Reviewer’ s report
Title: The impact of pre-evacuation ultrasound examination in histologically confirmed
hydatidiform mole in missed abortion
Version: 1Date: 20 Jun 2020
Reviewer's report:
Dear Editors.
I would like to thank you for the opportunity to review the paper: "The impact of pre-evacuationultrasound examination in histologically confirmed hydatidiform mole in missed abortion".Similarly, I would like to congratulate the authors for their interest in the topic.I would like to highlight some aspects that deserve more reflection.
The prevalence of hydatidiform mole in the studied sample (14%) drew attention. A similar
Brazilian study found a frequency of 2%.https://www.scielo.br/scielo.php?pid=S0100-032012000600003&script=sci_abstract&tlng=pt
In the same vein, the prevalence of cases of complete hydatidiform mole (86%) undiagnosed in
abortion cases was especially high, since ultrasonography has a better ability to detect these cases,compared to partial hydatidiform mole. As I suppose that the technical capacity of diagnosticmedical sonographers to detect hydatidiform mole is adequate, only early gestational age atdiagnosis of abortion would justify this low detection of cases of complete hydatidiform mole.And here there is a limitation of the study that needs to be addressed: the lack of gestational age oftermination of pregnancy. This can be easily achieved by ultrasound itself or calculated evenlythrough the date of the last menstruation. This would be important to show that these cases were
actually from early pregnancies.
The authors also referred to naked eye as a methodology for evaluating the uterine product. Thisshould be better characterized in the methods section: who made this assessment? In the case ofdifferent evaluators (which is very likely) was there a concern for it to be performed by the mostexperienced doctor on the team? Or could this have been done by professionals with differentlevels of experience (such as residents, junior staff or seniors)?Still in the methods section, the authors must describe which hCG kit was used for hormonaldosage and whether this kit was uniformly adopted throughout the study period (10 years). It isknown that different amounts of hCG provide different dosages and if this occurred it should bedescribed as a limitation of the study.https://pubmed.ncbi.nlm.nih.gov/28692637/
Regarding the comparison of hCG level preevacuation between patients with hydatidiform mole
and those with abortion, my suggestion is that a differentiation also be made between patients withcomplete and partial hydatidiform mole, since patients with complete mole have higher hCGlevels than those with partial mole. There may be a difference in the hCG level preevacuationbetween patients with complete mole and those with abortion. And, since patients with completemole have an increased risk to development of gestational trophoblastic neoplasia, this is an
interesting question to be evaluated.
In the discussion, this should be modified: "to date there is no study reporting the incidence of
hydatidiform mole in missed abortion.". Since it is always a risky statement, it is not wise to makeit.
https://www.scielo.br/scielo.php?pid=S0100-032012000600003&script=sci_abstract&tlng=pthttps://pubmed.ncbi.nlm.nih.gov/16343264/
https://pubmed.ncbi.nlm.nih.gov/15818571/
I also suggest that Figure 1 A and B be expressed in a box plot, side by side, with calculation of
medians and quartiles, and due statistical analysis.
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YesAre the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
NoDoes the work include the necessary controls?
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YesAre the conclusions drawn adequately supported by the data shown?
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Yes
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 furtherassessment in your comments to the editors.
I recommend additional statistical reviewQuality of written English
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Acceptable
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