Title: Migrated Intra-Uterine Device to Infra-umbilical skin: A rare Case Report
Version: 1 Date: 17 Oct 2024
Reviewer:  Antonio Bandala-Jacques
Reviewer's report:
Dear authors - I have read your manuscript and offer the following suggesitons:
INTRODUCTION
A) In "Intrauterine device is one of the most effective, relatively safe and long acting reversible
contraceptive (LARC)(1).", it would be better to pluralize the subject to make this a generalizable
fact
B) "The mechanism of Levonorgestrel containing devices for contraception is by thickening of
the cervical mucus there by "
Thereby should be a single word
C) "Complications of IUDs include menstrual disturbance, pain mostly related to Copper "
Chemical elements are not proper nouns,, please adjust capitalization
D) In " increased risk of ectopic pregnancy if method fails and uterine perforation or  transmural
migration and resultant device misplacement(4) (5). "
This is hard to read, please use an Oxford comma and rephrase.
E) "IUD migration and misplacement is very rare complication with one per 1,000 users
reported(6)."
this sentence is missing an article
F) Overall , please review for language, as the sentences and paragraphs don't have a natural flow
G) "Several cases have been reported with the IUDs extracted with in "
within is a single word
H) Please fix capitalization in "any segment of the Gastrointestinal tract(13, 24-26),
Omentum(27), ovary(28), pouch of Douglas(29)  and anterior abdominal wall(30)."
I) This sentence looks incomplete:
"Hysteroscopy as an initial work up helps confirm the absence of intrauterine location of IUDs
once lost strings on physical examination(31). "
once lost strings on physical examination what?
J) "There are Cases reported with robot assisted removal of Misplaced IUDs(35). We present
an unusual case of misplaced IUD under the infra umbilical skin which is to our knowledge on
the current literature not yet reported. "
Please fix capitalization. Also, infraumbilical is a single word
CASE
K) "The patient, a 38 years old para VI mother had regular monthly menstrual cycle. "
This looks like a note from a clinical record. Please rephrase as a complete sentence and spell out.
L) "After 7 weeks of her last delivery she had the IUD inserted 2 years back by the attending
registered professional midwife at the Michu clinic of university of Gondar comprehensive
specialized Hospital but never had follow up visits onwards neither tried to palpate IUD strings. "
This sentence is excessively long. Please edit. Also, what type of IUD?
Instead of mentioning the name of the clinic, I recommend specifying what kind of facility this
is. Is this an urban general hospital? A rural fist-level clinic?
M) "physical examination her vital signs were normal with Blood Pressure 120/75mmHg, Pulse
Rate 74beats per minute, Respiratory Rate 16breaths per minute, and Temperature of 36.6 degree
centigrade. " Please fix spacing and capitalization
N) "On abdominal examination, there was infra umbilical skin discoloration which is dark
and hyperpigmented area measuring 7cm along its longest dimension with one stem of copper
containing IUD visible through skin tract (Figure 1). "
Please fix grammatical issues here
O) "She doesn’t need to have any form of contraceptive by the time she was counseled after
IUD removal and was sent home without any complication."
The change in verb tenses is confusing. Please use past tense when referring to the case
And what do you mean by she doesn't need? Why didn't she need contraception?
DISCUSSION
P) As you do no have a lot of information on the patient, including timing of migration, it seems
like your discussion is mostly repeating your background and does not add significantly to your
manuscript.
Q) What are the implications of your finding? even if you can't find any other such case reports,
there surely are other instances of subcutaneous IUD mutation. I would discuss such cases
(causes and outcomes)