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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
Case report
Full Version
Anaesthesia Management in Case of Placenta Accreta undergoing Caesarean Delivery with Internal Iliac Artery Balloon Catheterisation and Embolisation
Correspondence Address :
Dr. Monica Pandey,
DNB Resident, Department of Anaesthesia, Eternal Heart Care Centre and Research Institute, Jaipur-302017, Rajasthan, India.
E-mail: monicapandey79@gmail.com
Abnormal invasion of the placenta into the uterine tissue during pregnancy is one of the most common causes of peripartum hysterectomy, as well as morbidity and mortality. A multidisciplinary approach is the best way to manage such cases in order to maintain perioperative haemodynamic stability, which leads to lower rates of complications and shorter hospital stays for both the parturient and the newborn. The authors hereby report the case of a 27-year-old female {Gravidity and Parity (G1P2)} at 36 weeks of gestation, diagnosed with central placenta accreta with bladder invasion. In the present case, authors performed a balloon-assisted caesarean delivery under general anaesthesia while avoiding hysterectomy. The patient had a history of a previous caesarean delivery 1.5 years prior. Placenta accreta was diagnosed during her ultrasound. All routine laboratory results were within the normal range, except for haemoglobin, which was 10.1 g/dL. An elective caesarean section with a consented hysterectomy under general anaesthesia was planned. Adequate blood and blood products (4 units of packed red blood cells and 2 units of fresh frozen plasma) were arranged before surgery. Bilateral internal iliac artery embolisation was performed to reduce perioperative bleeding. Flexible cystoscopy was conducted prior to surgery to confirm the extent of bladder invasion. The caesarean section was successfully carried out with the multidisciplinary team approach under general anaesthesia, and hysterectomy was not performed, allowing for a successful fertility-sparing caesarean delivery by our team. The patient was transferred to the Intensive Care Unit (ICU) after the surgery for proper vital monitoring and adequate pain management. She was moved to the ward on day 2 and discharged on day 3. In conclusion, balloon occlusion of the internal iliac artery is effective for haemostasis in most cases of patients with placenta previa.
Balloon occlusion, Haemodynamic stability, Obstetric haemorrhage
A 27-year-old female, G2P1, presented at 36 weeks of gestation with a Body Mass Index (BMI) of 32 kg/m2 for safe confinement and an elective caesarean section. She was a known case of central placenta previa with placenta accreta, along with bladder invasion. She had no other significant medical or family history. Her past obstetric history included one caesarean section 1.5 years ago under spinal anaesthesia at 38 weeks of gestation, which was uneventful. This time, her caesarean section was planned at 36 weeks, as it was found that there was thinning at the uterine scar site from the previous caesarean delivery. All standard laboratory findings were within normal limits, with the exception of haemoglobin, which was 10.1 g/dL. Abdominal ultrasonography confirmed placenta accreta.
Therefore, a planned elective caesarean section under general anaesthesia was scheduled, along with a consenting hysterectomy. Adequate blood and blood products (4 units of packed red blood cells and 2 units of fresh frozen plasma) were arranged before surgery.
Before transferring the patient to the operating theatre, she was taken to the cardiac catheterisation lab for the insertion of bilateral internal iliac artery catheters via femoral arteries under all aseptic precautions. The patient was shielded with a lead apron to minimise radiation exposure. Following the procedure, the patient was transferred to the operating room, where flexible cystoscopy was performed under local anaesthesia to confirm intravesical invasion. Local anaesthesia was used to minimise the duration of anaesthetic drug exposure to the foetus. Flexible cystoscopy was preferred to avoid lithotomy positioning of the patient, which could have displaced the internal iliac artery catheters.
All routine monitors (pulse oximeter, invasive arterial blood pressure, electrocardiogram, blood pressure, and end-tidal CO2) were attached. The patient’s baseline vitals prior to induction were: blood pressure 126/74 mmHg, heart rate 112 beats per minute, and saturation 98% on room air. Two large-bore peripheral intravenous cannulas (16-gauge and 18-gauge) were secured. Invasive arterial monitoring was performed by connecting the monitor to one of the femoral arterial lines. Antibiotic coverage with 750 mg of intravenous amikacin and 1.5 grams of cefuroxime was administered, along with 40 mg of pantoprazole and 4 mg of ondansetron intravenously 15 minutes prior to induction. After five minutes of preoxygenation, rapid sequence induction of anaesthesia was performed with premedication of injection glycopyrrolate at 0.005 mg/kg and suxamethonium at 1-1.5 mg/kg body weight. Tracheal intubation with an endotracheal tube of 7 mm internal diameter was facilitated by Intravenous (i.v.) thiopentone at 3 mg/kg. The tube was secured at 20 cm after checking for equal bilateral air entry. Anaesthesia was maintained with oxygen (50%) and air, sevoflurane (1.0-1.5%), and i.v. atracurium at 0.3 mg/kg.
Injection tranexamic acid, 1 gram, was given intravenously slowly over one minute. A single live female foetus was delivered.
Following the delivery of the baby, intravenous fentanyl at 1.5 micrograms/kg and 100 micrograms of carbetocin were administered, along with 20 units of oxytocin in 100 mL of Ringer’s lactate. Once the placenta was separated manually, there was an incident of heavy bleeding, for which 250 micrograms of carboprost were given intramuscularly, along with 0.2 micrograms of methyl ergometrine. One unit of packed red blood cells was started, and bilateral internal iliac artery balloons were inflated to stop further uterine bleeding. After 10 minutes, the balloons were deflated, and the uterine bleeding resumed. Subsequently, internal iliac artery embolisation was performed by an interventional radiologist, and the uterine bleeding ceased. After confirmation of the cessation of placental bleeding, the uterus was closed.
