Title: A rare case of fundal intramural ectopic pregnancy associated with previous B-Lynch
sutures
Version: 2 Date: 17 Dec 2023
Reviewer's report:
Dear respected [Authors],
I hope this letter finds you well. I appreciate the effort and dedication you have invested in your
study, and I am committed to providing constructive feedback to contribute to the enhancement
of your manuscript. Please rest assured that my evaluation will be thorough and focused on
assisting you in achieving the highest quality in your publication.
Notes:
Title:
• Limited specificity: The title lacks specificity that highlights the unique aspect of the case –
the association with B-Lynch sutures. While "fundal intramural ectopic pregnancy" is accurate,
it's quite common and doesn't differentiate this case from others.
• Redundancy: "Case report" at the end is redundant in most academic publications and can be
omitted.
• Lack of keyword optimization: The title doesn't include relevant keywords for search engines,
which can impede discoverability.
Abstract:
• Lacks specific details about the unique aspects of the case, making it difficult to distinguish
it from other reports.
• The conclusion about laparoscopic surgery being safe and effective is overly general and
doesn't address the specific challenges of this case.
Introduction:
• Could be strengthened by briefly mentioning the challenges of diagnosing intramural
pregnancy and the lack of consensus on management.
Case presentation:
• The description of the clinical presentation and imaging findings could be more concise and
focused on the most relevant information.
• The explanation of the potential causes of the intramural pregnancy could be expanded, with
more details on the role of B-Lynch sutures and intrauterine adhesions.
Discussion:
• The limitations of the imaging techniques used in this case could be discussed in more detail.
• The section on treatment options could benefit from a more nuanced discussion of the risks
and benefits of each approach, specifically considering the context of this case.
• The reference to the case of successful term delivery could be elaborated on, highlighting the
exceptional nature of such an outcome.
Conclusion:
• Needs to be more specific and actionable, emphasizing the key takeaways from the case and
highlighting the importance of early diagnosis and individualized management of intramural
pregnancy.
References:
General notes:
• Limited scope: The references primarily focus on intramural pregnancy as a general concept,
neglecting the specific context of B-Lynch sutures in this case.
• Lack of recent references: Several references are from 2013 or earlier, potentially missing
newer advancements in diagnosis and management.
• Reliance on case reports: The majority of references are case reports, which offer limited
generalizability and evidence-based recommendations.
Specific notes:
• Reference 1 (Bannon et al., 2013): While relevant to the topic, it doesn't specifically address
B-Lynch sutures as a potential risk factor for intramural pregnancy.
• Reference 2 (Chida et al., 2016): This case report describes an intramural pregnancy after
curettage, not relevant to B-Lynch sutures.
• Reference 3 (Chukus et al., 2015): This review article discusses various ectopic pregnancy
locations but doesn't delve deeper into intramural pregnancy specifically.
• Reference 6 (Nees et al., 2020): Another case report, this time focusing on laparoscopy for
intramural pregnancy, but without mentioning B-Lynch sutures.
• Reference 7 (Petit et al., 2013): This case report describes a successful term pregnancy with
intramural implantation, which is not the focus of this case report and might not be relevant to
management decisions.
Additional suggestions:
• Consider adding a table summarizing the key clinical findings, imaging results, and
management decisions.
• Discuss the potential impact of B-Lynch sutures on the risk of intramural pregnancy and
propose recommendations for future practice.
• Emphasize the importance of multidisciplinary collaboration between gynecologists,
radiologists, and pathologists in the management of complex ectopic pregnancies.
Best regards,