Indications for Cesarean Section

Cesarean deliveries were initially performed to separate the mother and the fetus in an attempt to save the fetus of a moribund patient. They subsequently developed to resolve maternal or fetal complications not amenable to vaginal delivery, either for mechanical limitations or to temporize delivery for maternal or fetal benefit. Globally, caesarean rates have been rising in developing countries. The aim of this study was to investigate the Cesarean Section rate, indications, Cesarean Section in relation with maternal age, parity, birth weight and gestacional age. This is a prospective-retrospective case control study of Cesarean deliveries performed between January and December 2015 at the Obstetrics and Gynecologic Clinic of the University Clinical Center of Kosova. This study evaluated the Caesarean delivery rate by maternal age, parity, by neonatal weight at birth as well as by gestational age at birth. Indications for caesarean delivery including emergent, maternal, fetal and other indications for first and for repeated caesarean delivery are reviewed and presented also. Out of the total 9641 deliveries conducted during the study period, 33 % were Cesarean deliveries. According to the indications, maternal indications were found in 59.34% of cases, fetal indications in 18.73 % and other indications were present in 14.11 % of cases. Emergent cesarean section was performed 7.91 % of cases. Most common maternal age group (46.38 %) was between 30-40 years. In first parity, Cesarean Section was performed in 55.02%. Primary Cesarean delivery, independent of parity, was present in 56,15 % of cases, while the repeat caesarean delivery was found to be once repeat in 32.46% of cases , twice repeat in 8.8 % ,three times repeat in 2.01% and four times repeated caesarean delivery was present in 0.53 % of cases. Among 3258 newborns delivered by Cesarean Section, the most common gestational weight at birth (80 %) was between 2500-4200 gr and the gestational age between 37 to 41 weeks in 84 % of cases. Based on the results of the research, we found thet CS rate is decreaset for 0,34% for year 2015 in comparation with 2014 year. We consider that the rate of caesarean delivery, at least should not increase. We suggest the constitution of a group of experts who would review the indications for Cesarean Section, especially for the first births. With the aim to decrease the rate of cesarean delivery we should follow the recommendations for how to convey normal birth as given by Effective Perianatl Care Program, and ACOG/SMFM recommendations for prevention of primary cesarean section

Premature Birth and Peripartal Outcome

The World Health Organization defines premature birth as a birth that occurs ≥22- 37weeks based on gestational age, or less than 259 days from the first day of the last menstrual cycle. 8-10% of pregnancies result in premature birth. Premature newborns are at risk of Respiratory distress syndrome(RDS), Intracranial Haemorrhage (HIC), Necrotizing enterocolitis (NEC), as well as other renal and neurologic complications. 10% of premature newborns remain handicapped throughout growth, have neurologic disorders, defects in sight and hearing, mental retardation, emotional disorders with social maladaptation as well as slowed intellectual development.Premature birth is a global problem which occurs even in Kosovo. Despite all the treatments premature birth cannot be prevented but only managed. In Kosovo, every year around 2500 births are premature, whereas the survival of the newborns is dependent on the gestational age. Therefore, births before 32 weeks and especially before 28 weeks are more challenging. The Aim.The aim of this study is to investigate premature births in the Obstetrics and Gynecology Clinic in Prishtina. This is a retrospective study in which we have analyzed the peripartal outcome based on maternal and fetal parameters. Material and Methods.This is a retrospective, descriptive, and analytic study of cases with premature births in the Obstetrics and Gynecology Clinic in Prishtina between January 2019 and March 2019. Data has been collected from medical records and evidence in the departament of delivery and operative ward. Cases with premature births have been analyzed according to maternal and fetal parameters. Maternal parameters that we have analyzed are the age, parity, mode of delivery whereas newbon parameters that were analyzed included gestational age, mode of delivery, weight at birth and vitality in the first and fifth minute according to the APGAR score.Excluding criteria: Term birthsResults:In this study, the rate of preterm birth is found to be 9.03%. Preterm birth rate was highest among women in group age between 30-40 (51%), followed by women ages 20-30 (38%), ages 40 years and older (7%) and women under age 20 (4%). Specific prematurity rate was the highest for women 40 and older (16.86%) followed by women under age 20 (12.69%). The highest proportion of premature birth was observed among primiparous women (42%) whereas women in their fourth and more pregnancy had lowest proportion (12%). The proportion of premature birth was 28 % in second pregnancy and 18% in third pregnancy. The highest rate of specific prematurity (10.41) was observed among women in their fourth and more pregnancy followed by nulliparous women (10.20%). Based on the gestational age 12.31% of cases were between 22-28 gestational weeks, 9.7% were between 28-32, 17.24% were between 32-34 and the majority respectively 60.59 were between 34-37 gestational weeks. Cesarean delivery was performed in 59% of the cases compared to vaginal birth which represented 41%. According to newborns weight at birth ,12% were between 500-1000 grams, 9% weighing between 1000-1500 and 17 % between 1500-2000 grams. 31% of premature infants were with birth weight 2000-2500 grams and 31% ≥2500 grams. There were 4% stillbirths, whereas 11% had severe asphyxia and 16% moderate asphyxia.Conclusion Based on our results, premature birth is still a problem due to unfavorable peripartum outcome.Thus, we highly recommend to increase the awareness among women regarding the importance of regular antenatal visits in order to identify women at risk for preterm birth as early as possible and to manage these cases according to the recommendations of the EPC program. since clinical efforts focus mainly on problem-solving rather than prevention

