AUCTORES
Globalize your Research
Research Article | DOI: https://doi.org/10.31579/2578-8965/238
1Department of Obstetrics and Gynaecology, Abia State University, Uturu, Nigeria
2Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Rivers State, Nigeria
3Department of Medical Laboratory Science, Babcock University, Ilishan. Ogun State, Nigeria
4Department of Physiology, Abia State University, Uturu, Nigeria
5Department of Surgery, Abia State University, Uturu, Nigeria
6Department of Biochemistry, Lead City University, Ibadan, Oyo State, Nigeria
*Corresponding Author: Augustine I. Airaodion, Department of Biochemistry, Lead City University, Ibadan, Oyo State, Nigeria.
Citation: C. O. Onyemereze, F. C. Alumona, O. O. Adesina, K. K. Mba, A. I. Airaodion, et al, (2024), Assessment of Risk Factors Associated with Placenta Previa in a Tertiary Health Institution in Southeast Nigeria, J. Obstetrics Gynecology and Reproductive Sciences, 8(7) DOI:10.31579/2578-8965/238
Copyright: © 2024, Augustine I. Airaodion. This is an open-access article distributed under the terms of The Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 23 September 2024 | Accepted: 01 October 2024 | Published: 08 October 2024
Keywords: Placenta previa; risk factors; pregnancy complications; cesarean section; multiple pregnancies; maternal health
Background: Placenta previa is a significant obstetric complication that can lead to adverse maternal and fetal outcomes. Understanding its risk factors is crucial for early diagnosis and management, particularly in healthcare settings in Nigeria.
Objective: To assess the risk factors associated with placenta previa among pregnant women in a tertiary health institution in Southeast Nigeria.
Materials and Methods: This prospective descriptive study was conducted over two years (January 2021 to December 2022) and included all pregnant women who delivered in the institution during this period. Data were collected using a structured, interviewer-administered questionnaire after obtaining informed consent from participants. Placenta previa was identified through abdominal ultrasonography, and all confirmed cases were managed according to the MacAfee regimen. Descriptive statistics and chi-square tests were used to analyze the data using SPSS version 26.
Results: Out of the 8,766 deliveries recorded in the hospital during the period of this study, 94 (1.07%) were diagnosed with placenta previa. Significant associations were found between placenta previa and factors such as advanced maternal age (≥40 years, p=0.041), history of complications during previous pregnancies (p=0.039), previous cesarean section (p=0.009), history of placenta previa (p<0.001), multiple pregnancies (p=0.001), bleeding during pregnancy (p<0.001), and uterine surgeries apart from cesarean sections (p=0.001). Smoking history was also a significant risk factor (p<0.001).
Conclusion: The study identified several risk factors for placenta previa, including advanced maternal age, previous cesarean section, history of placenta previa, multiple pregnancies, uterine surgeries, and smoking. These findings highlight the importance of targeted interventions and close monitoring of at-risk pregnant women to reduce complications.
Placenta previa, a significant obstetric complication, remains one of the leading causes of maternal morbidity and mortality worldwide. This condition is characterized by the placenta's abnormal implantation in the lower uterine segment, often resulting in painless vaginal bleeding in the second or third trimester of pregnancy [1]. It poses significant risks not only to the pregnant woman but also to the fetus, necessitating urgent medical intervention and often leading to preterm delivery or cesarean section [2].
The prevalence of placenta previa varies globally, with higher rates reported in developing countries due to differences in maternal healthcare access, socioeconomic factors, and varying degrees of awareness regarding prenatal care [3]. In Nigeria, particularly in the Southeast region, placenta previa remains a significant contributor to maternal and perinatal morbidity and mortality [4]. The region's unique demographic and cultural characteristics further compound the challenge of managing this condition effectively.
Several risk factors have been identified for placenta previa, including advanced maternal age, multiparity, history of cesarean delivery, and previous uterine surgeries, among others [5]. Advanced maternal age, particularly women over 35, has been linked to an increased risk due to degenerative changes in the uterine vasculature, which may affect placental implantation [6]. Multiparity has also been shown to be a significant risk factor, as repeated pregnancies can lead to uterine scarring and changes that predispose women to abnormal placental implantation [7].
