Modified Vejnovic technique

Tihomir Vejnovic — Serban Dan Costa — Atanas Ignatov - Aleksandra Vejnovic

Tihomir Vejnovic was born in Apatin on 22nd November 1958. He graduated from University
of Novi Sad, Faculty of Medicine in 1984. and two years after got employed at the Clinic of
Gynaecology and Obstetrics in Novi Sad. Meanwhile and during military service he used to work in a
Military Hospital at general surgery department and teach anatomy at the Faculty of Medicine. In 1997
he became head of the second biggest Delivery department in Serbia with approximately 6500
deliveries per year. Since he started his education and clinical work at the Clinic, pronounced changes
in obstetrical practice happened. During his residency most of the breech presenting fetuses and
multiple pregnancies were delivered vaginaly using Bracht maneuver, internal podalic version etc.
Afterwards, as caesarean section became safer to perform, many manual skills in vaginal delivery were
progressively replaced by caesarean section (Table 1). The rate of caesarean section sharply started to
increase.

Table 1 — Obstetrical operations rates in period 1990-2015 expressed as percentages of vaginal

deliveries (episiotomy, vacuum extraction, breech delivery) and total number of deliveries (caesarean
section) res ectivel (1)
- 1990 1995 2000 2005 2010 2015
Episiotomy 60.5% 64.5% 36.3% 41.8% 44.2% 37.1%
Vacuum extraction 2.4% 2.5% 1.3% 0.7% 0.8% 0.9%
Breech delivery 84.9% 55.9% 31.0% 22.1% 27.5% 9.1%
Caesarean section 11.7% 12.2% 20.8% 25.5% 29.0% 30.5%

Tihomir Vejnovic belonged to both obstetrical eras, so he became skilled in wide spectrum of
obstetrical procedures, knowing surgical principles and anatomy by heart. Working in referent center
for Obstetrics made him competent for the management of various kinds of complications. All this
helped him to learn, respect and understand nature of vaginal delivery.
Since his early career he was receptive and open-minded for new solutions which could reduce
maternal and neonatal morbidity. Together with Prof Dr. Aleksic he replaced lower midline
laparotomy with suprapubic laparotomy in caesarean section at Novi Sad clinic (Figure 1).
,r 90

80

70

60

50

40

30

20

10

o
93 '94 '95 '96 '97 '98 '99
= Lap.mediana inferior 56,05 47,98 54,19 47,13 33,41 22,49 14,89
—=- Lap.sec.Pfannenstiel 43,95 52,02 45,81 52,87 66,59 77,51 85,11

Figure 1. Percentage of lower midline laparotomy and Pfannenstiel laparotomy at the Clinic of
Gynaecology and Obstetrics Novi Sad