in 2245 cases and the outcome was known in 1406 cases. The majority ojf women were between 25 and 29 years of age (37%), and 12% were older than 35 years. NT was below the median in 43% of cases and above in 57%, 3.7% of cases were above the 95th centile. 89% of women iwere younger than 35, and the risk was reduced in 97% of cases. There were three false negative cases. In 3% of women from this group the risk was increased, out cf which there were five cases of trisomy 21 and two terminations were done due to major anomalies. In the group of women over 35 years, the risk was reduced in 95% of cases and in all of them but two the karyotype was normal. In one of the two cases there was a large omphalocele and the karyotype was trisomy 18, and in the other fetus appeared normal, but after amniocentesis due to maternal anxiety, karyotype was 47, XYY. In 5% of women at higher risk there was one trisomy 21, bilateral multicystic kidneys were fund in one case as well as one hydrocephalus., Conclusion: Combined screening by maternal age and nuchal translucency is superior to screening by maternal age only--(sensitivity 66% vs. 20%, false postive results 3% vs. 15%, area under ROC 0.90 vs. 0.69).

Introduction: The aim of this paper is to present a case of prenatal diagnosis of a congenital tumor of the oral cavity diagnosed at 28 weeks of gestation., Case Report: After the diagnosis of oral cavity tumor was made by 21) ultrasound, a 3D scan was performed, which confirmed the diagnosis revealing a peduncle at the upper border of maxilla. A detailed scan was performed and no additional anomalies were seen. Magnetic resonance imaging was performed, confirming the diagnosis and the site of the tumor. Karyotype was previously done, and a normal female karyotype was found. Regular three-week follow-up scans were performed to follow the growth of the tumor, as well as the state of the amniotic fluid. No tumor growth was detected, and the amniotic fluid volume was normal until 39 weeks of gestation. Cesarean section was scheduled, due to the risk of tumor disruption during a vaginal delivery. A maxillofacial surgeon was present during an uneventful cesarean section and a complete surgical excision was done immediately after the baby was extracted and umbilical cord ligated. The histopathological diagnosis was: granular cell myoblastoma. The female newborn was developing normally, and at 5 months of age there were no traces of scarring at the place of the tumor., Conclusion: In cases of prenatal diagnosis of tumors of the oral cavity, where development of polyhydramnios can be expected, as well as difficulties with feeding and breathing after birth, it is important to make a plan for adequate follow-up and prompt surgical treatment immediately after birth.

Introduction: The cervical length is a predictor of premature delivery or abortion. In order to detect the risks of such complications, it is necessary to establish the factors affecting the length of the cervix., Material and Methods: A transversal prospective study was carried out in a sample of 579 pregnant women with low risk, singleton pregnancies of various gestational ages. Cervical length was measured by transvaginal ultrasound as part of routine pregnancy monitoring. At the same time, data on previous first-trimester or mid-trimester abortions, as well as on premature deliveries and term deliveries, were collected and taken into consideration., Results: The cervical length in primiparous women was not statistically significantly longer than in women with a previous pregnancy, except during the second trimester, (primiparous women: 33.8 mm, women with a previous pregnancy: 35.8 mm). Bearing in mind the empirical facts that the cervix in primiparous women, since intact, is significantly longer, the above mentioned findings cannot be easily explained. The cervix in women with a previous vaginal delivery was statistically significantly longer (35.6 mm) than in women with no vaginal delivery (34.09) (p = 0.011). In women with previous abortions of any kind, the cervical length was 34.2 mm. The cervical length in women without previous abortions was 34.7 mm, and there were no significant differences. Moreover, no statistically significant differences were established in women with or without previous abortions, regardless of the type., Conclusion: Taking into consideration the data from previous obstetric histories, the results of our study indicate that cervices of women.

Systemic lupus erythematosus (SLE) is a chronic inflammatory connective tissue disease commonly diagnosed after the age of 20, mostly around the age of 30 years. It is more common in women than in men, especially during the fertile period. Women with SLE are at higher risk for spontaneous abortions, intrauterine fetal death, preeclampsia and eclampsia, preterm delivery and intrauterine growth retardation. This paper is a case report of a pregnant woman with SLE complicated with preeclampsia, but it also discusses follow-up of such pregnancies.