Another crucial factor is the history of cesarean sections and uterine surgeries. Studies have demonstrated that the risk of placenta previa increases with each subsequent cesarean section due to the development of scar tissue, which may alter the normal placental implantation process [8]. This is particularly concerning in regions where cesarean delivery rates are rising, leading to an increased burden of placenta previa [9].
Lifestyle and environmental factors, such as smoking and exposure to secondhand smoke, have also been associated with placenta previa, with nicotine affecting placental development and function [10]. Additionally, multiple pregnancies, closely spaced pregnancies, and infertility treatments have been highlighted as contributing factors [11].
Despite the recognition of these risk factors, there is still limited data on the incidence and specific risk factors associated with placenta previa in Southeast Nigeria. Understanding these factors is critical for developing targeted preventive strategies and improving maternal and neonatal outcomes. The lack of comprehensive studies in this region underscores the need for research that focuses on identifying and assessing the risk factors specific to this population, as cultural, socioeconomic, and healthcare-related factors can significantly influence the incidence and management of placenta previa [12].
This study aims to fill the gap in knowledge by assessing the risk factors associated with placenta previa in a tertiary health institution in Southeast Nigeria. The findings will be instrumental in informing healthcare policies and developing intervention strategies to reduce the incidence and complications associated with placenta previa in the region.
This prospective descriptive study was carried out for two years, from January 2021 to December 2022. All pregnant women who delivered their children during the period of this study were enrolled in this study. Data were collected using a structured, interviewer-administered questionnaire. Participants were assured of the confidentiality of their responses, and data was anonymized to protect their identity. Informed consent was obtained from all participants, and they were informed of their right to withdraw from the study at any time without any consequences to their medical care.
Placenta praevia was identified via abdominal ultrasonography, revealing the placenta situated in the lower uterine section, with its lowest edge positioned beneath the dome of a distended urinary bladder. All preterm diagnoses of placenta previa were admitted and handled according to the MacAfee regimen (expectant management), with interventions implemented only at term or in the event of complications. Immediate delivery was performed in symptomatic instances endangering mother or foetal life, regardless of gestational age, as well as in cases presenting at term. In this hospital, Caesarean sections were routinely performed for all instances of placenta praevia, with the diagnosis confirmed intraoperatively. The collected data was analyzed using the Statistical Package for Social Sciences (SPSS) version 26. Descriptive statistics such as frequencies and percentages were used to summarise the demographic characteristics and obstetrics and gynaecology history. The proportion of women diagnosed with placenta previa was calculated for prevalence assessment. Chi-square tests were used to determine associations between categorical variables such as age, parity, etc. with the prevalence of placenta previa.
During the period of this study, a total of 8766 deliveries were recorded in this hospital. Most of them were aged 30-39 years (38.71%), with a significant number having attained secondary education (60.54%). Most respondents were married (99.14%), employed in the public sector (45.13%), and resided in urban areas (80.54%) (Table 1).
The majority had been pregnant 2-3 times (63.79%), with 36.38% having one delivery (parity). Previous pregnancy complications were reported by 8.16%, with premature birth being the most common complication (57.06%). Cesarean sections were reported by 34.33%, and a small proportion (0.44%) had a history of placenta previa, mostly diagnosed in the third trimester (71.79%) (Table 2). Regular antenatal care attendance was high (90.88%), with most participants satisfied with the information provided (42.43%). Only 11.34% reported challenges in accessing antenatal care (Table 3).
Only 1.07% of the women experienced placenta previa, indicating a relatively low occurrence (Figure 1). Most participants were non-smokers (96.55%), did not consume alcohol (93.82%), and did not have a history of hypertension (96.22%) (Figures 2-4). Significant associations were found with factors like age (p = 0.041), parity (p = 0.005), history of pregnancy complications (p = 0.039), cesarean section (p = 0.009), history of placenta previa (p = 0.000), multiple pregnancies (p = 0.001), bleeding during pregnancy (p = 0.000), uterine surgery (p = 0.001), smoking status (p = 0.000), and fibroid diagnosis (p = 0.011).
