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Large numbers of young women who have undergone this procedure now live in the United States. You can provide better care for such patients by learning more about circumcision, its complications, and ways to prevent obstetrical problems. [ABSTRACT FROM AUTHOR]

Background: Female genital cutting is a cultural practice seen in parts of Africa and Asia. Women who have undergone type III female genital cutting (excising the external genitalia and suturing the remnant tissue to cover the urethra and part of the introitus) can suffer various long-term complications. Defibulation, a procedure that opens the overlying scar can alleviate or resolve symptoms.Case: A 32-year-old Somali woman presenting with type III female genital cutting complained of infertility, dyspareunia, dysmenorrhea, and exquisite pain upon sitting. She underwent a defibulation procedure to create neolabia majora. Intraoperatively, a 0.8 cm urinary calculus was found beneath the urethra. Postoperatively, all of her symptoms resolved.Conclusion: Infibulated scars create a favorable environment for stagnant urine to crystallize and become a urinary calculus. [ABSTRACT FROM AUTHOR]

The standard care model in the postpartum period is ripe for disruption and attention. Hypertensive disorders of pregnancy (HDPs) can continue to be a challenge for the postpartum person in the immediate postpartum period and is a harbinger of future health risks. The current care approach is inadequate to address the needs of these women. We propose a model for a multidisciplinary clinic and collaboration between internal medicine specialists and obstetric specialists to shepherd patients through this high-risk time and provide a bridge for lifelong care to mitigate the risks of a HDP. KEY POINTS: · HDPs are increasing in prevalence.. · The postpartum period can be more complex for women with HDPs.. · A multidisciplinary clinic could fill the postpartum care gap for women with HDP.., Competing Interests: None declared., (Thieme. All rights reserved.)

Female genital cutting (FGC) is a persisting global practice that increases patients' risk for experiencing long-term health sequelae. Existing meta-analysis evidence strongly supports an association between FGC and the development of long-term dyspareunia, urinary tract infections, and sexual dysfunction as well as increased risk obstetrically of prolonged labor, cesarean section, perineal lacerations, and episiotomy. Surgical defibulation is recommended in patients with type III FGC to decrease obstetric and gynecologic morbidity. Existing evidence does not seem to definitively support clitoral reconstructive surgery. More research is needed to study conservative treatment and management approaches to long-term sequelae of FGC., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Female genital mutilation or cutting (FGM/C) involves medically unnecessary cutting of parts or all of the external female genitalia. It is outlawed in the United States and much of the world but is still known to occur in more than 30 countries. FGM/C most often is performed on children, from infancy to adolescence, and has significant morbidity and mortality. In 2018, an estimated 200 million girls and women alive at that time had undergone FGM/C worldwide. Some estimate that more than 500 000 girls and women in the United States have had or are at risk for having FGM/C. However, pediatric prevalence of FGM/C is only estimated given that most pediatric cases remain undiagnosed both in countries of origin and in the Western world, including in the United States. It is a cultural practice not directly tied to any specific religion, ethnicity, or race and has occurred in the United States. Although it is mostly a pediatric practice, currently there is no standard FGM/C teaching required for health care providers who care for children, including pediatricians, family physicians, child abuse pediatricians, pediatric urologists, and pediatric urogynecologists. This clinical report is the first comprehensive summary of FGM/C in children and includes education regarding a standard-of-care approach for examination of external female genitalia at all health supervision examinations, diagnosis, complications, management, treatment, culturally sensitive discussion and counseling approaches, and legal and ethical considerations., Competing Interests: POTENTIAL CONFLICT OF INTEREST: Dr Johnson-Agbakwu has a grant relationship with Arizona State University from the 2018 copyright of “Female Genital Mutilation/Cutting (FGM/C): A Visual Reference and Learning Tool for Health Care Professionals.”, (Copyright © 2020 by the American Academy of Pediatrics.)

