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Background and Objectives: The Advanced Life Support in Obstetrics (ALSO) course is widely utilized in the United States as an evidence-based program that bridges knowledge gaps and improves skills via hands-on training, group learning, and memorization of standardized mnemonics in a team-based approach to patient care. This reduces communication barriers among maternity care providers, ultimately decreasing potential negative outcomes. A needs assessment identified that Serbian providers would benefit from structured learning and hands-on simulation approaches in obstetrics from a structured training like the ALSO course. The objective of this study was to explore the changes in clinicians’ knowledge and preferred scenario responses in managing obstetrics cases before and after participation in the ALSO course. Methods: The ALSO training lasted 2 days and included lecture sessions, interactive workshops, a written knowledge test, and a simulated skills test. Participants completed an additional 20-item questionnaire assessing their knowledge and preferred scenario responses two weeks pre- and immediately post-ALSO training. Using a paired t test we assessed changes between pre- and posttest knowledge and preferred scenario response scores. Results: Twenty-seven participants provided complete data. For the entire sample, the pretest mean number of correct items on the knowledge and preferred scenario response assessment was 10.8 and the posttest mean number correct was 15.2, representing an increase of 4.4 correct answers (P

Introduction. Malignant melanoma accounts for 3% of all cancers in Europe. Malignant melanoma of the genitourinary tract is very rare, accounting for 1% of all cases. In addition, primary malignant melanoma of the urethra accounts for 0.2% of all melanomas and 4% of all urethral cancers. The abnormal migration of melanocytes during the embryonic development may explain their occurrence in the urethra. Also, vulva contains a relatively high concentration of melanocytes, so it may be the reason for higher incidence of malignant melanomas in females than in males, especially located at the meatus or in the distal urethra. Case Report. A 60-year-old woman presented with a solid tumor protruding through the vaginal introitus. Computerized tomography revealed a 5 cm large tumor of the urethra, infiltrating the bladder neck and the anterior vaginal wall. In addition, a bilateral pelvic lymphadenopathy was observed. The patient underwent anterior pelvic exenteration with urethrectomy, bilateral pelvic lymphadenectomy and bilateral ureterocutaneostomy, followed by immunochemotherapy. Nonetheless, the patient died 10 months after the surgery. Conclusion. Urethral melanoma is a tumor with a very poor prognosis and high recurrence rate (71%), even after wide surgical resection, adjuvant radiotherapy, chemo and immunotherapy.

Introduction. Rupture of the urinary collecting system, associated with perirenal or retroperitoneal extravasation of the urine, is a rare condition usually associated with the obstruction of the urinary system. A urinoma is a localized collection of urine in the retroperitoneum, outside the urinary tract, and occurs after injury to the wall of the urinary system. Ureteral obstruction caused by a bladder tumor is a rare cause of urinoma. Case Report. We report a case of a 62-year-old patient who was admitted to the Clinic of Urology of the Clinical Center of Serbia, due to an invasive bladder cancer. A computerized tomography scan of the abdomen and pelvis revealed a massive bladder tumor dominant on the left side, invading the vagina, uterus and significantly obstructing both kidneys. Intraoperatively, a mass of 18 cm in diameter was identified in the right retroperitoneal space and it was dissected from the peritoneum. Two liters of clear fluid were aspirated from the mass, and the walls of urinoma were resected. The site of perforation was not identified. The patient underwent anterior pelvic exenteration. The pathohistological analysis revealed a high grade transitional cell carcinoma of the bladder. The treatment is individual and involves surgical and interventional radiology treatment. Conclusion. A spontaneous retroperitoneal urinoma is a very rare condition. In this case report it appeared most likely due to right ureteral obstruction and perforation. The growth of urinoma was slow, due to the absence of acute symptoms and the thickness of the urinoma wall.

