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Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
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Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
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.
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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.
On April 2011

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
On Jan 2020

Important Notice

Case Series
Year : 2022 | Month : October | Volume : 16 | Issue : 10 | Page : TR01 - TR03 Full Version

Urinary Bladder Calculus as a Rare Cause of Obstructed Labour: A Series of Three Rare Cases

Published: October 1, 2022 | DOI:
Punya Pratap Singh, Jagrati Kiran Nagar, Kavita Gahlot, Omkar Thakur, Bheekam Patel

1. Associate Professor and Head, Department of Radiodiagnosis, Bundelkhand Medical College, Sagar, Madhya Pradesh, India. 2. Associate Professor, Department of Obstetrics and Gynaecology, Bundelkhand Medical College, Sagar, Madhya Pradesh, India. 3. Obstetrician and Gynecologist, Department of Obstetrics and Gynaecology, Ayushman Hospital, Sagar, Madhya Pradesh, India. 4. Assistant Professor, Department of Surgery, Bundelkhand Medical College, Sagar, Madhya Pradesh, India. 5. Demostrator, Department of Paediatrics, Bundelkhand Medical College, Sagar, Madhya Pradesh, India.

Correspondence Address :
Dr. Punya Pratap Singh,
Flat No 9, Type - 4 Quaters, bmc Residential Complex, Sagar-470002, Madhya Pradesh, India.


Obstructed labour by large urinary bladder stones is one of the rare complications. Very small number of cases have been described in available literature. The diagnosis is generally based on the history of patient, their clinical evaluation and ultrasonography scans during pregnancy. Majority of antenatal cases in rural areas come first time in Primary Healthcare Centre (PHC) with labour pain and usually without any previous ultrasound scans. These cases are referred to higher centres due to prolonged obstructed labour. Although rare, but one should consider a large urinary bladder calculus as a cause of obstructed labour as early diagnosis and timely management of urinary bladder stones can prevent various complications like mechanical dystocia and Vesico-vaginal Fistula (VVF). Here, authors reported three cases of a large urinary bladder calculus causing obstructed labour. Caesarean section was done for obstructed labour and cystolithotomy was performed simultaneously in all three cases.


Caesarean section, Cystolithotomy, Dystocia, Pregnant women, Ultrasound

Out of the various causes of obstructed labour, vesical calculus is a very rare cause (1). The incidence being 1 in 2000-3300 pregnancies (2). Urinary bladder stones in women accounts approximately 5% of all bladder stones (3). A large calculus weighing more than 100 gm, causing obstructed labour which is a very rare type of clinical entity case (4). Urinary bladder without any symptom can attain a big size. In rare cases, such large urinary bladder calculus may be diagnosed first time during labour as in the presented cases. Timely intervention of these types of cases can prevent various serious complication (5). The diagnosis is based on the history of patients, their clinical evaluation and Ultrasonography (USG). Most part of the population having deficient healthcare system and prolonged non progressive labour or dystocia which is an intrapartum emergency (6). Due to lack of USG facility and lack of awareness in rural areas, diagnosis of obstructed labour by large urinary bladder calculus cannot be made and therefore referred to higher centre with labour pain due to obstructive features of labour or no progression of labour. This indicates importance of prenatal USG for better outcome of pregnancy. In doubtful cases or USG is inconclusive, non contrast enhanced Magnetic Resonance Imaging (MRI) is also helpful. After confirmation of diagnosis of urinary bladder calculus as a cause of mechanically obstructed labour, urgent emergency Lower (Uterine) Segment Caesarean Section (LSCS) followed by cystolithotomy should be performed to avoid various complications. Here, authors have reported three cases of a large urinary bladder calculus causing obstructed labour.

Case Report

Case 1

A 20-year-old, primigravida patient with history of amenorrhoea of nine months and non localisation of foetal heart sound with obstructed labour was referred from district hospital and admitted in labour room of the medical college. On general examination, her general condition was average. Patient was ill looking, dehydrated, exhausted and afebrile to touch, pulse rate was 88/minute, Blood Pressure (BP) was 140/100 mmHg, pallor and oedema was present.

On per abdomen examination: Uterus was full term, longitudinal lie, and no scar marks or dilated veins were seen.

On palpation: Uterus full term, longitudinal lie, cephalic presentation, vertex down, fixed and contraction was present.

On auscultation: Foetal heart sound was not localised.

On Pervaginal examination (P/V): Cervix was fully dilated, fully effaced, vertex presentation at +1 station, membrane was absent, meconium stained liquor and primary caput were present. A firm stony hard, smooth globular mass of about 5×6 cm was felt through anterior fornix.