The coronavirus disease 2019 (COVID-19) pandemic is a public health emergency requiring significant changes in obstetric and gynecologic health care delivery to minimize the risk of transmission to healthy patients and health care workers. Although these changes are necessary, they will differentially affect patients in a way that highlights and exacerbates existing inequities in health care access and outcomes. Socially vulnerable groups are already disproportionately affected by COVID-19 infection and more likely to experience severe morbidity and mortality. Some reasons for this include a limited ability to practice risk-reducing behaviors such as physical distancing, higher prevalence of chronic medical conditions, and less access to medical care. Additionally, the structural changes now taking place in health care delivery have negatively affected the ability of socially vulnerable groups to obtain necessary obstetric and gynecologic care, which may lead to poorer outcomes. As physician-leaders enact new policies to respond to the COVID-19 public health crisis, it is important to consider the potential for exacerbating existing health inequities and to be proactive in creating policies that promote equity.

Background: The aims of this study were to identify factors influencing participation in global health electives during residency and to understand the career impact of global health electives on alumni of an Obstetrics and Gynecology (OB/GYN) residency program., Methods: This was a cross-sectional, web-based survey of alumni of a residency program in the United States., Results: The response rate was 49%. Out of 73 respondents, 29 (39.7%) had completed a global health elective. Availability of funds and flexibility of elective time were the main enabling factors for participating in global health electives. Most participants of global health electives in residency reported a positive impact on their competence in domestic and global women's health and on their career choices. Completing a global health elective in residency was associated with career work in global health and/or local health disparities (OR 4.62 (95% CI: 1.20-17.87))., Conclusion: Global health electives are important in the career development of residents. To foster OB/GYNs that continue global health and health disparities work, OB/GYN programs should give trainees the opportunity to participate in funded global health electives.

This study documents the perceptions and experiences of immigrant women and men in the US related to female genital cutting (FGC). This paper examines the effects of migration on these perceptions, with the goal of optimizing health services and informing public policy to support women who have undergone FGC. This qualitative study consisted of individual interviews conducted from 2014 to 2015 with 42 women and men living in Boston, Massachusetts, who immigrated from a variety of communities where FGC has been practiced. Most participants felt strongly against the continuation of the practice, describing a change in their personal and community viewpoints over time, which they attributed to education, religion and immigration. The men in our study collectively took a stand against FGC and believed that they had a particular duty to raise awareness in their families and their communities about its physical and emotional harms. Our study provides strong support for the inclusion of men, religious leaders, and immigrants in FGC-related efforts. Our unique preliminary exploration of the role of members of the diaspora provides some support for initiatives that would involve emigrants in the effort to curb FGC in their home countries. Changing views in the diaspora could play a significant role in affecting opinions and practices in contexts where FGC is prevalent. Finally, our findings do not support the fear that "vacation cutting" might be common among US immigrants. We should therefore exercise caution in our promotion of legislation and clinical practices that target this fear., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Group-based health services can improve maternal and newborn health outcomes. Group antenatal care and participatory learning and action cycles (PLA) with women's groups have been cited by the WHO as health systems interventions that can lead to improvements in adherence to care and health outcomes in pregnancy and the postpartum period., Methods: We used a mixed-methods approach to assess the feasibility of a light touch group-based support intervention using the WhatsApp text-messaging platform. Pregnant women were enrolled at Jacaranda Health (JH), a maternity center in peri-urban Kiambu County, Kenya. Their phone numbers were added to WhatsApp groups consisting of participants with similar estimated due dates. The WhatsApp group administrator was a JH employee. Acceptability, demand, implementation, and practicality of this service were evaluated through in-depth interviews (IDIs), surveys, chart review, and analysis of group chats. Limited analysis of program efficacy (ANC visits, any PNC, and post-partum family planning uptake) was assessed by comparing participant data collected through chart review using a concurrent comparison of the general JH patient population., Results: Fifty women (88%) of 57 eligible women who were approached to participate enrolled in the study. Five WhatsApp groups were created. A total of 983 messages were exchanged over 38 weeks. No harms or negative interactions were reported. Participants reported several benefits. Participants had differing expectations of the level of the group administrator's activity in the groups. ANC and PNC attendance were in line with the hospital's metrics for the rest of JH's patient population. Higher rates of postpartum long acting reversible contraception (LARC) uptake were observed among participants relative to the general patient population., Conclusions: A moderated mobile-based support group service for pregnant women and new mothers is safe and feasible. Additional research using experimental designs to strengthen evidence of the effectiveness of the support intervention is warranted., Competing Interests: Conflict of Interest: The authors have no conflicts of interest to declare.

