Risk factors for post-partum hemorrhage in patients who underwent operative vaginal delivery in a tertiary care center

Background: Operative vaginal delivery is a timely intervention to cut short second stage labor when imminent delivery is in the interests of mother, fetus, or both. It reduces second stage cesarean section morbidity and uterine scar and its influence on future obstetric career. The possible structural neonatal adverse outcomes due to operative vaginal delivery are well quantified. However, its effects on maternal outcome need to be understood better. In this paper, we study the effect of operative vaginal delivery on maternal post-partum hemorrhage (PPH) and the associated risk factors.Methods: It was a retrospective study carried out for the period July 2016 to July 2020 at Ramaiah Medical College, Bengaluru. Total number of vaginal deliveries in this period were 6318. Out of these, 1020 patients underwent assisted vaginal delivery using vacuum/ forceps/ sequential use of instrument. Blood loss greater than 500 ml is considered PPH for the purpose of this study. 15% of the study population was noted to have PPH. We employ a multivariate logistic regression to identify statistically significant risk factors for PPH in women undergoing operative vaginal delivery.Results: The logistic regression model identifies multiparity, maternal age, neonatal birth weight more than 3.5 kg, application of forceps in women with hypertensive disorders, III-degree tear, cervical tear to significantly increase the risk of PPH in our study population.Conclusions: Certain factors seem to increase the risk of PPH in operative vaginal delivery. The risks and benefits must be weighed properly before use of instruments

Gonadotropin-releasing hormone agonist and depot medroxyprogesterone acetate following uterine artery embolization in the management of uterine arteriovenous malformation

A young woman presenting with recurrent episodes of uterine bleeding due to an extensive uterine arteriovenous malformation was treated with two sessions of uterine artery embolization. Further bleeding was managed with a combination of gonadotropin-releasing hormone and depot medroxyprogesterone acetate. The patient remains asymptomatic with a significant decrease in uterine and pelvic vascularity at one year follow-up. These drugs may decrease the need for repeat embolization

Gonadotropin-releasing hormone agonist and depot medroxyprogesterone acetate following uterine artery embolization in the management of uterine arteriovenous malformation

A young woman presenting with recurrent episodes of uterine bleeding due to an extensive uterine arteriovenous malformation was treated with two sessions of uterine artery embolization. Further bleeding was managed with a combination of gonadotropin-releasing hormone and depot medroxyprogesterone acetate. The patient remains asymptomatic with a significant decrease in uterine and pelvic vascularity at one year follow-up. These drugs may decrease the need for repeat embolization

Ectopic pregnancy: a life threatening gynaecological emergency

Background: Ectopic pregnancy is a life-threatening gynecological emergency, and a significant cause of maternal morbidity and mortality.Methods: This is a retrospective study of ectopic pregnancies managed at M. S. Ramaiah Medical College and Hospital, Bangalore, India over a period of 1 year from March 2015 to March 2016. The medical records of the patients managed for ectopic pregnancy during the period, under review were retrieved and data were collected from registers. There were 30 cases of ectopic pregnancies over one year.Results: Ectopic pregnancy constituted 3% of all gynecological admissions, and its incidence was 2.5%. The mean age of the patients was 26 ± 2 years, 21 of 30 (70%) had ruptured ectopic pregnancies, and the remaining nine (30%) were unruptured. The commonest (20 of 30, 66.6%) clinical presentation was abdominal pain, and the commonest (9 of 30, 30%) identified risk factor was a previous history of induced abortion.Conclusions: Ectopic pregnancy is a recognized cause of maternal morbidity and mortality and has remained a reproductive health challenge to manage

Bounds on the strength distribution of unidirectional fiber composites

Failure mechanisms under tensile loading of unidirectional fiber composites comprising of Weibull fibers embedded in a matrix are studied using Monte-Carlo simulations. Two fundamental mechanisms of failure are recognized--stress concentration driven failure and strength driven failure. It is shown that the cumulative distribution function for composite strength predicted by the stress concentration -driven failure and strength-driven failure form apparent upper and lower bounds respectively and also that failure mechanism switches from one to the other as fiber strength variability changes

