Background: Although it has been more than a century since endometriosis was initially described in the literature, understanding the etiology and natural history of the disease has been challenging. However, the broad utility of murine and rat models of experimental endometriosis has enabled the elucidation of a number of potentially targetable processes which may otherwise promote this disease.Objective: To review a variety of studies utilizing rodent models of endometriosis to illustrate their utility in examining mechanisms associated with development and progression of this disease.Results: Use of rodent models of endometriosis has provided a much broader understanding of the risk factors for the initial development of endometriosis, the cellular pathology of the disease and the identification of potential therapeutic targets.Conclusion: Although there are limitations with any animal model, the variety of experimental endometriosis models that have been developed has enabled investigation into numerous aspects of this disease. Thanks to these models, our under-standing of the early processes of disease development, the role of steroid responsiveness, inflammatory processes and the peritoneal environment has been advanced. More recent models have begun to shed light on how epigenetic alterations con-tribute to the molecular basis of this disease as well as the multiple comorbidities which plague many patients. Continued de-velopments of animal models which aid in unraveling the mechanisms of endometriosis development provide the best oppor-tunity to identify therapeutic strategies to prevent or regress this enigmatic disease.

Abortion has been legal since the 1973 United States Supreme Court decision in Roe versus Wade. Since 1973, there have been nearly 53 million abortions performed, with 1.06 million abortions in 2011 [1]. In 2011, the abortion rate was the lowest since 1973, with 16.9 abortions per 1000 women age 15- 44 years [2]. Although the abortion rate had declined, the unintended pregnancy rate remained constant at 50% and almost half of these pregnancies resulted in abortion [3]. There has been a consistent demand for abortion services; however, the number of U.S. abortion providers declined 4% between 2008 (1,793) and 2011 (1,720) [1]. Studies have shown that physician intent to provide abortions prior to residency training and sufficient abortion training in residency are positively associated with future abortion provisions after residency [4-6]. Abortion education in medical school and abortion training in residency are thus essential to continued access to safe abortion services for women. This article will provide a brief history and update of the current state of U.S. abortion education, focusing specifically on education and training of physicians. Keywords: Abortion, education, training.

Random household survey was conducted in Kassala State, eastern Sudan, from 1st March to 30th June 2013 to investigate the socio-demographic characteristics and reproductive data associated with short inter-pregnancy interval. According to the recent recommendations three subcategories of birth interval among the respondents has been measured as followed (I) short birth interval (less than 36 months), (II) optimum birth interval (36 to 60 months) and (III) long birth interval (above 60 months) categories [11]. A total of 692 women had been enrolled, the average of children per woman was 4 and the number of children for each woman ranged between two to 14. Among the total women, 419 (60.6%), 259 (37.4%) and 14 (2%) reported the optimum birth interval between the last two successive births to be below 36 months, 36 to 60 months and greater than 60 months, respectively. Again among the total respondents the mean (SD) of actual birth interval between the last two consecutive live births was 26 (95% CI= 1.3─1.4) month whereas the mean (SD) of preferred birth spacing was 38.4 (95% CI= 1.6─2.9). With regard to the associated risk factors while age, residence, parity, and occupation were not associated with birth intervals, mother education less than secondary level (OR=2.6; CI=, 1.3-5.2; P =0.004), younger age at marriage (OR=0.8; CI=, 0.8-0.9; P = <0.001), husband education < secondary level (OR=0.3, CI, 0.1-0.6, P = 0.002), utilization of contraception (OR=3.0; CI=, 2.0-4.5; P =<0.001) and number of living babies (OR=0.4; CI=, 0.3-0.6; P =<0.001) were associated with short birth intervals. Thus the results of this study call for urgent intervention to increase the mean child spacing period with certain consideration of the associated factors in particular educational status, early age of marriage and utilization of contraceptive methods. Keywords: Birth interval, birth spacing, pregnancy, Sudan.

