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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
Determinants and Outcomes of Primary Caesarean Section: A Retrospective Observational Study
Correspondence Address :
C Kavyarani,
4th Cross, Jayanagara, Kolar-563101, Karnataka, India.
E-mail:kavyaranic@gmail.com
Introduction: A Primary Caesarean Section (PCS) is defined as the first caesarean delivery in a woman with no previous uterine scar. PCS rates are rising globally, necessitating an understanding of associated factors to improve maternal and foetal outcomes.
Aim: To determine the prevalence of PCS, examine its indications, and analyse sociodemographic and obstetric factors associated with PCS, with particular emphasis on parity.
Materials and Methods: The present retrospective observational study was carried out between March 2024 and December 2024 in the Department of Obstetrics and Gynaecology at Sri Devaraj Urs Medical College, Kolar, Karnataka, India. A total of 620 women undergoing PCS with a gestational age of >28 weeks were enrolled. Data on maternal age, Body Mass Index (BMI), parity, gestational age, antenatal co-morbidities, and indications for caesarean section were collected from medical records. Chi-square and binary logistic regression analyses identified significant associations and independent predictors of PCS.
Results: Out of 2710 deliveries, 872 were PCS (32% overall rate). Among 620 included participants, 330 were predominantly under 25 years (53.2%), 394 were from lower socioeconomic status (63.5%), and 450 were primigravida (72.6%). The leading indication was foetal distress among 220 participants, accounting for 35.5% of cases, followed by cephalopelvic disproportion in 98 participants (15.8%). Fifty PCS were due to maternal request and accounted for 8.1%. Factors significantly associated with higher odds of PCS included maternal age ≥36 years (Adjusted Odds Ratio (AOR) 5.16; 95% Confidence Interval (CI): 2.39-11.26), although the wide confidence interval suggests limited precision due to the smaller number of women in this age category. PCS was also associated with increased maternal morbidity (AOR 4.19) and neonatal intensive care unit admission (AOR 2.20). Notably, all neonatal deaths occurred among multigravid mothers.
Conclusion: PCS remains a major contributor to rising caesarean rates. Factors such as advanced maternal age, high BMI, diabetes mellitus, and induction of labour significantly increase the likelihood of PCS. Targeted strategies, including adherence to evidence-based guidelines, judicious labour management, and regular audits, are essential to reduce unnecessary PCSs while ensuring maternal and neonatal safety.
Elective, Indication, Multigravida, Primigravida
The Caesarean section (CS) is a critical life-saving intervention that plays a significant role in reducing maternal and neonatal morbidity and mortality. It is the most frequently performed surgical procedure worldwide. The World Health Organisation (WHO) recommends an optimal caesarean section rate of 15%; however, this threshold has been surpassed in India, where the rate has reached 21.5%, as reported in the 2019-2021 National Family Health Survey-5 (1). In the private sector, these numbers stand at 43.1% (2016) and 49.7% (2021) (1). The sharp rise in caesarean birth rates, without a corresponding reduction in maternal or neonatal morbidity and mortality, raises concerns regarding the appropriateness and justification of the indications for these procedures (2). This issue is further highlighted by the WHO’s 2015 statement, which stresses that the focus should be on ensuring access to caesarean sections for women who genuinely require them, rather than aiming to meet a predetermined rate (3).
A PCS is defined as the first caesarean delivery in a woman with no previous uterine scar (4). The most common indications for primary caesarean delivery are foetal distress, failure to progress, foetal malpresentation and cephalopelvic disproportion [5,6]. Non-medical indications (e.g., maternal request) constitute one-third of the total 18.5 million caesarean sections performed annually (7). Multiple factors contribute to the rise in primary caesarean rates like increased use of electronic foetal monitoring, medico-legal concerns, maternal requests, rising maternal age, increased prevalence of assisted reproductive technologies, and higher rates of labour inductions (8).
Achieving a safe reduction in the caesarean section rate necessitates a comprehensive evaluation of the indications currently recommended and implemented in clinical practice. Accordingly, the present study aimed to determine the prevalence of PCS, examine their indications, and analyse the associated sociodemographic and obstetric factors influencing PCS, with particular emphasis on parity, in a tertiary care centre in Southern India.
The present Retrospective observational study was conducted at a tertiary care hospital affiliated with Sri Devaraj Urs Academy of Higher Education and Research (SDUAHER) from March 2024 to December 2024 in the Department of Obstetrics and Gynaecology. Ethical clearance for the study was obtained from the Institutional Ethics Committee of SDUAHER (Approval No: SDUAHER/KLR/R&D/CEC/F/NF/2024-25/43).
Inclusion and Exclusion criteria: The study population comprised all pregnant women who underwent PCS during the study period, had a confirmed gestational age of 28 weeks or more and provided informed consent to participate. Exclusion criteria included patients with a history of previous uterine surgery, those with incomplete medical records, deliveries that occurred outside the study facility, and individuals who declined to provide informed consent. A total of 620 women who met the inclusion criteria were enrolled consecutively during the study period.
Study Procedure
Data were collected from hospital records, operation theatre registers, and patient case sheets using a predesigned data collection proforma. The parameters collected included demographic details (age, parity), antenatal complications (e.g., Gestational Diabetes Mellitus (GDM), Pregnancy Induced Hypertension (PIH), anaemia), mode of labour onset (spontaneous/induced), type of caesarean (elective/emergency), indication for caesarean section, intraoperative findings and complications, maternal outcomes (e.g. post-partum haemorrhage) and neonatal outcomes (e.g., birth weight, APGAR (Appearance, Pulse, Grimace, Activity, and Respiration) scoring, Neonatal Intensive Care Unit (NICU) admission). Socioeconomic status was categorised using the Modified Kuppuswamy Scale (9). For analysis, the original five categories of the Modified Kuppuswamy Scale were grouped into ‘high/medium’ (combining upper, upper-middle, and lower-middle classes) and ‘lower’ (combining upper-lower and lower classes).
