Reviewer ’s report  
 
Title: Trends in Comprehensive Abortion Care (CAC) and Characteristics of Women Receiving  
abortion care in Tertiary Hospital in Nepal.  
 
Version: 3 Date: 01 Apr 2018  
 
Reviewer: Roger Rochat  
 
Reviewer's report:  
 
This is a very  interesting manuscript --and especially useful in that it is not the main teaching 
hospital. The authors could strengthen it by describing the timing of recognizing complications. 
Were they all recognized at time of procedure? Or did some women return afte r leaving the 
hospital. Was there any systematic follow up of women who left the facility to determine 
whether or not they had complications? Any lack of systematic followup should be included in a 
limitations section in discussion. The annual trends in se rvices would be more informative if they 
included trends by type of provider. Presently it is unclear when nurses began to provide CAC 
services. The authors do not make clear why abortions are provided in a hospital rather than in a 
clinic or physician off ice--is that because of the law? If the authors could provide a map of the 
hospital's location and primary service catchment area --and any other key providers in vicinity, 
that might help inform the decline associated with the last year.  
 
Most critically, if 88% of the women were primigravid, how could over half state that they had 
completed family size? That is not credible.  this is not a rigorous scientific comparison of 
complication rates for doctors and nurses and therefore should not draw the conclusi on that 
nurses perform CAC as safely as doctors. This is an observational retrospective study that 
identified a lower complication rate for nurses than doctors. the authors raise at least two 
plausible reasons for this: first that nurses restrict CAC to ab ortions for pregnancies < 8 weeks 
gestation and second, that doctors are often early in their training. but the authors should be more 
descriptive and possibly humble about the quality or completeness of complication case 
ascertainment.  
 
The authors may h ave other unstated reasons to promote nurses as providers of CAC services. 
They might state those reasons. they might also cite published experiences of non physician 
CAC providers elsewhere. Based on rigorous research on safety of early abortion services by 
licensed nurse practitioners, the State of California made such providers legal.  
 
 
 
 
 
 
 
 
 
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 wh at aspects require further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
 
 
 
 
 
 
 
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