Objectives: To correlate the identification of fetal head position through digital examination (DE) and transabdominal ultrasound (TAU) prior to vacuum delivery. A secondary objective was to recognize how knowledge of the exact fetal head position affects the placement of the cup. Method: Women in active labor at term with normal singleton cephalic fetus were included. Transvaginal digital examination was performed and followed immediately by transabdominal ultrasound assessment. After birth, the distance between the center of the chignon and the flexion point was measured on the newborn. Results: 81 cases were included. TAU identified the fetal head position in 100% of cases and the DE in 96.3%. In 71.5% (58/81) patients DE was consistent with TAU. 100% of these cases were occiput anterior positions and 60% occiput posterior. Placing the cup in a flexing position, the lateral deviation was 0.7+/-0.5cm and the distance between the center of the chignon and the flexion point was 1.6+/-1.0cm, The center of the chignon was accurately placed at less than 2cm posterior to the flexion point in 92.5% (75/81) of the cases. Conclusions: Using DE only the vacuum cup was placed inaccurately in 1 of every 4 cases. The employment of TAU improved this result to 1 in 10. Keywords: Delivery, intrapartum, ultrasound, vacuum.

Postpartum haemorrhage (PPH) is a major cause of maternal deaths in developing as well as developed countries. The Present article is to have an update on whys, hows of PPH and if PPH occurs the prevention of disability and death. Primary PPH, (within 24 hrs of birth) can be minor or major, further divided into moderate, severe. Once diagnosed by seeing excessive bleeding, case needs to be evaluated for the cause which could be uterine atony or injury to reproductive tract, retained placental pieces or coagulation problems. Visual evaluation underestimates blood loss. Risk factors are past PPH, fetal macrosomia, multiple births, placenta previa, placental abruption, prolonged labour, episiotomy or delay in expulsion of placenta. If placental separation and expulsion is expedited through medication and manualstimulation, risk of PPH can be reduced. Oxytocin for prevention continues to be the drug of choice with less side effects and efficacy similar to ergometrine, prostaglandins. Misoprostol, oral, stable at room temperature is being promoted. Any cut on perineum needs to be avoided. Correction of anemia before delivery is essential. Cornerstone of treatment is restoration of blood volume. If uterus is not well contracted, mechanical, pharmacological measures are instituted. All injuries need timely repair. Timely uterine packing or sutures stop bleeding and step wise devasculcusation preserves fertility. Pneumatic compression devices reduce mortality at all levels of health care. Hysterectomy is definitive therapy, needs to be done timely especially in placenta accreta, uterine rupture. Because of bleeding there is risk of reduced blood supply to anterior pituitary which can affect milk secretion and breastfeeding. Similarly supply to heart, and kidney can get affected and blood components might get depleted. Depression can occur. It is essential to continue research to know best modality of prevention of PPH and if it occurs aggressive therapy to prevent disability and death. Keywords: Postpartum haemorrhage, prevention, risk factors, sequale, therapy.

The aim of this study was to reveal whether pregnant women fast in Ramadan, a lunar month, and to determine in which trimesters of pregnancy they fast. The impetus for this study was recognition of several fasting pregnant women in Ramadan in a district where nursing students have practice classes and visit homes. The study was conducted between 11 August and 9 September, which corresponded to the lunar month Ramadan. The researcher designed a questionnaire and determined criteria for inclusion of subjects during Ramadan. As a result, the sample included 81 pregnant women. Data were collected at home visits with the questionnaire developed by the researchers and were analyzed with descriptive statistics and Chi-square test. In total, forty-two percent of the women fasted and one third of them fasted for over 20 days. As pregnancy progressed, the number of fasting women and duration of fasting decreased. In the light of research results, pregnant women must be informed about short term and long term effects of fasting and especially nutrition. Keywords: Fasting, nursing, pregnant women, Ramadan.

