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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Spectrum of Grand Multiparity
Correspondence Address :
Francis N P Monteiro, MBBS, MD, Diplomate NB, Dip. Cyb. Law
Associate Professor of Forensic Medicine & Toxicology,
A.J. Institute of Medical Sciences,
Mangalore - 575004, India.
Phone: +91 9448327389 (R)
E-mail: drfrancis@rediffmail.com
This prospective research of comparing the outcome of the grand multipara women with that of non grand multipara was conducted in one of the tertiary health care centres and teaching hospitals of southern Karnataka. The study sample comprised of 100 grand multipara women and 100 non grand multipara women who were admitted to the maternity unit during the period from June 1996 to May 1997. Most of the grandmultipara women belonged to the age group of 26 to 35 years. 87% of the non grandmultipara women were illiterate, and 59% of the grand multipara women had haemoglobin levels which were less than 10 gm%. Out of 11 cases of antepartum haemorrhage, 3 had placenta previa and 8 had abruption of the placenta. 21 patients of the grand multipara group had pregnancy induced hypertension, and 2 of the grand multiparas had pre-eclamptic toxaemia (PET). 90% of the grand multipara women and 86% of the non grand multipara women had normal vaginal deliveries. 29% of the babies of the grand multipara women weighed less than 2.5 kg and a maximum number of babies of both the grand multipara and the non grand multipara women weighed between 2.6 to 3.5 kg. There were 12 still births among the grand multiparas and two among the non grand multipara women. 12 among the grand multipara women had post partum haemorrhage (PPH), while only 4 of the non grand multiparas had PPH.
Grand multipara; anaemia; post partum haemorrhage; non grand multipara
INTRODUCTION
The historical origins of the term “grand multiparity” are uncertain, and a number of definitions have been used (mostly four1 or five 2 previous viable births). (1), (2) Grand multiparity, as per the International Federation of Gynecology and Obstetrics, is the delivery of the fifth to ninth infant, whereas women who are undergoing their tenth (or more) delivery are considered to be great-grand-multiparas. (3),(4),(5),(6),(7) Grand multiparity (GMP) is considered as a dangerous and high risk clinical entity, as certain complications during the pregnancy, labour and the puerperium are thought to occur with an increased incidence in these women. In terms of the minimal risk concept: the safest babies to have are the second, third and the fourth. The hazards are greater for women in their fifth pregnancy and onwards. (8) Some complications that are classically associated with grand multiparaes include abruptio placentae, placenta previa, postpartum haemorrhage, ruptured uterus, macrosomic babies and anaemia. (9) This prospective research of comparing the outcome of the grand multipara women with that of the non grand multipara women was conducted in one of the tertiary health care centres and teaching hospitals of southern Karnataka. The purpose of this study was to evaluate the parity related complications during pregnancy and labour in the grand multiparas and to see the outcome of pregnancy and labour in them.
This prospective research of comparing the outcome of the grand multipara women with that of the non grand multipara women was conducted in one of the tertiary health care centres and teaching hospitals of southern Karnataka which provided healthcare services predominantly to the rural population. This prospective study was conducted during the period from June-1996 to May-1997. The number of deliveries which were conducted during this period was 1635. The sample comprised of 100 grand multipara women and 100 non grand multipara women who were admitted to the maternity unit. The samples were selected by adopting a convenient sampling technique and after following pre-determined set criteriae like; grand multipara women who were delivering after the 28th week of gestation after five or more previous viable pregnancies and non grand multipara women who had three or less previous viable pregnancies. After admission to the hospital, information regarding the demographic variables of the patients, relevant medical history and details of the examination and treatment were collected. All the information was collected in preformed proformas and were then tabulated.
37% of the grandmultipara women belonged to the age group of 26 to 30 years, whereas 46% of the non grandmultipara women belonged to the age group of 21 to 25 years, as is depicted in (Table/Fig 1),(Table/Fig 2),(Table/Fig 3).
o(f2 t)he non-grand multipara women( 3w)ere primiparas and that 33% of the grand multipara women were para 7. Only one 43 year old lady was para 14. (Table/Fig 4) shows that 59% of the grand multipara women had haemoglobin levels which were less than 10 gm%, whereas only 12% of the non-grand multipara women had anaemia. Out of 11 cases of antepartum haemorrhage, 3 had placenta previa and 8 had abruption of the placenta.
Out of 100 grand multipara women, 3 had uterine prolapse. Twenty one cases of grand multiparas had pregnancy induced hypertension, whereas among the non grand multiparas, only 1% had pregnancy induced hypertension. 2 of the grand multiparas had pre-eclamptic toxaemia (PET). 90% of the grand multipara women and 86% of the non grand multipara women had normal vaginal deliveries, as is depicted in (Table/Fig 5).