| Socio-Demographic Information | Frequency (n = 8766) | Percentage (%) |
| Age (in Years) | ||
| Below 20 | 362 | 4.13 |
| 20-29 | 2896 | 33.04 |
| 30-39 | 3393 | 38.71 |
| 40 and above | 2115 | 24.13 |
| Educational Level | ||
| No formal Education | 18 | 0.21 |
| Primary Education | 126 | 1.44 |
| Secondary Education | 5307 | 60.54 |
| Tertiary Education | 3315 | 37.82 |
| Marital Status | ||
| Single | 31 | 0.35 |
| Married | 8691 | 99.14 |
| Divorced/Widowed | 44 | 0.50 |
| Employment Status | ||
| Unemployed | 334 | 3.81 |
| Self-employed | 2495 | 28.46 |
| Private sector employee | 1854 | 21.15 |
| Public sector employee | 3956 | 45.13 |
| Student | 127 | 1.45 |
| Residence | ||
| Rural | 1706 | 19.46 |
| Urban | 7060 | 80.54 |
Table 1: Socio-Demographic Information of Participants
| Variable | Frequency (n = 8766) | Percentage (%) |
| How many times have you been pregnant including this present one (Gravida)? | ||
| 1 | 1893 | 21.59 |
| 2-3 | 5592 | 63.79 |
| 4-5 | 834 | 9.51 |
| More than 5 | 447 | 5.10 |
| How many deliveries have you had (Parity)? | ||
| None | 1912 | 21.81 |
| 1 | 3189 | 36.38 |
| 2-3 | 3127 | 35.67 |
| 4 or more | 538 | 6.14 |
| Did you experience any complications during previous pregnancies? | ||
| Yes | 715 | 8.16 |
| No | 6158 | 70.25 |
| Not Applicable | 1893 | 21.20 |
| If yes, please specify | ||
| Pre-eclampsia | 217 | 30.35 |
| Placenta previa | 11 | 1.54 |
| Premature birth | 408 | 57.06 |
| Others | 79 | 11.04 |
| Have you ever had a Cesarean section? | ||
| Yes | 3009 | 34.33 |
| No | 5757 | 65.67 |
| If yes, how many times? | ||
| 1 | 1674 | 55.63 |
| 2-3 | 1324 | 44.00 |
| More than 3 | 11 | 0.37 |
| Have you had any previous miscarriages? | ||
| Yes | 811 | 9.25 |
| No | 7955 | 90.75 |
| Do you have a history of placenta previa in previous pregnancies? | ||
| Yes | 39 | 0.44 |
| No | 8727 | 99.56 |
| At what gestational age were you diagnosed with placenta previa (if applicable)? | ||
| First trimester | 00 | 0.00 |
| Second trimester | 11 | 28.21 |
| Third trimester | 28 | 71.79 |
| Have you ever had multiple pregnancies (twins, triplets, etc.)? | ||
| Yes | 1719 | 19.61 |
| No | 7047 | 80.39 |
| Have you experienced any bleeding during this pregnancy? | ||
| Yes | 683 | 7.79 |
| No | 8083 | 92.21 |
| Do you have a history of diabetes (gestational or otherwise)? | ||
| Yes | 561 | 6.40 |
| No | 8205 | 93.60 |
| Have you ever been diagnosed with fibroids? | ||
| Yes | 1105 | 12.57 |
| No | 7661 | 87.39 |
| Have you ever had uterine surgery apart from C-sections? | ||
| Yes | 1111 | 12.67 |
| No | 7655 | 87.33 |
| Have you ever used assisted reproductive technology (e.g., IVF)? | ||
| Yes | 985 | 11.24 |
| No | 7781 | 88.76 |
| Do you have a history of anemia during pregnancy? | ||
| Yes | 1008 | 11.50 |
| No | 7758 | 88.50 |
Table 2: Obstetric and Gynecological History of Participants
Figure 1: Occurrence of Placenta Previa
Figure 2: Smoking of Tobacco
Figure 3: Consumption of Alcohol
Figure 4: History of Hypertension
| Variable | Frequency | Percentage (%) |
| How often do you attend antenatal care services during pregnancy? | ||
| Regularly (as recommended) | 7967 | 90.88 |
| Occasionally | 709 | 8.09 |
| Rarely | 90 | 1.03 |
| How satisfied are you with the information and care provided by healthcare professionals regarding pregnancy complications, including placenta previa? | ||
| Very satisfied | 2654 | 30.27 |
| Satisfied | 3719 | 42.43 |
| Neutral | 1696 | 19.35 |
| Dissatisfied | 444 | 5.07 |
| Very dissatisfied | 253 | 2.89 |