The fetal endometrium becomes responsive to steroid hormones around the fourth month of pregnancy starting with an oestrogenic phase, which is followed late in pregnancy by a secretory phase. Based on post-mortem studies, the endometrium at birth is secretory in only one-third of neonates and proliferative in the remaining cases. Decidual or menstrual changes are rare in fetal endometrium despite high circulating steroid hormone levels, which drop rapidly after birth. Hence, acquisition of progesterone responsiveness appears to be dependent on endometrial maturation and relative immaturity may persist in a majority of girls until the menarche and early adolescence. Two major reproductive disorders have been linked with either advanced or delayed endometrial maturation. First, early-onset endometriosis may be caused by menstruation-like bleeding in the neonate, leading to tubal reflux and ectopic implantation of endometrial stem/progenitor cells. Second, persistence of partial progesterone resistance in adolescent girls may compromise deep placentation and account for the increased risk of major obstetrical syndromes, including preeclampsia, fetal growth retardation and preterm birth. The concept of neonatal origins of common reproductive disorders poses important research challenges but also subsumes potential new preventative strategies.

Adequate level of prenatal ultrasound scan is a prerequisite for a successful definition of high risk population that needs further investigations. ”Basic”, standardized fetal mid-trimester scan, with an informative report enables not only diagnosis of anomaly but also evaluation of state of pregnancy in general. This paper was aimed at reviewing the benefits of and requirements for a complete basic mid-trimester fetal ultrasound scan and the necessary documentation. Potential directions for development of organization of basic mid-trimester fetal ultrasound scans are standardization of the scan, with establishing the number and the level of examination, and continual education of both the doctors and the patients. In order to standardize the exam, a uniform check list is needed, so that the examination should always be done in the same manner and at the same level, no matter where it is done and by whom. International and national guidelines should be agreed upon and they should state clear standards on who should do the scan, how, what kind of ultrasound machine should be used and what documentation should be kept. This paper presents a possible standardization of basic level mid trimester fetal ultrasound scan. A routine complete second trimester ultrasound between 18 and 22 weeks and a complete ultrasound report will provide the best opportunity to diagnose fetal anomalies and to help in the management of prenatal care. It will also reduce the unnecessary number of ultrasound examinations done during the second trimester for completion of fetal anatomy survey, which would decrease the costs.

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 of 38 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.

Aim To investigate differences between the infants born in occipital and breech presentation relative to the passive and active motility. Method A prospective study was conducted in the period from 2006 to 2007 at the Department of Obstetrics and Gynecology in Novi Sad. Subjects were 50 breech-presenting and 87 occipital-presenting term newborns delivered by elective cesarean section following a regular course of pregnancy, without fetal, newborn, and the pregnant female disease. Outcome measures were popliteal angle; extension of the hip-joint; ventral flexion and dorsal extension in the axis; spontaneous displacement; crawling reflex; righting reaction in vertical and sitting positions; righting reaction in horizontal suspension, the automatic walking investigated on the second and fourth day of life. Results Except for righting reaction in horizontal suspension, the newborns from breech presentation had a significantly lower score for all investigated parameters of active movements at the first and second examination. There was no difference between occipital and breech-group relative to the ventral flexion and dorsal extension in the axis. The popliteal angle was significantly increased, whereas the extension in the hip joint was significantly decreased in the breech group. Conclusions Investigations showed a significantly decreased expression of active movements in the breech group, which cannot be explained only by postural deformities.

Introduction. Even though placentas from assisted reproduction programs often differ from placentas of women who conceived naturally, they are rarely examined. The aim of our investigation was to determine some gross characteristics of placentas of women who conceived with assisted reproduction. Material and methods. We examined 30 placentas from an assisted reproduction program (20 from in vitro fertilization and 10 from intrauterine insemination) and 30 placentas of women who conceived naturally. All women were age matched. All the women were at term. Results. The mean weight of placentas from assisted reproduction program was 573 g and of those after natural conception - 582.67g. The mean length of the umbilical cords was 64.3cm after assisted reproduction and 66.3cm after natural conception. The mean placenta thickness after assisted reproduction was 2,22 cm and after natural conception 2.28 cm. Eight pla?centas of the study group had a marginal insertion of the umbilical cord, which lead to a statistically significant difference when compared to placentas of women who conceived naturally: ?? =7.07; p>0.01. Discussion. Marginal cord insertion into the placenta after assisted reproduction is also often described in the literature (as a possible "consequence " of embryo-transfer). Conclusion. There were no statistically significant differences in the mean weight and dimensions of placentas, length of the umbilical cord, gross pathological features of placentas and cords, mean birth weight of babies and placental/fetal ratios between women from assisted reproduction program and those who conceived naturally. .

