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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 journalsNo manuscriptsNo 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
Role of Maternal Anogenital Distance Measurement in Prediction of Perineal Tears during Vaginal Delivery: A Prospective Cohort Study
Correspondence Address :
Karishma Singh,
Plot No 31, Pocket 1, Sector 7, Ramprastha Greens Vaishali, Ghaziabad-201010, Uttar Pradesh, India.
E-mail: singhkarishma24@gmail.com
Introduction: Almost 85% of women suffer from perineal trauma during vaginal birth, which can have long-term consequences. Anogenital Distance (AGD) is a novel and useful parameter for predicting perineal tears during vaginal delivery.
Aim: To determine the accuracy and cut-off values of AGD in predicting ≥2nd degree perineal tears.
Materials and Methods: A prospective cohort study was conducted in the Department of Obstetrics and Gynaecology at GTB Hospital, New Delhi, India, from January 2021 to April 2022, including 80 patients in group 1 and 80 in group 2. Group 1 consisted of patients who experienced ≥2nd degree perineal tears during vaginal delivery, while group 2 included patients with an intact perineum or up to 1st degree tears. Anthropometric data such as Anus to Clitoris Distance (AGDac) and Anus to Fourchette Distance (AGDaf) (anus to fourchette distance), as well as labour parameters like foetal position, duration of the second stage, induction of labour and birth weight, were noted. Receiver Operating Curves (ROC) were plotted to obtain cut-off values for AGDac and AGDaf in predicting ≥2nd degree perineal tears. Unpaired t-tests and Chi-square tests were used to compare quantitative and qualitative parameters, respectively.
Results: The mean AGDac (75.99 vs. 77.05) and AGDaf (33.50 vs. 34.52) were lower in group 1 compared to group 2. AGDaf (75%) showed better sensitivity for predicting ≥2nd degree perineal tears and anal sphincter injury compared to AGDac (60%). The specificity of AGDaf (55%) was better for predicting ≥2nd degree perineal tears, while AGDac (51%) was more specific for sphincter injury. Foetal head position (p=0.016) and birth weight (p=0.002) were identified as the strongest risk factors for tears. Group 1 patients reported more bowel (25% vs. 10%) and prolapse symptoms (11.5% vs. 3.75%) compared to group 2 patients at six weeks postpartum.
Conclusion: Perineal length, as measured antenatally by AGD (both AGDac and AGDaf), is useful in predicting the occurrence of perineal tears during vaginal delivery. If found to be short, obstetricians can exercise greater caution during delivery, potentially reducing the incidence of anal sphincter injuries and their long-term consequences.
Anus to clitoris, Anus to fourchette, Anal sphincter, Episiotomy
Almost 85% of women experience some form of perineal trauma during vaginal birth, with the incidence of anal sphincter injury ranging from 0.5% to 7% (1). Perineal tears can lead to significant postpartum complications, both short-term and long-term, including psychological effects. Short-term complications may include pain, discomfort, increased blood loss, haematoma and infections. Long-term complications can involve chronic infections, urinary, faecal and flatus incontinence, sexual dysfunction and pelvic organ prolapse (2). Risk factors for perineal tears include Asian ethnicity, nulliparity, occiput-posterior position, shoulder dystocia, prolonged second stage of labour, instrumental delivery and higher birth weight (3). A short perineal length of less than 35 mm has been associated with an increased risk of perineal tears (4).
Perineal tears are classified as follows (Table/Fig 1) (5): The AGD is an emerging anthropometric parameter and serves as a marker of genital development in humans, typically observed between 8 to 14 weeks of gestation (6). It reflects the hormonal environment surrounding the foetus during prenatal life. AGD exhibits sexual dimorphism, being 2 to 3 times longer in males than in females due to higher androgen levels (7). Studies have indicated an association between AGD and hormone-dependent conditions in females, such as endometriosis, Polycystic Ovary Syndrome (PCOS) and pelvic organ prolapse (8),(9). A short perineum has been correlated with an increased risk of perineal trauma, episiotomy and long-term pelvic organ prolapse (10),(11),(12). The current study aimed to assess the accuracy of AGD in predicting perineal tears during vaginal delivery. The secondary objectives are to determine the risk factors for perineal tears and to evaluate the Pelvic Floor Distress Inventory (PFDI) and pelvic floor muscle strength at six weeks postpartum.
