Promoting antenatal care services for early detection of pre-eclampsia.

A prospective, quasi-experimental study was carried out in 2009 at urban health centres (UHCs) of five townships of Mandalay, Myanmar, to improve the skill of midwives (MWs) in diagnosis and referral of pre-eclampsia (PE) from UHC to the Central Women’s Hospital (CWH) and to enhance the supervision of midwives by lady health visitors (LHVs). The intervention was training on quality antenatal care focusing on PE using an updated training manual. Altogether, 75 health care providers (MWs & LHVs) participated. In this study, data were extracted from patient registers and monthly reports of UHCs and CWH. Interviewers were trained regarding the conduct of semi-structured questionnaires to elicit knowledge and to use checklists in observation of skills in screening of PE, measuring blood pressure and urine protein (dipstick test). A guide for LHVs was also used to obtain data, and data was collected six months prior to and after the intervention. Significant improvements from baseline to endline survey occurred in the knowledge (p<0.001) and skill levels (p<0.001) including skills for screening, measuring blood pressure and urine protein. At CWH, there was an increase in referred cases of PE after the intervention, from 1.25% to 2.56% (p<0.001). In conclusion, this study highlights the early detection of pre-eclampsia by widespread use of quality antenatal care, education and training of health-care providers to improve their performance and increase human resources for health care, in order to enable women in our society to have healthy pregnancies and healthy babies.

Case report on a successfully operated renovascular hypertension

This is a case report of a sixteen year old girl with renovascular hypertension, who had been successfully operated. The importance of the role of radiology, particularly Rapid Sequence Urography before an Aortogram is stressed. Percutaneous Transluminal Angioplasty (PTA) a new technique for the treatment of renal artery stenosis is also mentioned.

Four cases of hiatus hernia with a note on the methods of demonstrating a hiatus hernia

Four cases considered to be cases of hiatus are described. They led the author to read up some of the recent literature. The symptoms complained of were perhaps confusing until the possibility of hiatus hernia was considered, when a new light was shed on the diagnostic problem. Once diagnosed, simple medical treatment can in many cases produce very satisfactory results.The condition is rare, but not all that rare.The symptoms which presented were broadly, in case one, retro-sternal discomfort, occasional heartburn, and tiredness; in case two, retro-sternal pain, and pain in the arms, difficulty in swallowing and tiredness; (he had been treated for ten months as angina of effort); in case three there were confusing dyspeptic symptoms, pain in the epigastrium and upper abdomen, flatulence, heartburn and occasional vomiting; (these symptoms varied somewhat in their pattern from time to time).; in case four the symptoms were, retro-sternal pain, flatulence, occasional heartburn, loss of appetite, and "a block of air" in the chest when lying down at night. Cases two and three may well have had complications, for in number two there were changes in the E.C.G., and in number three a complicating peptic ulcer or peptic ulcer diathesis was not impossible. Hiatus hernia is a condition to be kept in mind by general practitioners, physicians and surgeons, in all cases presenting with retro-sternal discomfort, heartburn, dyspepsia, and on occasions, anaemia, with perhaps melaena. I am indebted to Dr. Kyaw Aung for his enthusias-tic co-operation, so freely given. I have also to thank Dr. Tha Din for his opinion on the X-ray and for his stimulating help in discussion.