Women from in vitro fertilization program are at higher risk for developing pregnancy induced hypertension, so we analyzed the incidence of preeclampsia and eclampsia in women who conceived in an in vitro fertilization program. A seven-year study included 144 parturients from in vitro fertilization program. The control group consisted of 39,112 parturients from general population. We analyzed only women with singleton pregnancies. There were 2.08% parturients from the in vitro fertilization program, and 0.40% from the control group, with diagnosis of preeclampsia, with chi2=6.24; p0.05. Eclampsia occurred in 0.69% women who conceived using in vitro fertilization, and in 0.06% parturients from the control group (chi2=2.05; p0.10). Parturients from in vitro fertilization program are at statistically significantly higher risk for preeclampsia, but not for eclampsia, when compared with women from general population.

Placentas from assisted reproduction programs are a poorly investigated research material. The aim of this investigation was to perform microscopic examination of placentas from assisted reproduction programs and to compare them with placentas from spontaneous pregnancies. The investigation comprised 12 placentas from assisted reproduction programs and 12 placentas from spontaneous pregnancies. We found a statistically significant increa of villous edema in investigated placentas (p=0,001). We also found a statistically significantly increased incidence of microcalcifications in placentas from assisted reproduction programs (p=0,04). There was no statistically significant difference between the two groups in regard to syncytial knots (?2=0,67, p>0,25). Microscopic examination showed that placentas from assisted reproduction programs present with more frequent pathological findings. Further investigations of placentas from assisted reproduction programs could provide better understanding of different pathological conditions of pregnancies and labor in women with artificial insemination.

The aim was to study the effect of twin gestations in a uterus with 2 bodies on the probability of breech presentation at delivery. The hypothesis was that the probability of breech presentation was not higher than 50%. A review was undertaken of MEDLINE (1966–2004) and of the article reference list for statistical analysis of presentation at delivery among twins in a normal uterus, singleton gestations in a uterus with 2 bodies, and case studies of twins in a uterus with 2 bodies. There are 10 studies of twin gestations in a normal uterus (Twin A 3036 cases, breech presentation 22.36%; Twin B 2758 cases, breech presentation 36.87%), 2 studies of singleton gestations in a uterus with 2 bodies (297 cases, breech presentation 42.09%), and 57 case report studies of twin gestations in a uterus with 2 bodies (Twin A 56 cases, breech presentation 14.29%; Twin B 54 cases, breech presentation 18.52%). The odds ratio and chi-square test for differences in probabilities show a significantly lower incidence of breech presentation for twins in a uterus with 2 bodies compared with twins in a normal uterus (Twin A, odds ratio = 0.58; χ2 = 2.08, p > .05, Twin B, odds ratio = 0.39, χ2 = 7.67, p < .05), and singleton gestations in a uterus with 2 bodies (Twin A, odds ratio = 0.23, χ2 = 15.51, p < .05; Twin B, odds ratio = 0.31, χ2 = 10.72, p < .05). Twin gestations in a uterus with 2 bodies decrease the probability of breech presentation.

Women conceiving by assisted reproduction are at higher risk for preterm and premature rupture of membranes. The aim of our study was to estimate and compare incidence of preterm premature rupture of membranes in singleton pregnancies of women who conceived by intrauterine insemination and in vitro fertilization, from 1999 to 2003. We investigated 87 women from the intrauterine insemination, and 102 from the in vitro fertilization program. There were no statistically significant differences in regard to preterm and premature rupture of membranes: p>0.75 in two groups. The incidence of premature rupture of membranes was 2.30% (after intrauterine insemination) and 2.94% (after in vitro fertilization). There was no statistically significant differences in regard to preterm and premature rupture of membranes in women who conceived by insemination and in vitro fertilization. Estimated incidence of preterm and premature rupture of membranes was similar to the literature data and also similar to incidence after natural conception.