Importance: Mosquitoes are the most common disease vectors worldwide. A combination of factors, including changes in public health policy, climate change, and global travel, has led to the resurgence and spread of these diseases in our modern world. Pregnant women are vulnerable to a number of these illnesses, and obstetricians are likely to encounter pregnant travelers who have been exposed., Objective: This review was conducted to summarize knowledge of mosquito-borne diseases and their relevance in pregnancy. This will allow obstetricians to provide proper advice regarding travel and prepare providers to recognize manifestations of these illnesses in the pregnant woman., Evidence Acquisition: A review of the current literature was performed to summarize the various manifestations of mosquito-borne illnesses in pregnant women and discuss obstetric outcomes and management of disease in pregnancy., Results: Mosquito-borne illnesses usually manifest after a period of incubation lasting from days to weeks. Symptoms usually include a febrile illness but may be nonspecific and may masquerade as pregnancy-specific illnesses such as preeclampsia or HELLP (hemolysis, elevated liver enzyme levels, and low platelet levels); a large number of patients remain asymptomatic. Pregnancy-related outcomes include spontaneous abortion, intrauterine fetal demise, intrauterine transmission to the fetus, and congenital anomalies. Management during pregnancy is mainly supportive. Precautions against disease include protective clothing and insect repellents. Vaccines are either available or in development., Conclusions and Relevance: Mosquito-borne disease should be considered in pregnant women who present with a febrile illness and a relevant exposure history. Prompt recognition can allow supportive treatment to the mother and fetal resuscitation and surveillance.

Purpose The mistreatment of women during childbirth in health facilities is a growing area of research and public attention. Description In many countries, disrespect and abuse from maternal health providers discourage women from seeking childbirth with a skilled birth attendant, which can lead to poor maternal and neonatal outcomes. This commentary highlights examples from three countries-Kenya, Mexico and the United States-and presents different forms of mistreatment during childbirth, which range from physical abuse to non-consented care to discriminatory practices. Assessment Building on the momentum from the United Nations Sustainable Development Goals, the International Federation of Gynecology and Obstetrics, and the Global and Maternal Neonatal Health Conference, the global community has placed respectful maternity care at the forefront of the maternal and neonatal health agenda. Conclusion Research efforts must focus on context-specific patient satisfaction during childbirth to identify areas for quality improvement.

With the growing number of Muslim patients in the United States, there is a greater need for obstetrician-gynecologists (ob-gyns) to understand the health care needs and values of this population to optimize patient rapport, provide high-quality reproductive care, and minimize health care disparities. The few studies that have explored Muslim women's health needs in the United States show that among the barriers Muslim women face in accessing health care services is the failure of health care providers to understand and accommodate their beliefs and customs. This article outlines health care practices and cultural competency tools relevant to modern obstetric and gynecologic care of Muslim patients, incorporating emerging data. There is an exploration of the diversity of opinion, practice, and cultural traditions among Muslims, which can be challenging for the ob-gyn who seeks to provide culturally competent care while attempting to avoid relying on cultural or religious stereotypes. This commentary also focuses on issues that might arise in the obstetric and gynecologic care of Muslim women, including the patient-physician relationship, modesty and interactions with male health care providers, sexual health, contraception, abortion, infertility, and intrapartum and postpartum care. Understanding the health care needs and values of Muslims in the United States may give physicians the tools necessary to better deliver high-quality care to this minority population.