A prospective cohort study was conducted in the Department of Obstetrics and Gynaecology at GTB Hospital, New Delhi, India, from January 2021 to April 2022. Ethical clearance was obtained from the Institutional Ethical Committee for human research (IECHR/2020/PG/47/42) and informed consent was obtained from the subjects.
After an extensive search, the authors found one study that was indirectly related, which provided a guiding number for the sample size (11).
Inclusion and Exclusion criteria: Primigravida patients with singleton pregnancies at ≥37 weeks in early labour were included in the study, while those with a history of pelvic floor trauma/surgery, instrumental delivery and malpresentation were excluded. Group 1 patients were defined as females sustaining ≥2nd degree perineal tears (including episiotomy, n=80), while group 2 patients were females with an intact perineum or sustaining up to 1st-degree perineal tears post-vaginal delivery (n=80).
Study Procedure
Anthropometric data such as AGDac (anus to clitoris) and AGDaf (anus to fourchette), along with labour parameters like foetal position, duration of the second stage, induction of labour and birth weight, were noted. AGD measurements were taken using digital vernier callipers by the same observer between contractions, with patients in the lithotomy position and thighs at an angle of 45 degrees to the examination table (Table/Fig 2). Each measurement was taken three times and the average for each AGD was calculated. The recruitment strategy has been summarised in the flowchart (Table/Fig 3).
Follow-up of the subjects was conducted at 6 weeks postpartum in the postnatal clinic, where the PFDI and pelvic floor muscle strength testing were performed to assess pelvic floor function. Of the 20 questions in the PFDI-20 form, each question had "yes" 7or "no" as potential answers. A "no" response corresponded to a score of "0." If the patient answered "yes," the response was based on an ordinal range from "1" to "4" in terms of bother and severity of symptoms (13).
For pelvic floor muscle strength testing, the examination was carried out after the patient emptied their bladder in a dorsal lithotomy position with knees semi-flexed. Patients were requested to contract the muscles of the pelvic floor and their responses were graded from 0 to 5 according to a validated Oxford scale (14).
Statistical Analysis
Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 22.0. The receiver operating characteristic curve was plotted to calculate the optimum cut-off values for AGD (AGDac and AGDaf). All continuous and categorical parameters were compared using an unpaired t-test and Chi-square test, respectively. Logistic regression analysis was conducted to identify the risk factors for the likelihood of perineal tears. A p-value of less than 0.05 was considered significant.
Demographic characteristics such as age, socioeconomic status, religion, education and Basic Metabolic Index (BMI) (kg/m²) were comparable in group 1 and group 2 (Table/Fig 4). The mean AGDac was shorter in group 1 compared to group 2, which was statistically significant (p-value of 0.029). Group 1 had a significantly shorter AGDaf compared to group 2 (p<0.001) (Table/Fig 5). Second-degree perineal tears, including episiotomies, were the most common perineal outcomes, accounting for 86.25%, followed by Obstetric Anal Sphincter Injuries (OASIS) at 8.75% and cervical or paraurethral tears at 3.75% (Table/Fig 6).
The left occiput anterior foetal head position and baby birth weight were significantly associated with the occurrence of second-degree or higher perineal tears (p=0.016 and p=0.002) (Table/Fig 7). Cut-off values obtained from the receiver operating curve (Table/Fig 8) for AGDac and AGDaf were 77.05 mm and 33.75 mm for predicting the occurrence of second-degree or higher perineal tears. However, AGDaf had better sensitivity (75%) and specificity (55%) for predicting these tears compared to AGDac (Table/Fig 9). The cut-off values obtained from the receiver operating curve (Table/Fig 10) for AGDac and AGDaf were 77.15 mm and 33.25 mm for predicting OASIS. AGDac exhibited better specificity (51%), while AGDaf demonstrated better sensitivity (71.4%) for predicting OASIS (Table/Fig 11).
At six weeks, patients in group 1 reported more bowel symptoms and symptoms pertaining to prolapse compared to group 2, while urinary symptoms were comparable in both groups, with no statistically significant difference found using the PFDI-20 (Table/Fig 12). Pelvic floor muscle strength, assessed by Oxford grading, was found to be comparable in both groups.
