Reviewer’s report
Title: 
The implementation of routine procedural transvaginal sonography to
decrease retained products of conception: A quality improvement initiative
Version: 
0 
Date: 
08 Jun 2021
Reviewer's report:
Dear Dr. Alyssa Larish, 
Thank you for performing a study on the use of transvaginal ultrasonography
during the uterine curettage. The study is well thought, yet I have several major
concerns that need to be addressed.
1. There is no clear description regarding patient selection. As it may seem from
the study, you perform suction curettage on most of patients with missed or
incomplete abortion, which I sincerely hope it not the case. In our centre we treat
almost all such patients solely with mifepriston and misoprostol and only around
5%-10% of cases lead to insufficient response where curettage is required. I'm
looking for detailed description of patient selection and more detailed criteria. 
2. Misoprostol was used preoperatively in some cases, please describe
indications
3. Please describe in more detail the indication for transabdominal ultrasound
4. Please include study power analysis
5. Pre and post procedure groups are not completely comparable according to
some parameters, please consider propensity score matching or some other
methods to avoid potential bias. 
6. in manuscript you describe study subjects with pregnancy up to 14 weeks,
while in table 1 has gestation range up to 19 weeks
7. considering indications for procedure in Table 1, numbers don't add up. Out of
95 post intervention procedures, 68 were missed abortion, 26 incomplete ab, 3
molar pregnancy, which is 97 altogether. There are other inconsistencies also. 
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
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from apparent manipulation?
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