Objective: To determine frequency, transcription and integration rates for high risk Human papillomavirus (HR HPV) types 16 and 18 in neoplastic cervical tissue of women with systemic lupus erythematosus (SLE). Methods: Cervical tissue of cervical intraepithelial neoplasia 1 (CIN 1) or greater severity were obtained from 112 women with SLE. HPV typing and integration was assessed by polymerase chain reaction (PCR) using primers specific for HPV 16 and 18 located in the open reading frames E7, E2, and E5. A commercially available kit was employed for transcriptional analysis of samples positive for HPV DNA types 16 or 18. Results: For the 112 SLE patients, 80.3% of the cervical biopsies were CIN 1 or CIN2 , 15.2% CIN 3, and 4.5% carcinoma in situ/ invasive cancer. HPV DNA 16 and 18 were detected in 20.5%, mostly type 16. Low integration and transcription rates were seen. There was no association of disease severity or immunosuppressive drugs with the presence of HPV DNA or RNA. Conclusion: The paucity of HR HPV along with lack of detectable viral transcripts, are unexpected findings and suggest HPV is latent in CIN lesions in SLE. Host- HPV interactions in this group of immunosuppressed women warrant further study. Keywords: Cervical Cancer, Cervical Dysplasia, HPV, HPV DNA, Human Papilloma Virus, Lupus, Systemic Lupus Erythematosus, SLE.

Bedside teaching is a commonly used educational tool in obstetrics and gynecology. In this clinical commentary, we analyzed and reviewed strategies for bedside teaching and guidelines for its use, and discussed its advantages and disadvantages. Electronic databases were searched for the period covering the years 2000 to 2012 for studies in the English language with the main outcome measure of the effectiveness of bedside teaching as an educational modality. There are no specific publications in the literature that address this issue in obstetrics and gynecology. Based on the literature in other settings, we infer that bedside teaching in obstetrics and gynecology is an effective teaching tool and should be studied further to determine its optimal usage as a teaching modality. The setting of labor and delivery is the most poignant example of bedside teaching in obstetrics and gynecology.

Although a variety of the health benefits have been attributed to regular physical activity, some studies suggested that strenuous exercise may be considered as an independent risk factor for the onset of urinary incontinence in young women. The aim of this article is to provide a review of the scientific literature concerning the role of physiotherapy in the prevention and treatment of urinary incontinence in sport women. Stress urinary incontinence is defined as a leakage of urine during elevated intra-abdominal pressure that can occur during exercise. This dysfunction may affect the quality of life, carrying negative implications on psychological, social and athletic performance. Pelvic floor muscle training has been shown to be an effective treatment in women in general population. However, few studies have been conducted showing the effects of the pelvic floor training in sportswomen. In addition, there are no randomized clinical trials studying this subject. Evidence suggests that stress urinary incontinency may be related to delays in pelvic floor muscles contraction in response to sudden increase of intra-abdominal pressure. Further research is necessary to determine the pelvic floor muscles function in women that perform physical activity with different levels of exigency. Keywords: Athletes, high impact sports, intra-abdominal pressure, muscle training, pelvic floor muscles, physical exercise, physiotherapy, stress urinary incontinence.

Overactive bladder is a common disorder that affects over 100 million adults worldwide though its prevalence has been grossly underestimated. The magnitude of this problem is increasing steadily with the growing elderly population, increased incidence of obesity, polypharmacy and increased awareness, making its treatment a challenging task for the physician. The treatment strategies may be nonpharmacologic or pharmacologic or both. Physical therapy techniques, such as bladder training, pelvic-floor exercises and electrical stimulation of the pelvic floor - are the nonpharmacological therapies that mitigate the sufferings of such patients. Anticholinergic agents remain the mainstay of the pharmacological therapy and act by decreasing or inhibiting the intensity of involuntary detrusor contractions. Immediate-release oxybutynin was the first dedicated antimuscarinic agent used for the treatment of overactive bladder symptoms. With geographic differences, other currently approved antimuscarinics are propiverine, tolterodine (immediate and extended release), trospium chloride (immediate and extended release), solifenacin (extended release), darifenacin (extended release) and fesoterodine(extended release). Still in the research phase and for use in refractory OAB are gabapentine and intradetrusor injection of botulinum toxin A. Symptom relief has been observed by more direct neuromodulatory techniques, such as acupuncture, posterior tibial nerve stimulation and sacral nerve stimulation, that address the underlying neurologic condition, although urodynamic data have not corroborated the same. Surgical intervention such as bladder augmentation, may rarely be resorted to in those with refractory urge incontinence and failure of conservative treatments. Eventually, the aim of all the treatment modalities is to improve the patients’ quality of life.