Obstetric hysterectomy: an emergency lifesaving procedure

Background: Although rare in modern obstetrics, emergency peripartum hysterectomy (EPH) remains a life-saving procedure, in the event of uncontrollable postpartum hemorrhage. Observations regarding the causes and outcomes of EPH provide valuable insights relevant to the current management perspectives in obstetrics. This study is intended to assess the contemporary prevalence, indications, and outcomes of EPH, at a Tertiary care referral institute.Methods: A descriptive observational study was conducted as a retrospective analysis of patient-records, over a span of 3 years January 2011-December 2013, in the department of obstetrics and gynecology, at the KEM hospital, in Mumbai. Cases of EPH were analyzed for information, maternal age, parity, gestational age, type of delivery, indications for EPH and outcomes of the procedure.Results: The average annual incidence rate was1 per 1000 deliveries. 44% of the cases had an indication of abnormal placentation. 60% of the cases had caesarean section deliveries. Multiparity, previous LSCS, and gestation period of <37 weeks, were the commonly observed associations. 52% of cases required ICU admission. Maternal mortality rate was 8%. 20% of the cases had intrauterine fetal death.Conclusions: Abnormal placentation was evident as the leading cause of uncontrollable hemorrhage. This is possibly in view of a continual improvement in the management of uterine atony, reduced incidence of uterine rupture, and importantly, a rising trend of caesarean section delivery. This calls for more thoughtful considerations, regarding decisions for caesarean section delivery, in obstetrics practice

Inequalities in maternity care and newborn outcomes: one-year surveillance of births in vulnerable slum communities in Mumbai

Background: Aggregate urban health statistics mask inequalities. We described maternity care in vulnerable slum communities in Mumbai, and examined differences in care and outcomes between more and less deprived groups. Methods: We collected information through a birth surveillance system covering a population of over 280 000 in 48 vulnerable slum localities. Resident women identified births in their own localities and mothers and families were interviewed at 6 weeks after delivery. We analysed data on 5687 births over one year to September 2006. Socioeconomic status was classified using quartiles of standardized asset scores. Results: Women in higher socioeconomic quartile groups were less likely to have married and conceived in their teens (Odds ratio 0.74, 95% confidence interval 0.69–0.79, and 0.82, 0.78–0.87, respectively). There was a socioeconomic gradient away from public sector maternity care with increasing socioeconomic status (0.75, 0.70–0.79 for antenatal care and 0.66, 0.61–0.71 for institutional delivery). Women in the least poor group were five times less likely to deliver at home (0.17, 0.10–0.27) as women in the poorest group and about four times less likely to deliver in the public sector (0.27, 0.21–0.35). Rising socioeconomic status was associated with a lower prevalence of low birth weight (0.91, 0.85–0.97). Stillbirth rates did not vary, but neonatal mortality rates fell non-significantly as socioeconomic status increased (0.88, 0.71–1.08). Conclusion: Analyses of this type have usually been applied across the population spectrum from richest to poorest, and we were struck by the regularly stepped picture of inequalities within the urban poor, a group that might inadvertently be considered relatively homogeneous. The poorest slum residents are more dependent upon public sector health care, but the regular progression towards the private sector raises questions about its quality and regulation. It also underlines the need for healthcare provision strategies to take account of both sectors

Uterine necrosis in a case of B-Lynch brace suture

B Lynch is a conservative surgical procedure for Atonic PPH not responding to medical line of treatment very few complications of this procedure have been reported. We describe B-Lynch suture erosion through the uterine wall identified on 16 day postpartum. A 24 year old primigravida underwent a primary low transverse cesarean section at term indication being primigravida with breach presentation intra-operatively there was torrential blood loss and uterus remained flabby despite treatment with uterotonics drugs delayed absorbable suture was used to place B-Lynch suture for control of the hemorrhage and had sepsis for which she had to undergo obstetric hysterectomy

On Unitification of ∗*-rings

S. K. Berberian raised the open problem ``Can every weakly Rickart $*$-ring be embedded in a Rickart $*$-ring? with preservation of right projections?" Berberian has given a partial solution to this problem. Khairnar and Waphare raised a similar problem for p.q.-Baer $*$-rings and gave a partial solution. In this paper, we give more general partial solutions to both the problems.Comment: arXiv admin note: text overlap with arXiv:1612.0168

Can we use Weak Lensing to Measure Total Mass Profiles of Galaxies on 20 kiloparsec Scales?

Current constraints on dark matter density profiles from weak lensing are typically limited to radial scales greater than 50-100 kpc. In this paper, we explore the possibility of probing the very inner regions of galaxy/halo density profiles by measuring stacked weak lensing on scales of only a few tens of kpc. Our forecasts focus on scales smaller than the equality radius (Req) where the stellar component and the dark matter component contribute equally to the lensing signal. We compute the evolution of Req as a function of lens stellar mass and redshift and show that Req=7-34 kpc for galaxies with the stellar mass of 10^{9.5}-10^{11.5} solar masses. Unbiased shear measurements will be challenging on these scales. We introduce a simple metric to quantify how many source galaxies overlap with their neighbours and for which shear measurements will be challenging. Rejecting source galaxies with close-by companions results in about a 20 per cent decrease in the overall source density. Despite this decrease, we show that Euclid and WFIRST will be able to constrain galaxy/halo density profiles at Req with signal-to-noise ratio >20 for the stellar mass of >10^{10} solar masses. Weak lensing measurements at Req, in combination with stellar kinematics on smaller scales, will be a powerful means by which to constrain both the inner slope of the dark matter density profile as well as the mass and redshift dependence of the stellar initial mass function.Comment: 19 pages, 14 figures, 3 tables, submitted to MNRAS, included the referee comment

Heterotopic pregnancy with molar changes

Trophoblastic disease of pregnancy is also called as gestational trophoblastic disease (GTD), a rare group of tumors that involves abnormal proliferation of the trophoblastic cells. GTD is generally benign but sometimes can be malignant due to its marked penetration into and destruction of myometrium as well as its ability to metastasize hence the groups of tumors are referred to as gestational trophoblastic neoplasm (GTN). These are among the rare tumors that can be cured even in the presence of widespread dissemination. Present study is a case of intrauterine partial mole with ectopic pregnancy in the right adnexa with vesicular changes, a rare entity in obstetrics