Background and Objectives: The incidence of labor induction is steadily increasing worldwide. The main aim of this study was to evaluate the ultrasound parameters and their mutual correlation and to analyze the parameters’ predictive capability in assessing the success of labor induction. The secondary goal was to assess patients’ tolerability and acceptance of transvaginal ultrasound and digital gynecological examination. Materials and Methods: This prospective observational follow-up study included 252 women selected for labor induction. The transvaginal ultrasound examination measured the posterior cervical angle, cervical length, the length and width funneling of the cervix, the distance between the head of the fetus and the external uterine os, and the position of the fetal occiput. After the ultrasound, a digital vaginal examination was performed (according to the Bishop score), and the women were asked to rate their perception of pain for each procedure. Results: The most common indication for labor induction was post-term pregnancy (57.59%), and the most common method of labor induction was oxytocin with amniotomy (70%). The results showed that a significant independent prediction of vaginal delivery could be provided based on the Bishop score and cervical length. Other investigated ultrasound parameters, the length and width of the funneling of the cervix (p < 0.001), the fetal head stage (p < 0.001), and the size of the posterior cervical angle (p < 0.05), showed statistical significance in relation to the success of labor induction. Patients reported lower discomfort and pain during transvaginal ultrasound examination (mean score 2, IQR 3) compared to digital examination (mean score 5, IQR 4), with p < 0.001. Conclusions: The results imply that the assessment of ultrasound parameters before induction of labor is necessary to predict the outcome and reduce the possibility of complications. In terms of tolerability and choice by the patients, the transvaginal ultrasound examination was better rated than the vaginal gynecological examination.

Introduction. Coronavirus infection may cause numerous complications in pregnant women, as well as an increased risk for the fetus. Disseminated intravascular coagulation and other coagulopathies can be caused by coronavirus disease 2019 infection. Case Report. A 22-year-old primigravida presented with a nineday history of dry cough, myalgia, nausea and fever. A nasopharyngeal swab for severe acute respiratory syndrome coronavirus 2 infection was positive. The patient?s condition rapidly deteriorated, resulting in severe liver damage and disseminated intravascular coagulation. Fetal cardiotocography showed a silent curve with late decelerations, while the umbilical artery Doppler showed end-diastolic block, indicating a fetal distress. Emergency cesarean section was performed at 28+5 weeks of gestation. After the cesarean section, the patient was treated with blood derivatives, thromboprophylaxis and supportive therapy and recovered quickly. Unfortunately, the premature infant died three hours after birth. Conclusion. It is very important to simultaneously monitor the parameters of the mother?s coagulation system, as well as the condition of the fetus, because there is a possibility of developing coagulopathies, including disseminated intravascular coagulation.

Introduction. Tocilizumab is an IgG1 monoclonal antibody targeting the interleukin 6 receptor. We present a case of a pregnant woman with COVID-19 pneumonia, which rapidly worsened despite the advanced treatment. Therefore, the administration of tocilizumab was deemed necessary. Case outline. Our patient was a 31-year-old pregnant woman hospitalized on the seventh day after contracting COVID-19. She was in the 21st week of a twin pregnancy, specifically monochorionic diamniotic. Her general condition was severe, accompanied by elevated inflammation markers: C-reactive protein ? 94.6 (mg/L), procalcitonin ? 1.44 (ng/mL), and IL-6 ? 79.3 (pg/mL), along with extensive bilateral pneumonia evident in the X-ray image. She required respiratory support in the form of high flow nasal cannula, continuous positive airway pressure, and intensive monitoring. The following day, her condition deteriorated further, prompting the decision to administer tocilizumab. After receiving tocilizumab, the X-ray image deteriorated, but the inflammation markers decreased. After 33 days of hospitalization, she was discharged with normal laboratory findings and a clear X-ray. On July 16, the patient was admitted to the Clinic for Gynecology and Obstetrics of the Clinical Center of Vojvodina at 36 weeks of gestation (35 gw + 2 day) due to premature contractions. On the same day, a caesarean section was performed, and both neonates were in good general condition. Conclusion. Managing severe COVID-19 in pregnant women poses significant challenges. This case study suggests that tocilizumab may hold efficacy in treating this condition.

Introduction. Rupture of an unscarred uterus is extremely rare and associated with severe maternal and fetal morbidity. Risk factors are second-stage dystocia, grand multiparity, high parity, labor induction or augmentation with oxytocin or prostaglandins, delivery after the 42nd week of gestation, neglected labor, fetal malpresentation, breech extraction, and instrumental delivery. Case Report. A 44-year-old multipara (gravid3 para3) underwent induction of labour at 40 + 3 weeks of gestation. The patient’s medical history showed no uterine surgeries, but her first delivery was instrumental, with vacuum extractor. The induction of labour was initiated by oxytocin infusion of 6 mIU/min. Continuous fetal heart rate monitoring was performed and there were no signs of fetal distress. Fetal descent in the second stage of labor lasted an hour, which is slightly over than average duration for multiparas. A live female infant weighing 3380 g was born and the pediatrician started resuscitation of the baby. Apgar score was 1/3/3. Ten days following the delivery, the patient was admitted to Emergency Gynaecology Department of the Clinic of Gynecology and Obstetrics due to abdominal pain, left sided retrouterine hematoma, and foulsmelling vaginal discharge. Laparotomy was indicated due to suspected uterine rupture. The intraoperative findings showed subinvolution of the uterus with signs of panmetritis and on the left side below the round ligament there was a 2 cm long rupture, passing through and invading the lateral and posterior walls of the uterus. A total abdominal hysterectomy with bilateral salpingo-oophorectomy on the left side was performed. Conclusion. Although a reliable prediction and prevention do not exist, the obstetricians’ awareness of this rare event in unscarred uterus may decrease maternal and neonatal morbidity. This case report is an example of a serious and difficult outcome after a seemingly low-risk situation.

Introduction. Autoimmune encephalitis associated with ovarian teratoma is a serious and potentially fatal pathology. While this clinical entity is known to neurologists, the available literature rarely mentions the role of a gynecologist in diagnostic imagining and treatment. Although several months have passed from the appearance of the symptoms to surgical treatment, this case shows that even then a complete recovery is possible. Case presentation. The patient was a 28-year-old female, brought to the hospital because a sudden onset of unusual behavior - an acute psychosis with suicidal thoughts and auditory hallucinations. Soon after the admission she became delirious, uncooperative and agitated. Blood check, neurological assessment and cranial computed tomography yielded normal results. Therefore, a psychiatric disorder was suspected. Electroencephalogram revealed a diffuse encephalitic insufficiency. As cerebrospinal fluid was negative for infections, the autoimmune etiology of the disease was suspected. Abdominal computer tomography showed a complex right ovarian mass measuring 50 x 40 x 30 mm, confirmed by vaginal ultrasound. Laparoscopy with right adnexectomy was performed. The pathohistological finding showed a mature teratoma. In the meantime, the result of the cerebrospinal fluid test came positive for anti NMDAR antibodies. Six months after surgery, the patient was in a good mental and neurological status without symptoms. Conclusion. Gynecologists should be aware of the presence of ovarian tumors in encephalitis cases. A timely diagnosis of the underlying gynecological cause of a neurological condition, allows for prompt treatment and can remarkably improve clinical conditions and, thus, be lifesaving.