Objective:
This cross sectional clinical trial aimed at exploring the association between chlamydia trachomatis infections and perimenopausal bleeding presenting at Al-Azhar University Maternity Hospital outpatient clinics.

Patients and methods:
This was a cross-sectional study involving 150 women divided into two equal groups of 75 women in each group. Women were allocated from the out-patient clinic of Al-Azhar Maternity University Hospital and they were counseled and arranged for Pipelle endometrial samples. Women of group I suffered from perimenopausal bleeding while group II were presented at the hospital due to any cause other than vaginal bleeding. Pipelle endometrial biopsy was taken and sent for detection of Chlamydia trachomatis by real time PCR.

Results:
In group I, 44 (58.7%) samples were positive for Chlamydial infection while the other 31 (41.3%) samples were negative for Chlamydia. In group II 17 (22.7%) samples were PCR positive. There was an apparent significant difference between the two groups regarding the prevalence of C. trachomatis among symptomatic perimenopausal women suffering from uterine bleeding.

Conclusion:
It is advisable to screen for Chlamydia trachomatis in women with perimenopausal bleeding.

Background: (Assuming this is the missing first paragraph)
infections, including human immune deficiency virus. Also antiretroviral treatment has contributed a lot in decline of human immune deficiency virus related morbidity and mortality but a little of it is known in our country.

Objectives:
To assess dual contraceptive utilization and associated factors among pre-ART and ART women living with human immune deficiency virus.

Methods:
Facility based cross-sectional study was conducted. Data were collected through interview using structured questionnaires. Participants were selected by using simple random sampling technique from patient registration book. Bivariate and multivariable analysis was performed using logistic regression on SPSS version 20.0. Adjusted odds ratio with 95%CI was used.

Results:
The prevalence of dual contraceptive utilization of women living with human immune deficiency virus in the Hospital was 28.3% (95% CI: 23.8, 33.7) and significantly associated with receiving follow up counseling (AOR: 6.05; 95% CI: 2.46, 14.83), starting ART(AOR: 0.21; CI: 0.07, 0.64), had no child (AOR: 0.19; 95% CI: 0.06, 0.57), supporting to use (AOR: 6.36; 95% CI: 2.49, 16.28).

Conclusions:
Dual contraception utilization was less than one-third and having no child; receiving follow up counseling in the last 3 months; starting antiretroviral treatment; supporting to use were significantly associated with dual contraceptive utilization. It needs governmental and non-governmental organizations, other professionals and researchers involvement to improve dual contraceptive utilization.

Background:
Major Obstetric Hemorrhage (MOH) is a leading cause of Severe Maternal Morbidity (SMM) world-wide, and around 50% of cases are potentially preventable.

Aim:
To present in-depth descriptive evaluation of the clinical pathway of cases of MOH identified in a SMM review, to highlight clinical action points for improvement in care.

Method:
A secondary analysis of the clinical pathway of women who were pregnant or within 42 days of pregnancy who were admitted to an intensive care unit or high dependency unit after suffering a major obstetric hemorrhage (defined as ≥2L blood loss) from 1st March 2011 - 31st August 2012 from four District Health Boards in New Zealand.

Results:
Forty-three women with major obstetric hemorrhage were identified. Of 11 women with identifiable risk factors only 6 had a documented plan for active management of third stage and preparedness for prevention of postpartum hemorrhage. Drug management varied and resuscitation was often inadequate. Uterine atony was the commonest source of bleeding (40%). The most common intervention after drugs was intra-uterine balloon, of which 77% were successful. B-Lynch sutures and interventional radiology were less frequently used. Four women required hysterectomy.

Conclusion:
This study highlights where improvements in clinical care and systems are needed, and gives recommendations to reduce the severity of morbidity for women suffering this severe obstetric event. These include recognition and documentation of risk factors, plan for active management of third stage, routine use of Modified Early Obstetric Warning charts, and adequate resuscitation.

Background:
International focus on lowering pregnancy related complications in women with type 1 diabetes has improved the outcome for both mother and child remarkably. However, research has shown that pregnancy is an extremely demanding and vulnerable time for this group of women and that glycemic levels deteriorate after birth. Little is known of the factors influencing the glycemic control in the post-birth period and this particular period seems unexplored. Therefore, the aim of this study was to explore and illuminate the potential factors influencing glycemic control after birth in women with type 1 diabetes.

Method:
Grounded Theory was applied to explore the pregnancy journey among postpartum women with pre gestational type1 diabetes. The women were theoretically sampled from 2007-2016. For two of the first ten sampled women, self-determined motivation seemed to improve the journey, why we subsequently explored the importance of self-determined motivation by sampling seven women with presumed higher self-determined motivation from earlier guided self-determination interventions.

Results:
A total of 17 women aged 20-45 years with pre gestational type1 diabetes were included in the study. A five-stage theory was developed with a core category, “Also for my sake,” explaining how greater self-determined motivation increased the women’s ability to manage the challenges of pregnancy and having a newborn. They 1) more easily achieved the green light for pregnancy; 2) perceived pregnancy as enjoyable and manageable; 3) had only a short child-first stage with less attention to their diabetes; 4) recognized and managed a child-or-me dilemma; and 5) achieved a child-and-me balance by prioritizing their long-term health and glucose management.

Conclusion:
Higher self-determined motivation before pregnancy seems to ease the pregnancy journey, with a potential positive long-term impact on glucose control.