USG obstetrics showed single Intrauterine Foetal Demise (IUFD) with large echogenic foci with distal acoustic shadow of maximum length 6.2 cm likely to have large urinary bladder calculus. Diagnosis was confirmed by USG of whole abdomen and pelvic x-ray as baby was IUFD. Risk of Pregnancy Induced Hypertension (PIH), non localisation of Foetal Heart Rate (FHR), severe anaemia and bladder stone was explained to the attender. After taking well informed written consent, patient was taken for LSCS with cystolithotomy. During caesarean section, thinned out lower uterine segment (as a feature of obstructed labour) was noted. Patient delivered a still birth baby of 2.5 kg weight on same day of admission by vertex followed by complete delivery. Cystolithotomy was performed by surgery on call consultant. Large calcified urinary bladder stone of about 6×6.5 cm (Table/Fig 1) was removed. Urinary bladder catheter was kept for 21 days. Haematuria was disappeared on 2nd day. Postoperative days were uneventful. One unit of blood was given in postoperative period and three doses of iron sucrose also given. Stitches were removed on 8th day and stitch line was healthy. Patient was discharge on 8th day and advised to present in Outpatient Department (OPD) for follow-up after seven days.

Case 2

A 23-year-old primigravida, postdated pregnant patient with breech presentation with large calculus in bladder was admitted in the medical college labour room, her bladder stone was detected in antenatal period at 28 weeks of gestation in USG by radiologist. So, she was planned for elective caesarean section. On general examination, her condition was good, afebrile to touch, pulse rate was 70/minute, BP was 110/80 mmHg; pallor, oedema and icterus was absent.

On per abdomen examination: Uterus was 36 to 40 weeks, relaxed, soft, foetal heart rate was present and regular (140 beats per minute), lie longitudinal and breech presentation.

On Pervaginal (P/V) examination: Cervical -os was closed, presenting part high up, no show and no leaking. A firm, stony hard smooth, globular, non tender immovable mass of about 5×6 cm was felt through anterior fornix.

Patient was taken for LSCS with cystolithotomy after taking well informed written consent. Patient delivered a male live baby of 2.4 kg weight on same day of admission. Baby cried immediately after birth attended by Paediatrician and Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) after five minutes was 10. Cystolithotomy was performed by surgery on call consultant and removed a large stone of about 6×5.6 cm (Table/Fig 2). Haematuria was disappeared on 2nd day and catheter kept for 21 days. Her caesarean stitches wound got infected and resuturing was done. Stitches removed on 8th day of resuturing. Patient was discharged on 22nd day after removal of catheter. Postoperative period was uneventful.

Case 3

A 20-year-old, primigravida patient registered at a PHC, three prenatal visits were done. Once this patient was seen by a private practitioner. Stone was missed in USG obstetrics, then patient came to the author, with history of eight months nine days amenorrhoea and pain in abdomen. She had history of recurrent urine infection. She has history of dyspareunia also.

On general examination, patient was thin, general condition was fair, afebrile to touch, pulse rate was 82/minutes, BP was 110/70 mmHg, Urine albumin 2+, oedema was absent.

On per abdomen examination: Fundal height was 32 to 34 weeks size {Uterus was not corresponding to gestational age may be due to Intrauterine Growth Retardation (IUGR)}, vertex down, fixed, major poles were above brim, contraction present, longitudinal lie and cephalic presentation was noted.

On auscultation: FHR was regular (144 beats per minute).

On P/V examination: A hard fixed, smooth, globular, immobile, non tender mass was felt anteriorly. As pelvic mass was big, its margins cannot be felt and cervix shifted backwards by mass. Cervix was dilated by 42 to 50 percent, effaced, cervix could not be felt easily, very posteriorly placed, felt by examining with finger only. Cervix was 1 to 2 cm in dilatation and membrane was present.

Steroid was given. Urinary bladder stone cannot be visualised in next day USG (may be due to foetal head shadowing, pelvic bone shadowing and calculus deeply impacted in pelvis). Next day, on P/V examination same findings were noted. Good uterine contraction was also noted and hard fixed mass felt anteriorly. Caesarean section was done. Patient delivered a preterm, 1.7 kg weight, male baby on 3rd day of admission. Uterus was not corresponding to gestational age because baby had IUGR. After that, cystolithotomy was performed by on call surgeon. Large urinary bladder calculus of about 10 to 12 cm of maximum dimension (Table/Fig 3) and 500 gm weight was removed by cystolithotomy. Postoperative period was uneventful. Mother and baby were healthy at time of discharge on 8th day. Features of all three cases are shown in (Table/Fig 4).