| Have you ever faced challenges in accessing antenatal care or ultrasound scans during pregnancy? | ||
| Yes | 994 | 11.34 |
| No | 7772 | 88.66 |
Table 3: Healthcare Services and Accessibility
| Risk Factors | Occurrence of Placenta Previa | p-value | |
With Placenta Previa (n = 94) | Without Placenta Previa (n = 8672) | ||
| Age (in Years) | 0.041* | ||
| Below 20 | 00 (0.00%) | 362 (100.00%) | |
| 20-29 | 00 (0.00%) | 2896 (100.00%) | |
| 30-39 | 21 (0.62%) | 3372 (99.38%) | |
| 40 and above | 73 (3.45%) | 2042 (96.54%) | |
| How many times have you been pregnant including this present one (Gravida)? | 0.216 | ||
| 1 | 22 (1.16%) | 1871 (98.84%) | |
| 2-3 | 32 (0.57%) | 5560 (99.43%) | |
| 4-5 | 20 (2.40%) | 814 (97.60%) | |
| More than 5 | 20 (4.47%) | 427 (95.53%) | |
| How many deliveries have you had (Parity)? | 0.005* | ||
| None | 00 (0.00%) | 1912 (100.00%) | |
| 1 | 00 (0.00%) | 3189 (100.00%) | |
| 2-3 | 37 (1.18%) | 3090 (98.82%) | |
| 4 or more | 57 (10.59%) | 481 (89.41%) | |
| Did you experience any complications during previous pregnancies? | 0.039* | ||
| Yes | 33 (4.62%) | 682 (95.38%) | |
| No | 61 (0.99%) | 6097 (99.01%) | |
| Not Applicable | 00 (0.00%) | 1893 (100.00%) | |
| Have you ever had a Cesarean section? | 0.009* | ||
| Yes | 89 (2.96%) | 2920 (97.04%) | |
| No | 5 (0.09%) | 5752 (99.91%) | |
| Have you had any previous miscarriages? | 0.062 | ||
| Yes | 2 (0.25%) | 809 (99.75%) | |
| No | 92 (1.16%) | 7863 (98.84%) | |
| Do you have a history of placenta previa in previous pregnancies? | 0.000* | ||
| Yes | 39 (100.00%) | 00 (0.00%) | |
| No | 55 (0.63%) | 8672 (99.37%) | |
| Have you ever had multiple pregnancies (twins, triplets, etc.)? | 0.001* | ||
| Yes | 91 (5.29%) | 1628 (94.71%) | |
| No | 3 (0.04%) | 7044 (99.96%) | |
| Have you experienced any bleeding during this pregnancy? | 0.000* | ||
| Yes | 69 (10.10%) | 614 (89.90%) | |
| No | 25 (0.31%) | 8058 (99.69%) | |
| Have you ever had uterine surgery apart from Cesarean sections? | 0.001* | ||
| Yes | 74 (6.67%) | 1037 (93.33%) | |
| No | 20 (0.26%) | 7635 (99.74%) | |
| Have you ever used assisted reproductive technology (e.g., IVF)? | 0.511 | ||
| Yes | 15 (1.52%) | 966 (98.07%) | |
| No | 79 (1.01%) | 7702 (98.93%) | |
| Do you smoke or have you ever smoked? | 0.000* | ||
| Current Smokers | 62 (70.45%) | 26 (29.55%) | |
| Never smoked | 00 (0.00%) | 8464 (100.00%) | |
| Former smoker | 32 (14.95%) | 182 (85.05%) | |
| Do you consume alcohol? | 0.614 | ||
| Yes | 7 (1.29%) | 535 (98.71%) | |
| No | 87 (1.06%) | 8137 (98.94%) | |
| Do you have a history of hypertension? | 0.594 | ||
| Yes | 4 (1.21%) | 327 (98.79%) | |
| No | 90 (1.07%) | 8345 (98.93%) | |
| Have you ever been diagnosed with fibroids? | 0.011* | ||
| Yes | 66 (5.97%) | 1039 (94.03%) | |
| No | 28 (0.37%) | 7633 (99.63%) | |
Table 4: Risk Factors associated with Placenta Previa
This study assessed the risk factors associated with placenta previa among pregnant women attending a tertiary health institution in Southeast Nigeria. The majority of participants (38.71%) were aged 30–39 years, with only 4.13% being below 20 years. Notably, the occurrence of placenta previa was significantly higher in women aged 40 and above (3.45%) compared to other age groups (p = 0.041). This aligns with the findings of Srisupundit et al. [13], who reported that advanced maternal age is a significant risk factor for placenta previa. The higher risk among older women could be attributed to increased parity and uterine scarring from previous pregnancies [14].
