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INTRODUCTIONThere is no ideal position for labour and delivery, the standard recommendation is to encourage and support the parturient to deliver in the position she feels most comfortable in.1,2 Although international guidelines advice against being recumbent or supine for long periods of time during labour, women are motivated to deliver in the supine position at most delivery centres in India. Women delivering in the supine position experience comparatively painful prolonged labors with increased incidence of foetal distress due to more aortocaval compression by the gravid uterus.1-5 However, supine position in the second stage of labour is favoured by most obstetricians as they are trained to take delivery in this position. It allows them to monitor the labour process better with ease of providing anaesthesia, enables them to give proper perineal support in the second stage of labour, and conduct operative vaginal deliveries.Upright labour positions have several physiological advantages over the supine position. Historically women were instinctively adopting upright positions for delivery as they experienced stronger, more efficient and less ABSTRACT Background: Women delivering in upright position have shorter labour due to efficient and stronger contractions with faster descent of foetal head. The present study aimed to find out effect of upright kneeling position in the second stage of labour on maternal and foetal outcome and assess patients' satisfaction. Methods: The study was carried out in a tertiary care hospital of North India from October 2012 to February 2014. Low risk women admitted in early labour were divided into two groups, women delivering in kneeling position and in supine position. The outcome measures studied were, duration of second stage of labour, mode of delivery, 2 nd degree perineal tears, Apgar scores at 5 minutes, NICU admission rate and patient satisfaction. Results: The mean duration of second stage of labour in kneeling group was shorter by 14.901 minutes. The rate of vaginal delivery was comparable for both primigravidas and multigravida in kneeling and supine groups, RR: 2.275, 95% CI (0.7872-6.5831) and RR: 1.633, 95% CI (0.393-6.775). Primigravidas had more 2 nd degree perineal tears in kneeling group as compared to supine, RR 4.191, 95% CI (1.54 to 11.41). No difference in Apgar scores >7 at 5 minutes was observed in both groups, however, significantly lesser babies in kneeling group were admitted in NICU, RR 0.246, 95% CI (0.079 to 0.761). There was no difference on comparing satisfaction scores of primigravidas and multigravida in both supine and kneeling position. Conclusions: Kneeling position reduces the duration of second stage of labour and NICU admissions.

A full factorial design of experiments was used to study the effect of blend shear strain on the compaction process, relative density and strength of pharmaceutical tablets. The powder blends were subjected to different shear strain levels (integral of shear rate with respect to time) using an ad hoc Couette shear cell. Tablets were compressed at different compaction forces using an instrumented compactor simulator, and compaction curves showing the force-displacement profiles during compaction were obtained. Although the die-fill blend porosity (initial porosity) and the minimum in-die tablet porosity (at maximum compaction) decreased significantly with shear strain, the final tablet porosity was surprisingly independent of shear strain. The increase in the in-die maximum compaction with shear strain was, in fact, compensated during postcompaction relaxation of the tables, which also increased significantly with shear strain. Therefore, tablet porosity alone was not sufficient to predict tablet tensile strength. A decrease in the 'work of compaction' as a function of shear strain, and an increase in the recovered elastic work was observed, which suggested weaker particle-particle bonding as the shear strain increased. For each shear strain level, the Ryskewitch Duckworth equation was a good fit to the tensile strength as a function of tablet porosity, and the obtained asymptotic tensile strength at zero porosity exhibited a 60% reduction as a function of shear strain. This was consistent with a reduced bonding efficiency as the shear strain increased.

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