SCREENING AND TREATMENT OF PREKANCEROUS LESIONS OF CERVIX UTERI National Guideline

It is proved that the Screening of Cervix for neoplasia has decreased the incidence and mortality from the Cancer of Cervix and has raised the scale of healing from the Cervical Cancer. Prevention of the Cervical Cancer throughout Southeastern Europe is barely documented, despite the fact that the Countries of this region are the most affected places in Europe by the Cervical Cancer. It is estimated that the number of cases with Cervical Cancer and the number of deaths from this malignity in 11 States of Southeastern Europe during the period from 2002-2004 has been around 9000 women affected from the Cervical Cancer and around 4600 deaths from this illness. Based on the incidence of the surrounding countries, the incidence in Kosova might be 7.8 to 10.1. 2 The standard ways of Screening and Diagnosing are Citology, Colposcopy, Biopsy and Histological confirmation of intraepithelial cervical neoplasia. The “see and do” approach may be applied as an alternative method, during which the decision for treatment is based on the Screening Test and treatment according to the positive test result. The available screening tests include: Testing for Human Papilloma Virus (HPV), Visual Inspection via Acetic Acid (VIA) and Citology (Pap Test). Possible Treatments are: Cryotherapy, Loop Electrosurgical Excision Procedure (LEEP) and Conisation. This guideline offers the recommendations for Screening and Treatment of intraepithelial cervical neoplasia . It is adapted from the existing guidelines of WHO and NCCN, NHS and USPTF. Methodology Group for the Guideline Adaptation has been appointed by the decision of the Ministry of Health, Republic of Kosova. Goal and Focus According to the Definition of intraepithelial cervical neoplasia (CIN), intraehelial cervical neoplasia ( CIN), is a premalignant lesion, which can be developed in one of these stages: CIN1, CIN2 or CIN3. If untreated, CIN2 and CIN3 may progress into a Cervical Cancer. Target Population Guideline recommends applying the Screening from the age 21 (when the Screening should begin) until the age 65. Dedication of Guideline Guideline is dedicated to the policy-makers, managers of medical institutions and medical professionals who have responsibility to apply the prevention programme of the Cervical Cancer on the Republican and Municipal level. In the future, from this guideline should be drawn Clinical Protocols for the respective diseases. Key words for literature research: ‘Clinical Guideline’, ‘Clinical Protocol’, ‘Cervical Cancer’, ‘intraepithelial neoplasia‘ Recommendation Based on the above Guideline, women suffer and die from the Cervical Cancer, hence it is of a particular importance that on the level of UBT to be charted a leaflet which is dedicated to the women, so that they may have the peace of mind knowing that they are able to protect themselves from the Cervical Cancer. Women of every group-age will understand that: - Cervical Cancer is a scary disease, but it is one of a few types of cancer that can be prevented. - What is Cervical Cancer - When the PAP test should be taken - Which group-age should check for the HPV virus (Humam Papilloma Virus) - Which is the connection between the virus HPV and the Cervical Cancer - How the human gets infected with this virus - Does it mean that every woman that is infected by this virus will get Cervical Cancer - Does a simple PAP test detect the HPV virus - What does the PAP test observe - What does the HPV test observe - In which age the women should do the PAP test - In which age should they do the testing for HPV - Will Insurance pay for the HPV test - What do the patients who are suffering or who have suffered from the Cervical Cancer say I strongly believe that the short explanations on these key points about the Cervical Cancer will be an undisputed contribution which will positively influence the consciousness of population. It is not enough to inform professionals and policy-makers alone, but the population,especially the women, who will enjoy the life instead of suffering, must be informed too. For making this leaflet, Faculty of Nursery, respectively the UBT will give an important contribution not only in education of nurses in the Bachelor studies, but also in the education of the population