More than 130 million women worldwide have undergone female genital cutting (FGC). FGC is practiced in parts of Africa and Asia, in societies with various cultures and religions. Reasons for the continuing practice of FGC include rite of passage, preserving chastity, ensuring marriageability, religion, hygiene, improving fertility, and enhancing sexual pleasure for men. The World Health Organization has classified FGC into four types depending on the extent of tissue removed. Immediate complications include hemorrhage, infection, sepsis, and death. Long-term complications include pain, scarring, urinary issues, and poor obstetric and neonatal outcomes. Efforts are being made nationally and internationally to eradicate this practice. In December 2012, the UN General Assembly accepted a resolution on the elimination of FGC. Although it is illegal to perform FGC in the United States, women from countries where the practice occurs have been and are still immigrating here. Many enter as refugees from war-torn, famine-stricken, or politically unstable countries. They bring along with them their cultural pride, health complications, and fears of being judged when visiting a health provider. A deeper understanding of the history, cultural beliefs, medical complications, and methods of surgical reconstruction is necessary to provide culturally and linguistically competent care to this unique group of women., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

The burden of disease and public health issues affecting girls and women throughout their lives is significantly greater in resource-poor settings. These women and girls suffer from high rates of maternal mortality, obstetric fistulas, female genital cutting, HIV/AIDS, malaria in pregnancy, and cervical cancer. Although the Millennium Development Goals (MDGs) are being met in some nations, the majority of the goals will not be reached by 2015. In addition, insufficient attention is given to non-communicable and chronic diseases such as diabetes, hypertension, hypercholesterolemia, cardiovascular diseases, stroke, obesity, and chronic respiratory diseases. A life-course approach that includes improvements in earlier-life factors such as diet and exercise is necessary to improve women's long-term health outcomes. Innovative diagnostic tools and treatment strategies along with cost-effective health service delivery systems are needed to make a significant impact on women's and girls' health worldwide.

Sex trafficking involves some form of forced or coerced sexual exploitation that is not limited to prostitution, and has become a significant and growing problem in both the United States and the larger global community. The costs to society include the degradation of human and women's rights, poor public health, disrupted communities, and diminished social development. Victims of sex trafficking acquire adverse physical and psychological health conditions and social disadvantages. Thus, sex trafficking is a critical health issue with broader social implications that requires both medical and legal attention. Healthcare professionals can work to improve the screening, identification, and assistance of victims of sex trafficking in a clinical setting and help these women and girls access legal and social services.

Tuberculosis (TB) infection poses substantial challenges for obstetricians and gynecologists globally, as gynecologic involvement may cause infertility, irregular bleeding, and pelvic pain. If TB-infected women are able to conceive, obstetric complications include intrauterine growth restriction and, more rarely, congenital transmission. Appropriate screening for high-risk populations is crucial for diagnosis and treatment of latent and active TB infection, which may prevent reproductive sequelae for individual patients and, eventually, contribute to complete eradication of the disease.

Interest in global maternal health has steadily increased over the past decade. Medical schools are offering courses on this subject, residencies are incorporating international elective rotations into their practices, and retiring practitioners are opting to spend a year or two in low-resource settings. Although interest is growing, sometimes wellmeaning health practitioners are not entirely prepared for their new experience. Prior to departure, a multistep process is necessary to prepare physicians for living and practicing overseas.

Tetanus is an acute disease manifested by motor system and autonomic nervous system instability. Maternal and neonatal tetanus occur where deliveries are performed under unsanitary circumstances and unhygienic umbilical cord practices are prevalent. Neonatal tetanus is almost always fatal in the absence of medical care. These deaths can be prevented with changes in traditional obstetrical practices and maternal immunization. This situation led to the development of the Maternal and Neonatal Elimination Initiative by the World Health Organization. Using a three-pronged approach, tetanus can be eliminated via promotion of hygienic practices during delivery, maternal and childhood immunization, and close surveillance.

