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On Sep 2018

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"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

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Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
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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.
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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.
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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)
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.
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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

Original article / research
Year : 2022 | Month : December | Volume : 16 | Issue : 12 | Page : QC05 - QC08 Full Version

Evaluation of Outcome of Pregnancy Complicated with Thrombocytopaenia- A Prospective Observational Study

Published: December 1, 2022 | DOI:
Rao Bahadur Badugu, Prabhadevi Kodey, Sowjanya Pappala

1. Associate Professor, Department of Obstetrics and Gynaecology, NRI Medical College, Mangalagiri, Andhra Pradesh, India. 2. Professor, Department of Obstetrics and Gynaecology, NRI Medical College, Mangalagiri, Andhra Pradesh, India. 3. Resident, Department of Obstetrics and Gynaecology, NRI Medical College, Mangalagiri, Andhra Pradesh, India.

Correspondence Address :
Dr. Rao Bahadur Badugu,
House No. 8-471/E, 8th Cross Road, Kuppurao Colony, Devunimanyam, Mangalagiri, Andhra Pradesh, India.


Introduction: Thrombocytopaenia occurs in 7-12% of pregnancies at the time of delivery. Knowledge, regarding the causes and effects of thrombocytopaenia on mother and newborn, facilitates proper diagnosis and management of thrombocytopaenia in pregnant women for better maternal and foetal outcomes.

Aim: To determine the incidence, causes and outcome of pregnancy with thrombocytopaenia.

Materials and Methods: A prospective observational study was conducted among women attending Outpatient Department for an antenatal checkup at NRI Medical College and General Hospital, Chinnakakani, Guntur, Andhra Pradesh, India, from October 2017 to October 2019. A total of 44 antenatal women with platelet count less than 1,50,000/cumm were included in the study. They were followed-up throughout the antenatal period until delivery to record any complications that developed due to low platelet counts in the mother and neonate. A neonatal platelet count was done on day one of life. Data was subjected to statistical analysis using Statistical Package for Social Sciences (SPSS) version 22.0, all qualitative variables were expressed in terms of proportion.

Results: A total of 500 cases were studied of which 50 cases had thrombocytopaenia with an incidence of 10%. Out of 50 cases, six were lost for follow-up and the remaining 44 cases were included in the study. Out of 44 patients, 23 (52.27%) had mild thrombocytopaenia, 12 (27.27%) had moderate and 9 (20.46%) had severe thrombocytopaenia at the time of diagnosis. Common causes seen were Gestational Thrombocytopaenia (GT) 17 (38.6%), Preeclampsia (PE) 8 (18.18%), Gestational hypertension 4 (9.09%). A total of 5 (11.36%) required intensive care unit care, 3 (6.81%) had multiorgan dysfunction syndrome (MODS), 2 (4.54%) underwent hysterectomy, 2 (4.54%) had postpartum haemorrhage (PPH), 2 (4.54%) had secondary suturing done for wound infection, 1 patient (2.27%) underwent laparotomy (for rectus sheath haematoma), and mortality was seen in two cases. A total of 14 cases (31.8%) required blood and blood product transfusions. Eight neonates were admitted to the neonatal intensive care unit. There was no case of neonatal thrombocytopaenia.

Conclusion: Thrombocytopaenia is a significant problem in pregnancy; hence, the routine antenatal platelet count should be done for a timely diagnosis of thrombocytopenia.


Gestational thrombocytopaenia, Haemorrhage, Hypertension

Thrombocytopaenia is defined as a platelet count of less than 1,50,000/cumm. It occurs in 7-12% of pregnancies at the time of delivery (1),(2). There is a physiological fall in the platelet count in normal pregnancy. These changes could be because of the dilutional effect, low platelet production, or may be because of increased platelet turnover in pregnancy (2).

The most common clinical manifestations of thrombocytopaenia are petechiae, ecchymosis, epistaxis, gum bleeding, and abnormal uterine bleeding. Surgical bleeding associated with thrombocytopaenia is uncommon unless platelet counts are less than 50,000/cumm, and spontaneous bleeding is rare unless the platelet count is below 10,000/cumm. However, pregnant women with a platelet count of less than 1,00,000/cumm should undergo further clinical and laboratory assessment (3).