In terms of educational level, a majority (60.54%) had secondary education, and 37.82% had tertiary education. However, there was no significant association between education level and placenta previa occurrence. Similarly, marital status did not show any substantial link with placenta previa, as nearly all participants (99.14%) were married. This finding differs from previous research by Sekiguchi et al. [15], which found that single women were more likely to experience placenta previa. This variation could be due to cultural differences and the predominance of married women in this study population.
The study revealed that multiparity (having 4 or more deliveries) was a significant risk factor for placenta previa (p = 0.005), with a prevalence of 10.59% among women with 4 or more deliveries. This finding aligns with the results of Adekanle and Adeyemi [16], who indicated that multiparity is a strong predictor of placenta previa. The higher risk could be due to repeated stretching and scarring of the uterine lining, which may predispose women to abnormal placental attachment [17].
A history of previous cesarean sections was another significant risk factor, as women with prior C-sections had a 2.96% occurrence of placenta previa (p = 0.009). This result supports the findings of Silver [18], who reported a strong association between cesarean deliveries and subsequent placenta previa due to scar formation in the uterus. Additionally, the study found that a history of placenta previa in previous pregnancies was a strong predictor of recurrence, with 100% of those with a previous history experiencing it again (p = 0.000). This is consistent with the study by Cunningham et al. [19], which indicated that women with a history of placenta previa have a tenfold increased risk of recurrence.
The occurrence of placenta previa was also significantly associated with multiple pregnancies (p = 0.001), as 5.29% of women with twins or triplets experienced placenta previa. This finding corresponds with the research of Jauniaux et al. [20], who noted that multiple gestations are linked to an increased risk of placenta previa, possibly due to an increased placental surface area required to support the pregnancy.
The study found that smoking was significantly associated with placenta previa (p = 0.000), with 70.45% of current smokers experiencing placenta previa. This aligns with the findings of Salihu et al. [21], who established that smoking increases the risk of placenta previa by up to fourfold, likely due to the vasoconstrictive effects of nicotine, which can affect placental implantation.
A history of fibroids was another significant risk factor, with 5.97% of women with fibroids experiencing placenta previa (p = 0.011). This finding is consistent with the study by Masukume et al. [22], which demonstrated that fibroids could interfere with normal placental implantation, leading to an increased risk of placenta previa.
In contrast, factors such as alcohol consumption and hypertension were not significantly associated with placenta previa in this study, which differs from some previous studies [23]. The lack of a significant association in this population might be due to the lower prevalence of these conditions among the study participants.
The majority of participants (90.88%) regularly attended antenatal care services, which is encouraging. However, the occurrence of placenta previa among women who attended antenatal care regularly suggests that early detection and management strategies should be enhanced. This finding is in line with the study by Fausett and Saade [24], which emphasized the importance of regular antenatal care in reducing the complications associated with placenta previa.
This study identified advanced maternal age, multiparity, previous cesarean sections, history of placenta previa, multiple pregnancies, smoking, and fibroids as significant risk factors for placenta previa. These findings are consistent with many previous studies, though some differences were observed, possibly due to variations in population characteristics and healthcare practices. Early detection and targeted interventions for high-risk women could help reduce the incidence and complications associated with placenta previa in Southeast Nigeria.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