Retrospective analysis of maternal mortality: a paradigm shift from 2010 to 2020

Background: Maternal mortality is attributed usually to complications that generally occur during or around labour and these are mostly preventable through proper understanding, diagnosis and management of labour complications. The quality of health services women receive during pregnancy, intranatal and postnatal periods are crucial for the survival and well-being of the mother and her newborn baby. The objective was to analyse the changing trends in maternal mortality occurring over a decade, to assess factors associated with maternal mortality and propose effective interventions in preventing such mortality.Methods: It was a retrospective study to analyse maternal mortality between January 2010 and January 2020 in Ramaiah medical college hospital. Data was collected the institutional medical and delivery records and patient details regarding obstetric history, pre-existing comorbidities, cause of death, interventions done was noted and review of maternal mortality was done.Results: The maternal mortality in the present study was 432.73/1 lakh live births. There were 57 maternal deaths in the study period. Most deaths occurred in the 20-25 age group. 42.10% of deaths occurred ninety six hours after admission. Sepsis (42.1%), hypertensive disorders (12.30%) and haemorrhage (10.5%) are the most common direct causes of maternal death. Post-operative and post abortal sepsis, ARDS, cardiogenic shock, pulmonary embolism and AFLP are the other direct causes. Hypertensive disorders (9.64%) and haemorrhage (19.5) is the two leading indirect causes of maternal deaths.Conclusions: Maternal health services should move beyond the focus on emergency obstetric care, to a broader approach that encompasses preventive and early interventions and integration with existing services. Most of the maternal deaths can be prevented if the high risk antenatal women are identified earlier and referred to the tertiary centre earlier for diagnosis and management.

Inkjet printed circuits with two-dimensional semiconductor inks for high-performance electronics

Air-stable semiconducting inks suitable for complementary logic are key to create low-power printed integrated circuits (ICs). High-performance printable electronic inks with two-dimensional materials have the potential to enable the next generation of high performance, low-cost printed digital electronics. Here we demonstrate air-stable, low voltage (< 5 V) operation of inkjet-printed n-type molybdenum disulfide (MoS2) and p-type indacenodithiophene-co-benzothiadiazole (IDT-BT) field-effect transistors (FETs), estimating a switching time of {\tau} ~ 3.3 {\mu}s for the MoS2 FETs. We achieve this by engineering high-quality MoS2 and air-stable IDT-BT inks suitable for inkjet-printing complementary pairs of n-type MoS2 and p-type IDT-BT FETs. We then integrate MoS2 and IDT-BT FETs to realise inkjet-printed complementary logic inverters with a voltage gain |Av| ~ 4 when in resistive load configuration and |Av| ~ 1.36 in complementary configuration. These results represent a key enabling step towards ubiquitous long-term stable, low-cost printed digital ICs

SIZE EFFECTS IN THE TENSILE STRENGTH OF UNIDIRECTIONAL FIBER COMPOSITES

Monte Carlo simulation and theoretical modeling are used to study the statistical failure modes in unidirectional composites consisting of elastic fibers in an elastic matrix. Both linear and hexagonal fiber arrays are considered, forming 2D and 3D composites, respectively. Failure is idealized using the chain-of-bundles model in terms of {delta}-bundles of length {delta}, which is the length-scale of fiber load transfer. Within each {delta}-bundle, fiber load redistribution is determined by local load-sharing models that approximate the in-plane fiber load redistribution from planar break clusters as predicted from 2D and 3D shear-lag models. As a result these models are 1D and 2D, respectively. Fiber elements have random strengths following either the Weibull or the power-law distribution with shape and scale parameters {rho} and {sigma}{sub {delta}}, respectively. Simulations of {delta}-bundle failure, reveal two regimes. When fiber strength variability is low (roughly {rho} &gt; 2) the dominant failure mode is by growing clusters of fiber breaks up to instability. When this variability is high (roughly 0 &lt; {rho} &lt; 1) cluster formation is suppressed by a dispersed fiber failure mode. For these two cases, closed-form approximations to the strength distribution of a {delta}-bundle are developed under the local load-sharing model and an equal load-sharing model of Daniels, respectively. The results compare favorably with simulations on {delta}-bundles with up to 1500 fibers. The location of the transition in terms of {rho} is affected by the upper tail properties of the fiber strength distributions as well as the number of fibers