Knowledge regarding the causes and effects of thrombocytopaenia on mother and newborn facilitates proper diagnosis and management of thrombocytopaenia in pregnant women for better maternal and foetal outcomes. Thrombocytopaenia in pregnancy can result in bleeding during pregnancy, preterm delivery, Intrauterine Growth Restriction (IUGR), Postpartum Haemorrhage (PPH), abortions, abruption, Intrauterine Death (IUD), excessive bleeding complication during caesarean delivery, neonatal thrombocytopaenia (4),(5).

Platelet count is not routinely done during the antenatal period, hence, the effect of thrombocytopaenia during pregnancy is not well studied in India. The present study was done with the aim to know the incidence, aetiology and outcome of pregnancy with thrombocytopaenia.

Material and Methods

A prospective observational study was conducted among women attending Outpatient Department for an antenatal checkup at NRI Medical College and General Hospital, Chinnakakani, Guntur, Andhra Pradesh, India, from October 2017 to October 2019. Ethical approval was taken for the study (NRIAS/IEC/431/2018). Informed consent was obtained from the participants.

A total of 50 out of 500 pregnant women included in the study were diagnosed with thrombocytopaenia with a platelet count <1,50,000/cumm at the first visit to the hospital. Out of 50 cases, six cases were lost for follow-up, and the remaining 44 cases were included in the study.

Inclusion criteria: Antenatal women with platelet count less than 1,50,000/cumm.

Exclusion criteria: Prior diagnosed cases of Idiopathic Thrombocytopenic Purpura (ITP), patients on steroids and Non Steroidal Anti-Inflammatory Drugs (NSAIDs) therapy, patients who underwent splenectomy, Human Immunodeficiency Virus (HIV) positive, and on drugs causing thrombocytopaenia.

Study Procedure

Platelet count estimation was done for all cases at the first visit and repeated in the third trimester. Platelet counts were repeated before and after delivery. Neonatal platelet count was done on day one of life. They were followed-up throughout the antenatal period until delivery to record any complications that developed due to low platelet counts. Platelet count was estimated by automated haematology analyser Symex XN 1000 by flow cytometry and manual method by peripheral smear. Based on platelet value, cases were divided as mild thrombocytopaenia (1,00,000-1,50,000/cumm), moderate thrombocytopaenia (50,000-99,000/cumm) and severe thrombocytopaenia (<50,000/cumm) (6).

Statistical Analysis

The data was analysed in Statistical Package for Social Sciences (SPSS) version 22.0. All the quantitative variables like age, platelet count, were expressed in terms of descriptive values like mean. All the qualitative variables were expressed in terms of proportion.


The incidence of maternal thrombocytopaenia was 10% i.e, (50/500). The mean age noted was 23.56±3.5 years. (Table/Fig 1) shows the socio-demographic data. Out of 44 patients, 52.27% (n=23) had mild thrombocytopaenia, 27.27% (n=12) had moderate and 20.45% (n=9) had severe thrombocytopaenia at the time of diagnosis.

Gestational Thrombocytopaenia (GT) accounts for 38.63% (n=17), gestational hypertension was seen in four patients (9.09%) (Table/Fig 2).

A total of 13.63% (n=6) delivered between 28-32 weeks of gestation, 6.81% (n=3) delivered between 32-36+6 week period of gestation, and 65.90% (29 patients) delivered after 37 completed weeks of gestation, and 13.63% (n=6) had abortion.

A total of 47.72% (21 patients) had vaginal delivery, 38.63% (17 patients) delivered by Lower Segment Caesarean Section (LSCS). LSCS was done for preeclampsia and antepartum haemorrhage (n=2), eclampsia+HELLP (n=2), severe preeclampsia (n=3), CPD (n=1), previous LSCS (n=4), foetal distress (n=2), failed induction (n=3). In 31.81% (14 patients) blood and blood product transfusions was required, of which 4.54% (n=2) required only platelets, 11.36% (n=5) required only packed red cells, 6.81% (n=3) required packed red cells and platelets, 6.81% (n=3) required packed red cells along with platelets and Fresh Frozen Plasma (FFP), 2.27% (n=1) required packed cells along with FFP’s and albumin. There was no need for transfusion in 68.18% (30 patients).

