Fetal programming addresses the health impact of exposures in fetal life on diseases that occur later, often much later, in life. Often we delay our observation time until these adult diseases start producing symptoms. Even when studying childhood diseases like Autism Spectrum Disorder (ASD), we cannot start calculating incidence rates before the children reach a certain age, e.g., 5 years.

Introduction:
Depression is reported as a risk factor for lack of mammography screening. The current study aims at investigating an association between depression and use of mammogram screening among elderly Canadian women.

Method:
This population-based, cross-sectional study utilized the Canadian Community Health Database (CCHS).The samples were from 10 provinces across Canada including 22,662 women aged 40 and above who answered questions on depression, mammography, socio-demographic status, and health-care utilization. The Short-Form of The Composite International Diagnostic Interview identified women with depression; depressed women were defined as those with score ≥ 5.

Results:
Following adjustment for confounders, the odds of reported mammogram were 1.3 (95%CI 1.2-1.5) for depressed compared to non-depressed women. Age was an effect modifier in this relationship between utilizing mammography screening and depression. Moreover, the odds of reported mammography were the highest for 60-69 year old depressed women (AOR 2.9, 95%CI 0.9-8.6), compared with their counterparts in the youngest age group (40-49 years). Having a regular family doctor was strongly associated with reported mammography (OR 2.2, 95%CI 1.9-2.5).

Conclusions:
Depression among elderly women is positively associated with utilization of mammography screening. Longitudinal studies are needed to explore the effect of age as an effect modifier. Further studies can investigate the impact of other competing factors such as anxiety. Reasons for the increased utilization of mammography screening among elderly women should further be explored.

Objectives:
To answer the question, is female genital mutilation has effect on different domains of female QoL (psychological, social, environmental and physiological)?

Patients and methods:
The study included 40 men mutilated females and 160 mutilated females. Our candidates were subjected to two questionnaires: 1-WHO QoL BREF questionnaire. All questions were answered by choosing one of five answers then the answer has a score range from one to five. 2- Sexual quality of life questionnaire. Each female was asked 18 questions about their sexual life. All questions were answered by choosing one of ix answers. Finally, comparing total score with QoL BREF questionnaire.

Results:
Generally, FGM has inverse proportion relationship with QoL. There were significantly different results between type I & type II only in the social domain and in the total score of sexual QoL questionnaire as P values were 0.019, 0.001 respectively. The higher scores were for type I. Also there were significantly different results between Health-Related QoL (HRQOL) and sexual QoL in total score and in two domains (physical and social) a P value for them was 0.053, 0.056 and < 0.001 respectively.

Conclusion:
FGM habit should not be routinely done, and the people should be helped to change these cultural multitudes toward this habit.

Objective:
To assess the accuracy of 5D automated measurements of long bones, three dimensional VOCAL measurement of fetal thigh volume in prediction of fetal weight in comparison to the conventional two dimensional Hadlock formulas.

Methods:
Fifty pregnant women with singleton pregnancy at 37 to 41 weeks of gestation admitted for planned delivery within 48 hours were enrolled. All patients were examined by 2D, 3D VOCAL and 5D long bones for the purpose of estimating the fetal weight. Each technique was performed by the same examiner for all the patients who were blinded to the results of the two other techniques. Results were compared to actual birth weights using a unified weight scale. The accuracy, precision and agreement between the three types of ultrasound were calculated as well the time needed to perform each technique.

Results:
2D estimated fetal weight was significantly less accurate than 3D estimated fetal weight as measured by absolute birth weight estimation error and percent birth estimation error. On the other hand comparing the accuracy of 5D to 3D ultrasound showed a statistical significance in favor of the 5D but the difference was so small to impose a clinical significance in obstetric practice.

Conclusion:
Three dimensional ultrasonographic measurement of fetal thigh volume is more accurate than two dimensional Hadlock formulae in fetal weight estimation in our population. The new 5D automated long bone represent a faster, more convenient and accurate method for assessment of birth weight.

Objective:
The main goal of the present prospective cross sectional study is to compare three ketamine, thiopental and probofol for sedation during In Vitro Fertilization procedures.

Design:
Prospective cross sectional study.

Setting:
Assisted conception center.

Population:
150 patients operated for In Vitro Fertilization procedures from period 1/1/2013 till 1/1/2015 divided into 3 equal groups every one containing 50 patients; group A: (Ketamine 1-2 mg/kg) ; group B: [Thiopental 4-5 mg/kg (5)]; group C: Probofol 1-2 mg/kg (2.5).

Methods:
150 patients operated for In Vitro Fertilization procedures were allocated for comparing the effect of ketamine, thiopental and probofol for sedation during In Vitro Fertilization procedures.

Main outcome measures:
Cleavage rate (rate of good embryo garding+rate of poor embryo grading), implantation rate, pregnancy and abortion. rapid recovery of group C.

Results:
The percentage of fertilization were for group A, B, C respectively (66.66%, 76.92%, 92.30%); the percentage of embryo development were for group A, B, C respectively (50%, 60%, 83.33%); the percentage of cleavage rate were for group A, B, C respectively (66.66%, 76.92%, 92.30%); the percentage of good embryo grading were for group A, B, C respectively (37.50%, 60%, 83.33%); the percentage of pregnancy rate were for group A,B,C respectively (20%, 30%, 50%); the percentage of the implantation rate were for group A, B, C respectively (20%, 30%, 50%); the percentage of abortion rate were for group A, B, C respectively (40%, 26.66%, 20%).

There was no significant difference of number oocyte of M II retrieved. There was significant difference in rapid recovery of group C.

Conclusions:
By comparing the effect of ketamine, thiopental and probofol for sedation during In Vitro Fertilization procedures in this study the propofol show significant difference regarding rapid recovery percentage of fertilization, good embryo grading, embryo development, cleavage rate, pregnancy rate, and implantation rate, with less abortion rate.

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.

Intrahepatic Cholestasis of Pregnancy (ICP) is the most common pregnancy-related liver disease and is characterized by onset of pruritus and elevated serum transaminases and Bile Acids (BA) in the third trimester of pregnancy. Symptoms and abnormal liver tests resolve following delivery but frequently recur in subsequent pregnancies [1]. We represent one 37 years old female who had Intrahepatic Cholestasis of Pregnancy (ICP) in three pregnancies at intervals of 2 and 10 years.

Posterior cord neurostimulation therapy is used to treat several syndromes such as complex regional pain. Many patients treated in this way are young women of a reproductive age, who subsequently can become pregnant, although the effects of this therapy during pregnancy and on the development of the fetus are still unknown.

We present a clinical case of a 26 year-old patient who became pregnant after posterior cord neurostimulator implantation. The purpose is to review and synthesize the existing literature and recommendations about the use of neurostimulation during pregnancy and childbirth.