The mean AGDac was lower in group 1 and higher in group 2 (75.99±3.43 mm vs. 77.05±2.62 mm, p=0.029). The mean AGDaf was also lower in group 1 and higher in group 2 (33.50±1.65 mm vs. 34.52±1.25 mm, p<0.001). Moya-Jiménez LC et al., conducted an observational prospective cohort study to compare perineal measurements {gh+pb, as per the Pelvic Organ Prolapse Quantification system (POP-Q)} and AGD to determine which perineal measurement can predict the likelihood of episiotomy. The gh+pb measurement was 77 mm in the episiotomy group and 81.9 mm in the no-episiotomy group, while its counterpart AGDac was 93.1±9.4 mm in the episiotomy group and 97.8±10.2 mm in the no-episiotomy group (11).
In the study conducted by Moya-Jiménez LC et al., the AGDaf was 35.9±6.9 mm and 34.9±7.4 mm in the episiotomy and no-episiotomy groups, respectively. They found that shorter lengths of gh+pb and AGDac were risk factors for episiotomy, which were comparable to the current study’s results.
Additionally, AGDac was found to be a more specific predictor of OASIS, while AGDaf was identified as a better predictor of ≥2nd-degree perineal tears and episiotomy (11). These results were consistent with the current study.
A study conducted by Lane TL et al., assessed the relationship between perineal body length and perineal lacerations (4). The mean perineal body length was 37±0.5 mm and the study concluded that a perineal body length of ≤35 mm was predictive of 3rd or 4th-degree lacerations. Geller EJ et al., conducted a study to determine whether a shortened perineal body is a risk factor for ultrasound-detected anal sphincter tears at first delivery and concluded that a perineal body length of <3 cm was associated with a significantly higher rate of tears (15).
The mean birth weight in group 1 was 2.7 kg and 2.5 kg in group 2 (p=0.002), which was statistically significant, suggesting it is significantly associated with the occurrence of second-degree or higher perineal tears. The study conducted by Marschalek ML et al., also found that birth weight was significantly associated with a high likelihood of perineal tears, similar to the results of the present study (3). AGD is an emerging and lesser-explored area in obstetrics and Gynaecology. More studies should be conducted to fully understand its implications. Further studies are needed to validate these findings on a larger scale.
Limitation(s)
Only primiparous women were included, so the results cannot be generalised to multiparous women. Additionally, since this was a single-centre study, the findings cannot be generalised to the entire population.
The shorter Anus to Fourchette Distance (AGDaf) has been found to have good sensitivity for predicting second-degree or higher perineal tears. In predicting Obstetric Anal Sphincter injury specifically, AGDaf demonstrated better sensitivity than the Anus to Clitoris Distance (AGDac); however, its specificity was lower than that of AGDac. Measuring AGD with vernier callipers in obstetric patients is simple and can be performed easily. If AGD is found to be short, along with the presence of risk factors for perineal tears, the obstetrician conducting the delivery can take more precautions. This can help reduce the occurrence of obstetric anal sphincter injuries and their long-term consequences.
Declaration: The present article is published as Abstract 181- Role of Maternal Anogenital Distance Measurement in Prediction of Perineal Tears during Vaginal Delivery, Continence, Volume 7, Supplement 1, 2023, 100899, ISSN 2772-9737. htt://doi. org/10.1016/j.cont.2023.100899
Author contributions: KS- Data collection, data analysis, manuscript preparation; SJ- Protocol development, data collection, manuscript preparation; RA- Data collection, data analysis; BPData collection, data analysis.
The first author is deeply grateful to his Supervisor Dr. Sandhya Jain, Professor, Department of Obstetrics and Gynaecology, UCMS and GTB hospital, under whose able and expert guidance; she has been able to complete this dissertation and feels overwhelmed to express sincerest regards to her parents. Their constant love, sacrifices and prayers have been instrumental in her achievements.
DOI: 10.7860/JCDR/2024/73912.20293
Date of Submission: Jul 07, 2024
Date of Peer Review: Aug 08, 2024
Date of Acceptance: Oct 08, 2024
Date of Publishing: Nov 01, 2024
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. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jul 09, 2024
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• iThenticate Software: Oct 07, 2024 (14%)
ETYMOLOGY: Author Origin
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