Two maternal deaths were seen (one patient died due to sepsis and MODS, and one due to acute fulminant hepatic failure). Out of 37 live births, 29 neonates were healthy, and eight neonates were admitted in NICU because of IUGR. There was no incidence of neonatal thrombocytopaenia (Table/Fig 3). The birth weight of two neonates was less than 1 kg, one neonate had birth weight of 1.2 kg, 12 neonates weighted between 1.6-2.5 kg, 22 neonates weighted between 2.6-4.0 kg. Twenty nine neonates had APGAR score at 5 minutes more than 7, and eight neonates had APGAR score at 5 minutes less than 7.


In the present study, the incidence of maternal thrombocytopaenia was 10%, which is comparable to the studies by Chauhan V et al., (7) (8.40%), and Singh N et al., (8) (8.80%). A higher incidence was observed by Ajibola SO et al., (9) (13.50%) and Onisai M et al., (10)(11.11%). In the present study, mean age was 23.56±3.5 years. Suri V et al., (11) Jaleel A et al., (12), Borna S et al., (13), Turgut A et al., (14) showed the mean age was 27, 28.43, 28, and 27.6±5.7 years, respectively. The present study, showed mean gravidity was 2.15±0.99. Chauhan V et al., (7), Dwivedi P et al., (15) showed mean gravidity of 1.75, and 2.15±0.99, respectively. In the present study, 45.45% (20 cases) were primigravida, 52.27% (23 cases) were second and third gravida, and 2.27% (one case) was fourth gravida patient. Brohi ZP et al., (16) study showed 40.8% were primigravida. In Katke RD and Gohil DP study 35% cases were primigravida, 32% cases were gravida 2 and 33% cases were gravida 3 to 5 (17). The present study showed mean gestational age at diagnosis was 32+1±8.7 weeks. In Parnas M et al., 74.4% were between 37-40 weeks of gestation (18). In Dwivedi P et al., the mean gestational age was 38 weeks (15).

The present study showed mild thrombocytopaenia in 52.27% (23 patients). Mild thrombocytopaenia was noted in 54% cases by Borna S et al., which is comparable to the present study (13). In Chauhan V et al., 63.2% women had mild thrombocytopaenia, which was higher as compared to the present study (7). In the present study, moderate thrombocytopaenia was seen in 27.27% cases and severe thrombocytopaenia in 20.46% cases. In Katke RD and Gohil DP 70.9% of patients had moderate thrombocytopaenia and 29.1% of patients had severe thrombocytopaenia (17). In Chauhan V et al., (7), Borna S et al., (13) showed 35.4%, 30%, respectively with moderate thrombocytopaenia and 1.5%, 16%, respectively with severe thrombocytopaenia. Singh N et al., (8) showed 7.4% of patients had severe thrombocytopaenia (8). In present study, mean gestational age at delivery was 34.44±8.5 weeks. Bouzari Z et al., (19), Chauhan V et al., (7), Lin YH et al., (20) showed mean gestational age at delivery of 35.83±3.61 weeks, 38.6±1.34 weeks, 39 weeks, respectively.

Present study showed Gestational Thrombocytopaenia (GT) (38.63%) as most common cause of thrombocytopaenia followed by PE (18.18%) (Table/Fig 4) shows a comparison of various causes in present study with different studies done by different authors (4),(5),(7),(17),(18),(21),(22),(23).