Worldwide, approximately 15 million babies (1 in 10) are born prematurely each year. Prematurity is the leading cause of death among newborns, accounting for 1 million deaths per year, and, after pneumonia, is the second leading cause of death in children under age 5 years. Newborns who do survive preterm delivery (PTD) struggle with visual, auditory, and learning disabilities. In order to reach the fourth Millennium Development Goal (MDG-4) of reducing the mortality rate in children under age 5 years by two-thirds between 1990 and 2015, there must be significantly fewer PTDs. In high-income nations, 50% of babies born at 24 weeks survive, whereas in low-resource nations, this survival rate is not achieved until 32 weeks of gestation. Over 90% of babies born in low-resource settings before 28 weeks die in the first few days of life (< 10% die in high-income nations), a 10:90 survival gap. Over 60% of PTDs worldwide occur in Sub-Saharan Africa and South Asia. Risk factors for PTD include adolescent pregnancy, short interval between births, poor prepregnancy weight (very low or high body mass index), chronic diseases (diabetes and hypertension), infectious disease, substance abuse, cervical incompetence, and poor psychological health. Thus, a commitment to improving maternal health and the quality of prenatal care is necessary to achieve the MDG-4.

Women who cannot negotiate condom use with their partners, often due to socioeconomic factors and sexual abuse, have no means of preventing themselves from acquiring the human immunodeficiency virus (HIV). There is a need to develop HIV-preventive methods initiated and controlled by women. Microbicides and other pre-exposure prophylaxis may help fill that need. Although two decades of research on broad-spectrum microbicides have generally been disappointing, recent trials with HIV-specific agents have yielded promising initial results. A new era of clinical research involves novel biochemical prevention methods, including HIV-specific vaginal microbicides and oral antiretroviral chemoprophylaxis drugs (pre-exposure prophylaxis; PrEP) that may help provide more control for women.

Schistosomiasis is a parasitic infection endemic in 74 resource-poor nations that affects approximately 200 million people. Schistosomes are water-borne flatworms or blood flukes that enter the human body through the skin. Some symptoms of schistosomiasis include fever, arthralgias, abdominal pain, bloody diarrhea, and hematuria. Ultimately, patients develop heptosplenomegaly, ascites, and lymphadenopathy. Schistosomiasis is a neglected tropical disease, and its global health impact is grossly underestimated. Women suffer considerably from female genital schistosomiasis that causes infertility, preterm labor, anemia, menstrual disorders, and dyspareunia. More effort is needed to prevent schistosomiasis. Treating pregnant and lactating women decreases the disease burden and improves maternal and fetal outcome.

There are 33.4 million people living with human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome. Globally, HIV/AIDS is the leading cause of death among women of reproductive age. In the United States and other developed countries, aggressive efforts to treat HIV-positive pregnant women with highly active antiretroviral therapy have decreased the maternal-to-child transmission (MTCT) from over 20% to less than 2%. However, in resource-poor settings, access to antiretroviral therapy (ART) is not readily available, and perinatal transmission rates remain as high as 45%. Women are at greater risk of heterosexual transmission of HIV, which is compounded by lack of condom use, imbalance of social power, and the high fertility rate. Prevention programs are needed to empower and educate women and engender community awareness for condom use. Prenatal screening and treatment, intrapartum ART, and postpartum prophylaxis must be made available to all women and children to prevent MTCT.

Marriages in which a child under the age of 18 years is involved occur worldwide, but are mainly seen in South Asia, Africa, and Latin America. A human rights violation, child marriage directly impacts girls' education, health, psychologic well-being, and the health of their offspring. It increases the risk for depression, sexually transmitted infection, cervical cancer, malaria, obstetric fistulas, and maternal mortality. Their offspring are at an increased risk for premature birth and, subsequently, neonatal or infant death. The tradition, driven by poverty, is perpetuated to ensure girls' financial futures and to reinforce social ties. One of the most effective methods of reducing child marriage and its health consequences is mandating that girls stay in school.

Cervical cancer kills 260,000 women annually, and nearly 85% of these deaths occur in developing nations, where it is the leading cause of cancer deaths in women. Disparities of health and poverty play a large role in this high mortality rate. Whereas routine Papanicolaou and human papillomavirus (HPV) testing has dramatically reduced cervical cancer deaths in Western nations, without proper infrastructure, facilities, and medical training, the rates of cervical cancer in developing nations will remain high. Studies on HPV DNA testing and the low-technology method of "screen and treat" are promising. In addition, reducing the cost and increasing the availability of HPV vaccines in developing nations brings hope and promise to the next generation of women.

