Quality of Antenatal Care Provided For Pregnant Women in Ribat University Hospital; Khartoum

Background:The purpose of antenatal care is to assure that every pregnancy culminates in the birth of a healthy baby without any impairment of the mother's health. The objective of this study was to study thequality of care given to pregnant women attending the referral clinics in Ribat University Hospital; Khartoum;Sudan.Methods:This is a descriptive; cross sectional study. 300 antenatal care cards were checked fordocumentation for the following parameters at the 5th month of pregnancy: date of the first visit; age of the pregnant woman; the address; date or duration of marriage; parity; the first day of the last menstrual period; the expected date of delivery; the gestational age; vaccination; blood pressure; fundal level; foetal heart sound; haemoglobin estimation; urine analysis; blood group; ultrasound check and the date of ultrasound check. Data was analysed by the computer using SSPS soft ware; version 16.Results:The date of the first visit; the age of the pregnant woman and her address were documented in 294(98); 296(98.7) and226(75.3) respectively. The date/duration of marriage; parity; the first day of the last menstrual period; the expected date of delivery; the gestational age and vaccination were documented in 70(23.3); 298(99.3);298(99.3); 295(98.3); 278(92.7) and 45(15) respectively. Blood pressure; fundal level and foetal heart sound were checked in 266(88.7); 280(93.3); 244(81.3) respectively. Haemoglobin; urine analysis; blood group and Rhesus factor; ultrasound were done in 187(62.3); 159(53); 173(57.7); 121(40.3) respectively.Conclusions: The study concluded that documentation of the personal history and obstetrical examination were adequate. On the other hand documentation of obstetrical history was high except for date of marriage and vaccination which were very poor. Documentation of results of investigation were average

Recurrent varicose veins: causes and management

High recurrence rates after varicose vein VV surgery still represent a major problem facing vascular surgeons. The aim of this study was to identify the possible causes of recurrent varicose veins RVV and the available management options. This study was conducted on 27 limbs in 23 patients presenting with RVV at Surgery Department, Zagazig University Hospitals. Those were [17] men and [6] women. Their ages ranged from 21-52 years old [mean = 34.3 years]. Clinical assessment, colour Doppler ultrasound US and varicography alone or with ascending venography were done for every patient. We divided our patients into 2 main groups according to the radiological findings. Type I RVV was due to incompetent saphenofemoral venous complex and occurred in 19 limbs [70.37%]. This type was further subdivided into 3 subgroups, A with intact incompetent long saphenous vein LSV in 7 limbs [25.93%], B with incompetent tributaries in 11 limbs [40.74%], and C with neovascularization in one limb [3.70%]. Type I RVV was treated by groin re-exploration and re-ligation of the saphenofemoral junction SFJ with ligation-excision of all varicosities including the LSV. Type II RVV was not related to incompetent saphenofemoral venous complex and occurred in 13 limbs [48.15%]. This type was further subdivided into 4 subgroups, A with cross-groin connections in 2 limbs [7.41%], B due to incompetent thigh perforators in 3 limbs [11.11%], C due to incompetent leg perforators in 5 limbs [18.52%] and D due to incompetent saphenopopliteal junction SPJ and incompetent short saphenous vein SSV in 3 limbs [11.11%]. Subgroups IIA and IIB were treated by ligation-excision of the affected perforators or connections. Subgroup IIC was treated by subfascial ligation of incompetent leg perforators through a posterior longitudinal midline incision, while subgroup lID was treated by ligation of the SPJ with excision of the SSV. Any subgroup of type I or II could occur independently or in combination with any subgroup of either type. No recurrence could be detected in all patients at the end of the 2-year period of follow-up. In conclusion, RVV were mainly due to deficient preoperative investigations missing other important sites of venous reflux and due to improper surgical technique at the SFJ. So, proper preoperative assessment of patients with VV by colour Doppler ultrasound must be done to identify the exact sites of venous reflux to decrease the recurrence rate. Ascending venography may be needed in difficult cases. In addition, VV surgery should be done by experienced senior staff doing proper flush-ligation of the SFJ with ligation-excision of all tributaries to the secondary tributary points and excision of the thigh portion of the ESV. Our aim is to decrease the patient morbidity and medicolegal actions following VV surgery and to save the resources of the national health services