(Table/Fig 6) indicates that 12 patients who belonged to the grand multipara group had post partum haemorrhage (PPH) and that only 4 among the non grand multiparas had PPH. The leastcommon post partum complications were puerperal sepsis and shock in the grand multiparas, which were absent in the non grand multiparas.
This prospective research of comparing the outcome of the grand multipara women with that of the non grand multipara women was conducted in one of the tertiary health care centres and teaching hospitals of southern Karnataka which provided healthcare services predominantly to the rural population. This prospective study was conducted during the period from June-1996 to May-1997. The number of deliveries which were conducted during this period was 1635. This study was carried out on 200 patients, out of which 100 were grand multiparas and 100 were non-grand multiparas.
Our study showed that 73% of the grandmultipara women belonged to the age group of 26 to 35 years. In our study, 33% of the grand multipara women were para 7. Anaemia was the commonest complication among the grand multiparas in our study. It may also be predicted that repeated pregnancies within a short span of life along with poverty, poor hygienic conditions, nutritional deficiency, widespread gastrointestinal disorders and round and hookworm infestations were the major causes of anaemia which were observed in the grand multipara women.
This study showed that about 21% of the grand multiparas had pregnancy induced hypertension (PIH) because of the fact that with advancing age and increasing parity, the cardiovascular system becomes lesser and lesser competent and therefore hypertension and associated disorders are more commonly seen in this group. This study was in concurrence with the studies which were conducted by Fayed HM and Abid SF. (10) This study revealed that only 2% of the grand multiparas had pre-eclamptic toxaemia and that none of the non grand multiparas had pre-eclamptic toxaemia.
The results of the present study revealed that abruption of the placenta was common among the grand multiparas (8%), whereas the occurrence of placenta previa was only 3%. Abruptio placenta is a major complication which is seen in the grand multiparas. The parity of the patients was considered to be significant factor for the occurrence of placental abnormalities. (11),(12),(13),(14),(15),(16)(17),(18) The above studiesshowed that there was a lesser incidence of APH, which can be attributed to a higher socio economic status, better nutrition and a better knowledge regarding the prenatal care of the people in the developed countries. So, the higher incidence of APH in the present study may be related to the poor socio economic status, poor nutrition and poor knowledge regarding the prenatal care of the population. In this study, 11 patients had antepartum haemorrhage, of which 7 underwent caesarean sections because of this complication (3 because of major placenta-previa and 4 because of abruption of the placenta).
Post partum haemorrhage is also an important complication. In this study, 12 grand multiparas and 4 non-grand multiparas had post partum haemorrhage. Out of the 12 grand multiparas, 5 had mild PPH and 7 had severe PPH, out of which one had cardiac arrest. 10 grand multiparas had atonic PPH and 2 had disseminated intra vascular coagulation. None of the cases of PPH had maternal mortality. Since these patients were often anaemic to start with, the effects of the haemorrhage were more pronounced. The full retraction of the myometrium in the grand multipara was impaired due to aging, scarring and exhaustion. Also, atherosclerotic changes in the uterine blood vessels led to their being less easily and less efficiently clamped off.
SUMMARY
• 73% of the grand multipara women belonged to the age group of 26-35 years, whereas 46% of the non-grand multiparas belonged to the age group of 21-25 years. • 87% of the multiparas were illiterate, whereas 93% of the non grand multiparas were literate. • A majority of the grand multiparas belonged to the muslim community, followed by Christians and Hindus. • The incidence of the parity was from 5-14 in the grand multiparas, but a higher incidence of the parity (7) was also seen. A majority (57%) of the non-grand multiparas belonged to the para one group. • A majority (59%) of the grand multiparas were anaemic, whereas only 12% of the non grandmultiparas had anaemia. • Almost all the complications of pregnancy and labour were observed to be higher among the grand multiparas. • 90% of the grand multiparas and 86% of the non-grand multiparas had normal vaginal deliveries. • 10% of the grand multiparas and 11% of the non-grand multiparas had LSCS. • There were no maternal deaths.
It can be concluded that in comparison with the other patients, grand multiparas are at a greater risk during pregnancy and labour. This risk can be effectively reduced with good antenatal care, butthey are still liable to the serious complications of pregnancy, which can lead to higher maternal and foetal morbidity and mortality. Preventation is always better than cure and hence grand multiparity should be prevented by effective family planning measures, by increasing the level of education and by the removal of old religious beliefs and stigmas.
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