Reviewer’s report
Title: Development and Internal Validation of a Nomogram for Preoperative Prediction of
Surgical Treatment Effect on Cesarean Section Diverticulum
Version: 0 Date: 01 Feb 2019
Reviewer: Dazhi Fan
Reviewer's report:
This paper presents a retrospective cohort study to develop and validate an individualized score based  
on  preoperative  parameters  to  predict  patient  outcomes  after  vaginal  repair  of  cesarean  section  
diverticulum. The authors conclude that the cesarean section diverticulum score can accurately predict  
the outcomes of cesarean section diverticulum and can be useful for counseling patients who are  
making treatment decisions.
Overall the topic addressed should be interest to most readers of BMC Pregnancy and Childbirth and  
has certain clinical significance. However, I have several concerns about the paper, as given below:
(1) There are many mistakes about the references in the whole manuscript that shouldn't have been  
made.
For example, 
a. reference 1 was misquoted in the first sentence (line69-70) in the background part. Please select the  
appropriate literature to support this argument.
b. Reference number appears confused, such as, ref 28, ref 29 (line 75), ref 27 (line 27), ref 23, 30 (line  
97), and so on, please re-check them.
c. the sentences in line 87-89 and line 148-149 should add references.
(2) There is something wrong with the common sense of statistics, please consulted the epidemiologists  
and health statisticians before revised the manuscript. 
For example,
a. the C-index is 0.718 in the data and the authors think it can accurately predict the outcomes. I think  
this conclusion is too confident. As far as I know, the C-index value is between 0.5 and 1. It is no  
accuracy at all when C-index equal 0.5; 0.50 -0.70 is low accuracy; 0.71-0.90 is medium accuracy, and  
above 0.9 is high accuracy. 0.718 is only of the lowest medium accuracy.
b. In line 158-159, the authors said patient characteristics and preoperative factors were analyzed using  
student's t test. Variables are expressed as the medians with ranges. Are the continuous variables normal  
distribution? If they are normal distribution, they should reported mean and standard deviation; if not,  
they should not use student's t test.
Other comments:
a. line 118-120 and line 122 and 124 are repeat writing, please deleted one of them.
b. line 203-206 is best done in the methods section.
c. line 214-217 is best done in the statistical analysis section.
d.  The  myometrium  changes  with  the  menstrual  cycle,  and  I  want  to  know  whether  the  time  
measurement the remaining muscular layer of the participants is uniform? 
e. Meanwhile, I also want to know the time measurement the white blood cell and fibrinogen, before or  
after the surgery?
f. I don't understand the phrase in bracket in line 26, (Canadian Task Force classification II-2), please  
explain it. 
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
No
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
Yes
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
No
Are you able to assess any statistics in the manuscript or would you recommend an
additional statistical review?
If an additional statistical review is recommended, please specify what aspects require further
assessment in your comments to the editors.
I am able to assess the statistics
Quality of written English
Please indicate the quality of language in the manuscript:
Needs some language corrections before being published
Declaration of competing interests
Please complete a declaration of competing interests, considering the following questions:
1.Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation  that  may  in  any  way  gain  or  lose  financially  from  the  publication  of  this  
manuscript, either now or in the future?
2.Do you hold any stocks or shares in an organisation that may in any way gain or lose
financially from the publication of this manuscript, either now or in the future?
3.Do you hold or are you currently applying for any patents relating to the content of the
manuscript?
4.Have you received reimbursements, fees, funding, or salary from an organization that holds
or has applied for patents relating to the content of the manuscript?
5. Do you have any other financial competing interests?
6.Do you have any non-financial competing interests in relation to this paper?
If you can answer no to all of the above, write 'I declare that I have no competing interests' below.
If your reply is yes to any, please give details below.
I declare that I have no competing interests.
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to the editors, which will not be published.
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