In the present study, the mean gestation age at delivery was 34.44±8.5 weeks and 23.68% had preterm delivery and 44.73% had LSCS. (Table/Fig 5) shows comparison of gestation age at delivery and mode of delivery between different studies and present study (5),(7),(17),(18),(22). According to a study by Anita H et al., 60% of cases delivered at term, those delivered before term were mostly due to abruption or for obstetric indications like severe preeclampsia, antepartum eclampsia, abruption or medical causes (5). In the present study, 44.73% (17 cases) delivered by LSCS, done for obstetrical indications like foetal distress (n=2), failed induction (n=3), previous Lower Segment Caesarean Section (LSCS) (n=4), cephalopelvic disproportion (n=1), severe preeclampsia (n=3), eclampsia+HELLP (n=2), preeclampsia and antepartum haemorrhage (n=2), but not due to thrombocytopaenia alone.

In the present study, out of 44 patients, 31.8% (n=14) required blood and blood product transfusions. In a study by Usha S et al., 66.8% required blood or blood product transfusion (22). Platelet transfusions were required in 43.1% of cases (n=69). In a study by Parnas M et al., 19.6% required transfusions and 3.21% required only platelet transfusion, which is comparable to the present study (18).

In Katke RD and Gohil DP study, one case required LSCS with obstetric hysterectomy, and one case required LSCS followed by internal iliac artery ligation and obstetric hysterectomy (17). These results are similar to the present study where two cases required hysterectomy. In the present study, PPH was seen in 4.54% (n=2). In Usha S et al., and Singh N et al., study PPH was seen in 12.4% (n=8) and 9.89%, respectively (8),(22).

In the present study, maternal mortality was seen in two cases (4.54%) cases. In a study by Katke RD and Gohil DP mortality was seen in 7.76% (n=8) due to causes like acute respiratory distress syndrome, haemothorax with liver failure, intracranial bleed, cardiorespiratory arrest, hypotension, pulmonary embolism, kidney failure, multiorgan failure, stroke (17). Birth weight <2.4 kg in the present study was seen in 40.5% neonates, which was less than study data reported by Usha S et al., (22) ( 67.1%) and more than Onisai M et al., study (24.48%) (10). In the present study, out of 37 live births, 21.62% (n=8) have APGAR score of less than 7 at 5 minutes, and in Chauhan V et al., study 6.15% of neonates had APGAR score of less than 7 at 5 minutes (7).

In the present study, IUGR was seen in 5.26% (n=2), out of which one foetus had IUD, and the other was admitted in NICU. According to Parnas M et al., (18) study, IUGR was seen in 8.5% and was associated with preeclampsia, HELLP syndrome, and DIC, which was similar to the present study. In the present study, IUD was seen in one case due to severe IUGR because of severe maternal preeclampsia. According to the study conducted by Parnas M et al., 6.5% of cases had still births (18). According to a study by Katke RD and Gohil DP 14.1% (14 patients) had a still birth (17). Neonatal thrombocytopaenia was not seen in the present study. In Chauhan V et al., neonatal thrombocytopaenia was seen in 3.1% (7). According to a study done by Anita H et al., one case had neonatal thrombocytopaenia (5). None of the babies had bleeding complications. According to Singh N et al., one neonate born to mother with ITP had neonatal thrombocytopaenia on day one, platelet count returned to normal on day 8. Bleeding manifestations were not seen in any of the neonates (8).

Mild thrombocytopaenia does not have much effect on the obstetrical management but severe thrombocytopaenia can have adverse outcome especially in life threatening conditions like HELLP syndrome which poses a great challenge to the treating obstetrician. Platelet count monitoring should be routinely done at antenatal visits for timely diagnosis of thrombocytopaenia and to achieve favourable foetal and maternal outcome in all types of thrombocytopaenia. Neonatal platelet count should be done in all cases where maternal thrombocytopaenia is diagnosed.


The sample size being very small is the limitation of this study.


Thrombocytopaenia is a significant problem in pregnant women. Maternal platelet count monitoring should be done as a routine antenatal investigation for timely diagnosis of thrombocytopaenia, which will help in administering accurate management and thereby, preventing maternal and neonatal morbidity and mortality.


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DOI and Others

DOI: 10.7860/JCDR/2022/60581.17228

Date of Submission: Oct 05, 2022
Date of Peer Review: Oct 28, 2022
Date of Acceptance: Nov 23, 2022
Date of Publishing: Dec 01, 2022

• 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

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