Elective caesarean sections were classified as procedures scheduled in advance and conducted prior to the onset of labour, while emergency caesarean sections were those undertaken in response to acute maternal or foetal complications (10).
STATISTICAL ANALYSIS
Statistical analysis was conducted using SPSS version 26. Sociodemographic variables were summarised as frequencies and percentages. Qualitative data were presented as frequencies and percentages and analysed using the chi-square test. Variables showing significant associations were subsequently subjected to binary logistic regression to identify independent predictors of PCS, with results expressed as adjusted odds ratios and corresponding 95% CI. A p-value of <0.05 was considered statistically significant.
In this study, out of 2710 deliveries, 872 were PCSs, resulting in an overall PCS rate of 32%. After excluding cases that did not meet the inclusion criteria, 620 participants were included. Most participants were under 25 years (53.2%), from lower socioeconomic status (63.5%), and primigravida (72.6%) (Table/Fig 1).
In this study, out of 2710 deliveries, 872 were PCSs, resulting in an overall PCS rate of 32%. After excluding cases that did not meet the inclusion criteria, 620 participants were included. Most participants were under 25 years (53.2%), from lower socioeconomic status (63.5%), and primigravida (72.6%) (Table/Fig 1).
A statistically significant association (p < 0.05) was observed between parity and maternal morbidity, birth weight, NICU admission, and neonatal mortality (Table/Fig 3).
Maternal age >36 years had markedly higher odds of PCS (adjusted odds ratio (AOR)=5.16), compared to the age groups 26-35 years, and <25 years, and this association was statistically significant. The presence of diabetes mellitus (AOR=3.79), and women who required induction of labour (AOR=3.17) exhibited higher odds of PCS with a statistically significant association (Table/Fig 4).
On comparing the maternal morbidity and PCS, mothers who underwent PCS had higher odds of developing maternal morbidity (AOR=4.19) with a statistically significant association. Neonates born to mothers who underwent PCS had higher odds of admission to the NICU (AOR =2.2), and the association was statistically significant (Table/Fig 5).
The overall prevalence of PCS in the present study was 32%, which is comparable to the 36% rate reported by Priyadarsene P et al., (11). In this study, advanced maternal age (>35 years) was significantly associated with increased odds of PCS. This is consistent with the systematic review by Bayrampour H et al., which included 21 studies (12). All studies demonstrated an increased risk of caesarean birth among women at advanced maternal age compared with younger women, for both nulliparas and multiparas (relative risk varied from 1.39 to 2.76). Similarly, higher BMI (>35 kg/m²) among women undergoing PCS was associated with higher odds of PCS, which is in agreement with the study by Saadia Z et al., where obese women undergoing CS delivery are at higher risk of several CS delivery complications. Also, they had a longer hospital stay and higher birth weight for their neonates compared with non obese women (13).
Diabetes mellitus emerged as a significant antenatal comorbidity, demonstrating higher odds of PCS (AOR 3.79; p<0.05) in this study. This finding is consistent with Remsberg KE et al., who demonstrated that after controlling for confounders, including birth weight, caesarean delivery was strongly associated with both preexisting diabetes {OR (95% CI) 6.20 (4.47-8.61)} and gestational diabetes (1.71 [1.41-2.07]) (14).
The present study found a significant association between gestational age and parity. This observation is consistent with Saurabh S et al., who demonstrated that the incidence of postdated pregnancy was higher in primigravida (15). The incidence of foetal distress and NICU admissions increased as the period of gestation increased.
Foetal distress (35.5%) was the leading indication for CS in both primigravidae and multigravidae, with a higher prevalence in primigravidae. These findings are consistent with those of Begum T et al., (16) and Chugh A et al., (6) who identified foetal distress as the most frequent indication for PCS, reported at 21%, 27.3%, and 34.2%, respectively. Caesarean delivery on maternal request accounted for 8.1% of all PCS in our study, which is lower than the 18.65% reported by Shrestha D et al., (17).
The present study also provides valuable insights from a tertiary care center, where a diverse set of obstetric cases are managed, improving the generalisability of the results within similar settings.
Limitation(s)
Primarily, the retrospective nature of the research restricts the ability to draw causal inferences. Additionally, the study was based on data from a single-centre, which may not fully represent the broader population of women undergoing caesarean deliveries in different regions or healthcare settings. Future studies with prospective cohort designs across multiple centers would help validate these findings and offer a more comprehensive understanding of the factors influencing PCSs.
The PCS remains a major contributor to rising caesarean rates. Factors such as advanced maternal age, high BMI, diabetes mellitus, and induction of labour significantly increase the likelihood of PCS. Targeted strategies, including adherence to evidencebased guidelines, judicious labour management, and regular audits, are essential to reduce unnecessary PCSs while ensuring maternal and neonatal safety.
DOI: 10.7860/JCDR/2026/87254.24510
Date of Submission: Jan 05, 2026
Date of Peer Review: Mar 09, 2026
Date of Acceptance: May 23, 2026
Date of Publishing: Oct 01, 2026
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Mar 07, 2026
• Manual Googling: May 19, 2026
• iThenticate Software: May 21, 2026 (1%)
ETYMOLOGY: Author Origin
EMENDATIONS: 7
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
- Index Copernicus ICV 2017: 134.54
- Academic Search Complete Database
- Directory of Open Access Journals (DOAJ)
- Embase
- EBSCOhost
- Google Scholar
- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
- Journal seek Database
- Popline (reproductive health literature)
- www.omnimedicalsearch.com