Title: Effect of pelvic position on ultrasonic measurement parameters of pelvic floor in
postpartum women
Version: 3 Date: 07 Jul 2024
Reviewer's report:
GENERAL COMMENTS
Dear Editor,
I read the study with interest. You can find my comments on improving the quality of the study
below. I think it may be appropriate to publish the study after the relevant revisions are made.
ABSTRACT
- It should be stated in the title that the study was conducted on postpartum women.
- If the study was conducted on women in the postpartum period, it should be explained in the
method section.
- Please remove statistical analysis methods in the Result section. For example; chi-square,
ANOVA, Kruskal Wallis test.
- In the Results section, you stated that PFM ultrasound parameters were different between the
three groups. But which group did this difference favor? These significant changes in favor of
posterior pelvic tilt should also be mentioned in the results section.
- "pelvic floor" can be considered as keywords instead of "pelvic organ prolapse".
INTRODUCTION
- In the Introduction section, the semantic integrity between paragraphs is missing.
- Why were the effects of pelvic position on ultrasound parameters examined in women in the
postpartum period? The answer to this question is not clear.
- I could not understand the relevance of this study to pelvic organ prolapse. Please make the
connection between paragraphs clearer.
- What will this change in ultrasound parameters affect in different positions?
- What was your hypothesis in this study?
MATERIAL AND METHOD
- It was stated that general information was given to all participants. On what subject and how
was it given? It should be explained in more detail.
- You specified "who had severe medical or surgical diseases" as the exclusion criterion. This is
not clear. What did you decide on? Did you mean pelvic and abdominal area surgery? Ultrasound
parameters may also change in patients who have undergone non-severe surgery.
- The sentence "This study has been registered…….." in line 123 should be moved under the
ethics approval heading.
- Please revise the author's hospital statement in line 131.
- During the measurements, was the pillow placed under L3 for anterior pelvic tilt and under the
tailbone for posterior pelvic tilt? Elaborate on this.
- How many seconds was the pelvic floor muscle contraction sustained?
- Specify the open form instead of the abbreviation PFMC.
- Was the amount of PFM displacement or PFM muscle thickness also evaluated? Especially
these USG parameters are effective on prolapse in the postpartum period. If it is not evaluated,
it can be considered a limitation of the research.
- What was the study you referenced for the sample size calculation?
- Were your data normally distributed? Was ANOVA or Kruskal Wallis analysis performed?
Was posthoc analysis performed to determine which group caused the difference between
groups?
RESULTS
- You stated that 29 participants were rejected. Why was it rejected? It would be more accurate
to explain this with a flow chart.
- Please remove statistical analysis names in the results section.
- There are too many abbreviations. Hard to understand. Avoid unnecessary abbreviations.
- Instead of constantly stating the difference between groups, indicate which group has a
significant difference in favor.
DISCUSSION
- State the main results of your study in the first paragraph of the Discussion section.
- The expression "posterior pelvic tilt results in greater PFMC ability.." in line 220 is not
understandable. Emphasize your results in a more understandable way.
- As far as I understand, you did not measure PFM activity in your study. However, in the
discussion section, you interpret the change in USG parameters as resulting from PFM activity.
The literature should be examined better. In particular, the results of studies evaluating PFM
ultrasound parameters in different positions should be discussed here.
- The Discussion section, similar to the introduction section, lacks integrity between paragraphs.
You should discuss all the results you found in your study.
- There are results that you attribute to Chinese women's toilet habits in the squat position. Are
there any studies showing that this habit has a high prevalence in the Chinese population? If
there is, it must be stated.
- In the discussion section, you should provide suggestions on how your results can be reflected
in clinical practice.
- You state that you only included women in the postpartum period in the study. However, it is
not clear why this study was conducted on these women.
- The fact that parameters related to PFM function such as PFM displacement amount, PFM
thickness, PFM endurance time, number of PFM fast repetitions have not been examined may
also be among the limitations.
CONCLUSION
- In this section, you should present the main results of your study more clearly and emphatically.
- Give suggestions for future studies.
FIGURES
- There are many figures available. Some of them can be combined into a single figure.
TABLES
- Table 1 title should be changed to "The participants' demographic and obstetric characteristics".
- Please show the units of measurement in parentheses. For example; age (years)
- The group column should be removed in Table 1. A single column should be presented as
Mean±SD or n (%).
- Sub-table explanations are required for all tables. The statistical analysis methods used should
be stated here.
- Write the clear form of the abbreviations CS and VD.
- The rate of vaginal birth appears to be higher. The effect of cesarean birth and vaginal birth on
PFM and prolapse is not similar. Therefore, this may affect your ultrasound results. Why didn't
you just include people who gave birth vaginally?
- Significant p values should be shown in bold. Please provide an explanation of the P/Z value
below the table.
- What do the abbreviations shown as C, V, R in Table 3 mean? Posthoc analysis results can
also be given in this table.