Introduction: Increased amniotic fluid volume may significantly increase the risk for preterm delivery. Amniodrainage is a symptomatic treatment by which excess amniotic fluid is reduced to provide fetal lung maturation. The aim of this stuldy is to estimate the efficacy and safety of this procedure, our results and give a literature review., Material and Methods: Sonografic criteria were used (AFI >400 ml, or the biggest amniotic fluid pocket >150 mm) to choose patients in whom 18G needle was used to allow leaking of excessive amniotic fluid., Results: 10 patients underwent 26 procedures. The procedures were performed at 28.6 th week gestation, on average and 6.25 weeks average gain or 1000 g. We had two sets of monochorionic twins with twin-to-twin transfusion syndronme (TTTS), where one child survived. One procedure was followed by premature placental abruption, and premature delivery in 28th week. The rest of procedures were uneventful., Conclusion: In our series of 10 women, 26 procedures were performed to prolong pregnancies, enable fetal maturation and weight gain. In majority of cases amnioreduction was done without complications, so we could repeat the intervention and prolong the pregnancy. Survival of one child in two TTTS pregnancies should not be regarded unsulccessful in our conditions.

A prospective longitudinal study of cervical length during pregnancy included 60 women. Three groups of patients were analyzed: group I--cervical length was measured in all three trimesters, group II--cervical length was measured in the first and second trimesters, and group III--length was measured in the second and third trimesters. Cervical length was measured in each group individually, with the aim of establishing the trend of change. In the group in which the cervical length was measured in all three timesters, there was either a mild progressive cervical shortening or cervix remained of the same length. The number of examined women is very small, though, so more valid is the information that the trend of mild shortening occurs in the second and third trimesters. None of the trends is particulary explicit and shows that there is a period in an uncomplicated singleton pregnancy of low risk for preterm delivery, during which there is a significant shortening before delivery takes place. During pregnancy there are different, individual modes of cervical changes, which leads to individualization when estimating the risk for preterm delivery. Reference values should be established for cervical length in order to assess risk for preterm delivery, rather than use the "cut-off" value after which the risk is considered higher.

Introduction: Amniotic fluid volume reduction can have serious consequences: prior to 24 gestational weeks hypoplasia of fetal lungs and later in pregnancy cord compression and fetal hypoxia as well as contractions of extremities. Diagnosis of oligohydramnios is made either after a subjective estimation of amniotic fluid reduction or if the biggest amniotic fluid pocket is less than 1 cm. Amnioinfusion is a procedure during which a crystalloid solution, most often saline, is instilled into the amniotic cavity substituting amniotic fluid. To estimate the efficacy and safety of amnioinsfusion using our results and literature review., Material and Methods: Up to 800 ml of sterile saline solution was instilled intraamniotically (10-15 ml/min) in cases where the amniotic fluid index was less than 10 and intraamniotic infection was excluded. After that, 1 g of Longaceph was given intraamniotically. Infusion was stopped immediately when 800 ml was instilled, if a subjective estimation showed that there was enough fluid or if contractions occurred., Results: During a six-month period there were five amnioinfusions--four therapeutical and one diagnostic; in four cases the procedure was successful and in one preterm rupture of membranes occurred 20 hours after the procedure. The procedure was most often done in the first half of the third trimester and continuation of pregnancy in successful cases was between 4 and 5 weeks, with average fetal weight gain of about 1200 gr. No complications occurred in cases where pregnancy continued., Conclusion: In our preliminary study amnioinfusion led to prolongation of pregnancy in majority of cases providing better maturation of fetal lungs and higher birth weight, without any complications. Further studies are necessary to reach definite conclusions about the efficacy and safety of amnioinfusion.

Introduction: Induction of labor represents initiation of uterine contractions before their spontaneous onset. The aim of the study was to establish the role of Bishop score in prediction of labor induction in routine clinical work., Material and Methods: The study was a prospective, blind, observational one. All patients had a vaginal examination prior to induction, during which Bishop score was evaluated. The mode of induction was either intravenous infusion of oxytocin or endovaginal prostaglandins. The induction was considered successful if vaginal delivery took place within 24 hours from the onset of induction., Results: There were 100 patients, and induction was successful in 74% and unsuccessful in 26%. Mean Bishop score in group A was 5.65 (SD 1.40, 95% CI 5.27-6.03), and in group B 4.15 (SD 1.04, 95% CI 3.66-4.63) (p < 0.01). Statistical analysis of the area under the ROC curve showed that Bishop score is a good and reliable predictor of the outcome of labor induction (0.816, 95% CI od 0.710-0.896), with the best statistical performances at the cut-off value of 5 (sensitivity 65.5%, specificity 95%, PPV 97.3%, NPV 50%)., Conclusion: In our study Bishop score proved to be a reliable and good method for prediction of the outcome of pregnancy if a single, experienced operator evaluates it, with best statistical performances at the cut-off value more than 5 (sensitivity 65.5%, specificity 95%, PPV 97.3%, NPV 50%). The next step would be introduction of more operators, of different skills and experience and subsequent further testing of the method in different conditions.