The patient was given 1 gram of intravenous paracetamol along with 75 mg of diclofenac in 100 mL normal saline intravenously for pain relief. After complete reversal of neuromuscular blockade with 0.005 mg/kg of glycopyrrolate and 50 mcg/kg of neostigmine, the patient was assessed. She exhibited adequate respiratory efforts, was able to follow commands, and could lift her head for more than five seconds. She was successfully extubated. Total blood loss during the surgery was approximately 800 mL. The femoral arterial sheath from one side was removed, and the patient was transferred to the intensive care unit for postoperative monitoring. The patient remained stable postoperatively and was shifted out of the ICU on the second day after surgery. She was discharged on the third day postsurgery.
In a normal pregnancy, the placenta anchors to the decidualised endometrium (1). The abnormal invasion of placental trophoblasts into the uterine myometrium is referred to as placenta accreta.
Depending on the extent of myometrial invasion, it constitutes a spectrum of conditions that includes placenta accreta, placenta increta, and placenta percreta. The incidence of Placenta Accreta Spectrum (PAS) is rising worldwide (2). This increase is most likely due to the rising rates of caesarean delivery, which is the major risk factor for PAS in subsequent pregnancies. PAS is one of the most dangerous conditions during pregnancy. It is the most common indication for peripartum hysterectomy and a frequent cause of severe maternal morbidity and obstetric haemorrhage (3). Placenta previa is present in approximately 80 percent of cases of placenta accreta. Placenta accreta has also been linked to other types of uterine surgery, such as myomectomy, uterine curettage, hysteroscopic surgery, prior endometrial ablation, uterine embolisation, and pelvic irradiation (1). Elective caesarean delivery is recommended for conditions such as major placenta previa and caesarean hysterectomy, even though leaving the placenta in-situ is advised for placenta accreta. For patients with placenta accreta who still wish to maintain fertility, an alternative option is the manual removal of the placenta by resection of the infected area, along with conservative management of leaving the placenta in-situ. A multidisciplinary approach may improve patient outcomes. Kumar R et al., also recommend that a multidisciplinary team approach under general anaesthesia is essential for such complicated procedures (4).
In the cardiac catheterisation laboratory (Cath lab), the interventional radiologist performs a technique known as bilateral internal iliac artery blockage. To protect the foetus from radiation exposure, a lead shield is placed over the parturient before the bilateral femoral arteries are punctured under local anaesthesia, and balloon-tipped catheters are inserted into the bilateral internal iliac arteries under limited fluoroscopic guidance (5). The parturient is then anaesthetised in the operating theatre. General anaesthesia is the preferred mode of anaesthesia due to concerns about haemodynamic instability and the potential need for massive transfusions (6).
The balloons are inflated manually once the obstetrician clamps the umbilical cord during a lower segment caesarean section. This intervention decreases the pulse pressure, thereby significantly reducing uterine blood supply, which leads to decreased blood loss during the caesarean section, shorter surgical time, and an overall reduced stay in the intensive care unit and hospital. In several situations, an obstetric hysterectomy can also be avoided if the placental tissue is completely removed from the uterus. Foetal blood flow is not affected, as the balloons are inflated only after the umbilical cord has been clamped (7).
Similar to the present case, according to Tan CH et al., patients with placenta accreta and its variations undergoing caesarean delivery may require fewer transfusions and experience less intraoperative blood loss when internal iliac artery occlusion balloons are used during the procedure. This is a safe and minimally invasive approach. There is no discernible increase in the length of hospitalisation or intensive care unit stay linked to this operation, only a shorter caesarean surgery time. In addition, compared to intraoperative endovascular embolisation procedures, it results in shorter fluoroscopy periods and lower radiation exposure to the foetus (8). However, Savukyne E et al., reported that the use of intermittent balloon occlusion catheters in patients with placental pathology is a safe method but does not significantly reduce intraoperative blood loss during caesarean delivery (9). Ahmed HA et al., also found no statistical difference in blood loss or the need for other measures to control haemorrhage between women with and without internal iliac artery balloon occlusion catheters (10).
Tan YL et al., presented data concerning 13 parturients whose diagnosis of placenta accreta was validated by colour Doppler, ultrasonography, and, when necessary, magnetic resonance imaging. They recommended that preventive internal iliac artery balloon occlusion be used as an adjuvant in cases of aberrant placentation in current clinical practice because it significantly reduces the amount of blood lost and transfusions needed (11). Gulino FA et al., reported on 37 cases of placenta accreta, of which 16 were in a balloon group and 21 were in a non balloon group. The balloon group experienced lower rates of bleeding, reduced blood transfusion volume, and fewer hysterectomies than the non-balloon group (12). Additionally, Carnevale FC et al., found that preventive internal iliac artery balloon occlusion is a safe method to lower bleeding and blood transfusion rates in patients with placenta accreta following caesarean section (13).
Balloon occlusion of the internal iliac artery is effective for haemostasis in most cases of patients with placenta previa undergoing caesarean section under general anaesthesia and may even prevent hysterectomy and excessive perioperative blood loss.
DOI: 10.7860/JCDR/2024/71424.19765
Date of Submission: Apr 28, 2024
Date of Peer Review: Jun 17, 2024
Date of Acceptance: Jul 08, 2024
Date of Publishing: Aug 01, 2024
AUTHOR DECLARATION:
• 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. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Apr 28, 2024
• Manual Googling: Jun 19, 2024
• iThenticate Software: Jul 06, 2024 (18%)
ETYMOLOGY: Author Origin
EMENDATIONS: 6
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
- Index Copernicus ICV 2017: 134.54
- Academic Search Complete Database
- Directory of Open Access Journals (DOAJ)
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- Google Scholar
- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
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- Popline (reproductive health literature)
- www.omnimedicalsearch.com