Malaria, a parasitic infection transmitted by mosquitoes, is one of the most devastating infectious diseases, killing more than 1 million people annually. Pregnant women, children, and immunocompromised individuals have the highest morbidity and mortality, and Africa bears the heaviest burden. The World Health Organization defines malaria as a disease of poverty caused by poverty. Pregnant women infected with malaria usually have more severe symptoms and outcomes, with higher rates of miscarriage, intrauterine demise, premature delivery, low-birth-weight neonates, and neonatal death. They are also at a higher risk for severe anemia and maternal death. Malaria can be prevented with appropriate drugs, bed nets treated with insecticide, and effective educational outreach programs.

Every year, worldwide, about 42 million women with unintended pregnancies choose abortion, and nearly half of these procedures, 20 million, are unsafe. Some 68,000 women die of unsafe abortion annually, making it one of the leading causes of maternal mortality (13%). Of the women who survive unsafe abortion, 5 million will suffer long-term health complications. Unsafe abortion is thus a pressing issue. Both of the primary methods for preventing unsafe abortion-less restrictive abortion laws and greater contraceptive use-face social, religious, and political obstacles, particularly in developing nations, where most unsafe abortions (97%) occur. Even where these obstacles are overcome, women and health care providers need to be educated about contraception and the availability of legal and safe abortion, and women need better access to safe abortion and postabortion services. Otherwise, desperate women, facing the financial burdens and social stigma of unintended pregnancy and believing they have no other option, will continue to risk their lives by undergoing unsafe abortions.

Sex-based health disparities are evident throughout the world; however, nowhere are these disparities greater than in resource-poor countries. Women in developing nations lack basic health care and face life-debilitating and life-threatening health issues. Some health issues never existed in the West, whereas science eradicated others decades ago. Maternal mortality, female genital cutting, child marriage, human immunodeficiency virus (HIV)/AIDS, and cervical cancer are a few of the issues that plague developing nations. This article introduces some of these challenging health problems. In subsequent issues, they will be explored in more depth. Reviews in Obstetrics & Gynecology hopes that highlighting global women's health issues will increase awareness and establish a renewed commitment to improving women's lives.

The present study was designed to compare the anti-inflammatory and antioxidant effects of two antidepressant drugs, desipramine [10,11-dihydro-5-[3-(methylamino) propyl]-5H-dibenz-[b,f]azepine monohydrochloride] and fluoxetine [N-methyl-3-phenyl-3-[4-(trifluoromethyl)phenoxy]-propan-1-amine], administered with variable doses, on experimentally induced colitis in rats. Two doses for each drug (10 and 20 mg/kg/day i.p.) were injected in 48 adult male albino rats for 2 weeks after induction of colitis by intracolonic administration of 2 ml of 3% acetic acid. Several parameters, including macroscopic (ulcer score index) and biochemical such as myeloperoxidase (MPO), reduced glutathione (GSH), tumor necrosis factor (TNF)-alpha, and interleukin (IL)-1beta, were measured using standard assay procedures. The study demonstrates that both desipramine and fluoxetine significantly attenuated the extent and the severity of the macroscopic signs of cell damage. Both drugs significantly reduced tissue MPO activity in a dose-dependent manner. Both desipramine and fluoxetine, at either dose, significantly increased GSH in colonic tissue. Desipramine and fluoxetine, at either dose, significantly reduced TNF-alpha and IL-beta. Desipramine at the dose of 20 mg/kg produced more decrease in the level of TNF-alpha compared with the effect of the smaller dose, but fluoxetine at 10 mg/kg diminished more in the level of IL-1beta compared with the effect of the larger dose. The present data indicate that both desipramine and fluoxetine have anti-inflammatory and antioxidants effects in experimentally induced colitis in rats, opening the avenue to their possible protective role in patients with inflammatory bowel disease.