Urinary bladder stones are uncommon in female population and even rarer in pregnancy period. Urinary bladder stones in women accounts approximately 5% of all bladder stones (3). Nephrolithiasis incidence during pregnancy ranges in between 1/200-1/2500. Generally urinary bladder stones are diagnosed in prenatal ultrasounds, urinary bladder calculus situated posterior to symphysis pubis and anterior to cervix, cannot be detected by USG due to foetal skull bone and pelvic bone shadowing (4). Urinary bladder calculus can cause various complication in which few are common like- Urinary Tract Infection (UTI), haematuria, preterm delivery, few are uncommon although serious like Vesico-vaginal Fistula (VVF) and rupture of uterus. Generally, serious type of complications is not common due to early diagnosis in antenatal period and their proper management. Urinary bladder stone management changes as per gestational age of foetus.

In antenatal period, a large urinary bladder stone is best managed by Supra-pubic cystotomy with minimal complication. This procedure is done in later stage of pregnancy to prevent preterm labour; (7) vaginal cystotomy cannot be done due to chances of severe complication like permanent fistula (7). But if patient presented with labour pain or in labour second stage. In these, caesarean section should be done followed by cystolithotomy in same sitting (7). There are several differentials for obstructed second stage of labour due to mechanical obstruction like retroperitoneal masses (sarcomas (8), ganglio-neuroma (9)), pelvic space occupying lesions (hydatid/echinococcus cysts) (10). The best management of obstructed labour due to urinary bladder calculus is caesarean section followed by cystolithotomy in same sitting. Urinary bladder calculus may be clinically silent and not showing any symptoms. However, these stones can be presented with haematuria, pelvic pain, dysuria and recurrent UTI (11). In case 3 recurrent urinary problems and history of dyspareuria was noted. Other two cases did not had any complaint related to urinary bladder stone. Large urinary bladder calculus causing mechanical dystocia can be easily diagnosed when it is palpable by pervaginal examination (11). As in case 1 and case 3, urinary bladder stone was suspected on P/V examination.

Due to no radiation related hazards, cystoscopy and USG are two best diagnostic method/procedure to diagnose urinary bladder calculus in pregnant women [11,12]. MRI can be used as problem solving method due to absence of radiation hazards, absence of teratogenic potential and inherence contrast by using different sequences. Some previous studies showed 100% sensitivity (13). In case 1- USG was done in last trimester to search for cause obstructed labour and findings suggestive of single IUFD foetus with suspected large urinary bladder stone which was confirmed by X-ray pelvis, case 2 Large urinary bladder stone detected on antenatal USG on 28 weeks of gestational age and case 3 USG was done two times but could not pick up large urinary bladder stone. In neglected cases of obstructed labour due to large urinary bladder calculus, rupture of urinary bladder and vaginal wall can occur and large stone might be expelled out via rupture site (14). In present series all three cases, caesarean section was done for obstructed labour and cystolithotomy performed simultaneously. Really interesting, case 2- planned elective surgery got infected (caesarean wounds get infected and resuturing was done) and other two cases done in emergency were healthy (postoperative period was uneventful).


Out of the various causes of obstructed labour, urinary bladder calculus is one of the very rare cause. Patient’s past and present history, pathological tests, clinical and prenatal USG scans are main tools to reach proper diagnosis. Size of calculus and gestational age of foetus are main factors taken into consideration to decide management of such cases. In doubtful cases, non contrast MRI is also helpful. The size of the urinary bladder calculus is also a main factor with other factors to deciding route of delivery. Complications can be avoided by early, timely diagnosis followed by proper management of case. When LSCS is indicated, intraoperative cystolithotomy with extraction of the calculus is best method to deal with urinary bladder calculus, however it may increase the occurrence of urinary fistula. In all three cases, after diagnosis of large urinary bladder calculus causing labourdystocia, LSCS was performed which was followed by cystolithotomy to minimise or prevent maternal and foetus morbidity and mortality.


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DOI and Others

DOI: 10.7860/JCDR/2022/57568.16983

Date of Submission: May 13, 2022
Date of Peer Review: Jun 20, 2022
Date of Acceptance: Sep 05, 2022
Date of Publishing: Oct 01, 2022

• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

• Plagiarism X-checker: May 14, 2022
• Manual Googling: Aug 08, 2022
• iThenticate Software: Sep 03, 2022 (25%)

ETYMOLOGY: Author Origin

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