Assessment of knowledge and practice of venous thromboembolism (VTE) prophylaxis after cesarean section among gynecologists and obstetricians in Al-Najaf hospitals.

Venous Thromboembolism (VTE) is associated with high morbidity and mortality rates after cesarean sections. VTE is likely four-time greater following cesarean section than normal vaginal delivery. Despite a large number of published studies and the availability of well-evidenced guideline recommendations for VTE prevention, it is evident that these guidelines are poorly implemented with suboptimal use of a prophylactic thrombotic agent. The objective of our study was to assess the knowledge and practice of gynecologists and obstetricians about guidelines of VTE prophylaxis after cesarean section. An observational study included 57 gynecologists and obstetricians from all hospitals in Al-Najaf province. The study used a validated questionnaire consisting of 40 items where the correct response scored 1, giving an overall total score of 40. The total overall knowledge and practice score was calculated for participants, and the knowledge and practice levels were evaluated. Only 57 participants out of 67 completed the study giving a response rate of 85%. The mean overall score of practice and adherence was 0.51±0.09. This study showed inadequate practice towards VTE and poor adherence to prophylaxis guidelines because of many barriers, mainly the cost, poor patient adherence, and inconvenience to use guidelines in our patients.

Endoscopic endonasal pituitary surgery: surgical and outcome analysis of 50 cases.

OBJECTIVE: Microsurgical transsphenoidal surgery for pituitary tumors has been standard therapy for decades and was established by Harvey Cushing in the early twentieth century. Today, endoscopy is increasingly accepted in the therapy of pituitary lesions. In this retrospective study, we analysed the surgical technique and outcome of 50 patients with pituitary lesions treated with an endoscopic endonasal trans-sphenoidal approach. METHODS: Between January 2004 and July 2005, 50 patients (30 female and 20 male) with pituitary tumors were operated upon using an endoscopic endonasal trans-sphenoidal procedure without nasal speculum or postoperative nasal packing. The follow-up period ranged from 3 to 18 months. RESULTS: All patients had normal airways through both nostrils immediately after extubation. Postoperative discomfort was minimal and hospitalization was 4-5 days. Three patients developed postoperative transient diabetes insipidus, persisting in one for a further 2 months. Among the 50 patients, total tumor removal was achieved in 47 patients (94%), subtotal in two patients (4%). One patient died intraoperatively due to subarachnoid haemorrhage. CONCLUSION: The endoscopic endonasal transsphenoidal approach for removing pituitary lesions is a form of minimally invasive surgery offering excellent postoperative results.