Over 2 million women worldwide have an obstetric fistula, with the majority of cases occurring in resource-poor countries. Afflicted women tend to be young, primiparous, impoverished, and have little or no access to medical care. Incontinent of urine and/or stool, these women become ostracized and shunned by their community. Most obstetric fistulas are surgically correctible, although surgical outcomes have been poorly studied. Programs that improve nutrition, delay the age of marriage, improve family planning, and increase access to maternal and obstetric care are necessary to prevent obstetric fistula.

More than 130 million women worldwide have undergone female genital cutting (FGC). FGC occurs in parts of Africa and Asia, in societies with various cultures and religions. Reasons for the continuing practice of FGC include rite of passage, preserving chastity, ensuring marriageability, religion, hygiene, improving fertility, and enhancing sexual pleasure for men. The World Health Organization has classified FGC into 4 types depending on the extent of tissue removed. Immediate complications include hemorrhage, infection, sepsis, and death. Long-term complications include pain, scarring, urinary issues, and poor obstetric and neonatal outcomes. Efforts are being made nationally and internationally to eradicate this practice.

Approximately 529,000 women die from pregnancy-related causes annually and almost all (99%) of these maternal deaths occur in developing nations. One of the United Nations' Millennium Development Goals is to reduce the maternal mortality rate by 75% by 2015. Causes of maternal mortality include postpartum hemorrhage, eclampsia, obstructed labor, and sepsis. Many developing nations lack adequate health care and family planning, and pregnant women have minimal access to skilled labor and emergency care. Basic emergency obstetric interventions, such as antibiotics, oxytocics, anticonvulsants, manual removal of placenta, and instrumented vaginal delivery, are vital to improve the chance of survival.

Despite international agreements and national laws, marriage of girls <18 years of age is common worldwide and affects millions. Child marriage is a human rights violation that prevents girls from obtaining an education, enjoying optimal health, bonding with others their own age, maturing, and ultimately choosing their own life partners. Child marriage is driven by poverty and has many effects on girls' health: increased risk for sexually transmitted diseases, cervical cancer, malaria, death during childbirth, and obstetric fistulas. Girls' offspring are at increased risk for premature birth and death as neonates, infants, or children. To stop child marriage, policies and programs must educate communities, raise awareness, engage local and religious leaders, involve parents, and empower girls through education and employment.

The study of Histocompatibility Locus Antigen (HLA) frequencies in 48 cases with congenital heart disease (CHD) in children in Cairo showed high incidence of A10. Cases with atrial septal defect have shown a significant association with A3 besides A10. There is also a significant association between B12-45 and right loop anomalies (Fallot's and pulmonary stenosis) together with A10. On the other hand, children with rheumatic heart disease have shown strong positive association with HLA group B8 and negative association with A28.

The present study was carried out on 429 children below 6 years of age from a village in Bani-Suef governorate to show the schistosomiasis prevalence rate among them. Direct sedimentation techniques of the urine and stool beside an indirect serological test (Dot-ELISA) were used for the diagnosis. The results indicate 14.5% and 26.3% positive cases as detected parasitologically and serologically, respectively. Other parasitic infections were also diagnosed. The serologic test enabled us to differentiate acute from chronic schistosomiasis cases in the studied sample. The serologically positive infants may suggested the congenital transmission of immunologic information rather than active infection. On the other hand, there were no correlations between the schistosomiasis incidence and both the anthropometric measurement and organ involvements.

Milk samples were collected from 35 mothers delivering preterm infants and from 35 mothers delivering term infants at 3 time intervals over the first 3 weeks of lactation. The samples were collected by manual expression from both breasts into polyethylene containers and were frozen at -20 degrees C and stored for analysis. The protein content of preterm milks during the first and second weeks is higher than that of term milk (P less than 0.05). The fat and lactose contents during the first week are slightly more in term milk than in preterm milk. During the third week the fat content of preterm milk is higher but its lactose content was lower. All these differences are not significant. These results are discussed.