Submited on: 09 Dec 2016 11:06:25 AM GMT
Published on: 12 Dec 2016 10:26:12 AM GMT
 

  • What are the main claims of the paper and how important are they?

    That is those pregnancies < 37 weeks there was no difference in 1 and 5 minute Apgar scores, umbilical cord pH or NICU admission in those with a decison to incision time of < 30 minutes vs. > 30 minutes. In the group > 37 weeks, there was no difference in 1 and 5 minute Apgar scores


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    These claims are consistent with the existing literature, which the authors have referenced # 5,6,8,9,10,11,12,13


  • Are the claims properly placed in the context of the previous literature?

    Yes


  • Do the results support the claims? If not, what other evidence is required?

    Yes the results support the claim particualrily for pregnancies < 37 weeks, however, Table # 3 which is the results of the the pregnancies > 37 is missing from the manuscript. Tables 1 and 2 and figures are present but there is no table 3, so it is impossible to fully evaluate the information in the description of the results without table 3


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    This was a retrospective study.


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    Yes


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    This is a small sample size for this paper, a larger sample size would have possible been more meaninful with only 135 pregnancies < 37 weeks and 77 greater than 37 weeks. The authors might talk about the power of their study based on their numbers to come to their conclusions.


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    The paper does not present any new information


  • Other Comments:

    Table 3 needs to added to the manuscript, without it the reader cannot evaluate those pregnancies > 37 weeks.

  • Competing interests:
    .
  • Invited by the author to review this article? :
    Yes
  • Have you previously published on this or a similar topic?:
    Yes
  • References:

    references 10 and 13

  • Experience and credentials in the specific area of science:

    Professor of OB-GYN and MFM with 38 years of experience and > 300 peer review publications

  • How to cite:  Magann E F.Does the Decison to Incision Time Affect Neonatal Outomes with Emergency Cesarean Deliveries[Review of the article 'Does the Decision-to-incision Time Affect Neonatal Outcomes in the Emergency Cesarean Section? ' by Kim M].WebmedCentral 2016;8(1):WMCRW003355
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Does the Decision-to-incision Time Affect Neonatal Outcomes in the Emergency Cesarean Section?
Posted by Prof. Muhammad Aslam on 25 Dec 2016 10:00:45 AM GMT Reviewed by Author Invited Reviewers

  • What are the main claims of the paper and how important are they?

    After a decision is made to deliver a baby by emergency cesarean section, it is recommended that CS should be performed promptly to minimize harm to the fetus and mother. Major medical societies have recommended a decision to incision (D-I) interval of 30 minutes for this purpose. This recommendation is not based on convincing scientific data to indicate that fetomaternal outcome is influenced by delay in D-I interval. The authors want to examine whether proposed D-I interval of 30 minutes is correlated to neonatal outcome in actual clinical settings or not. They have conducted a retrospective study on 212 mothers undergoing emergency CS to correlate neonatal outcome with the duration of D-I interval.

     

    The findings of a well conducted study will be important because inability to meet this target has been the basis for medico-legal suits; yet several studies have indicated that proposed D-I interval of 30 minutes is difficult to achieve in clinical settings especially in underdeveloped countries.


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    Similar studies have already been published and the authors have quoted references to those studies.


  • Are the claims properly placed in the context of the previous literature?

    Yes


  • Do the results support the claims? If not, what other evidence is required?

    1. Apart from the length of D-I interval, the neonatal outcome in a case of emergency CS depends on many variables e.g. gestational age, primary indication for CS, Pre-existing maternal medical conditions, choice of anesthesia, status of surgeon and anesthetist etc. No attempt has been made to control these variables apart from gestational age of the fetus.

    2. Mother is also a stakeholder in this study but maternal outcome is not considered.

    3. Sample size was not calculated to validate the results of this study.


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    No deviation from proposed methodology. 


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    Methodology is described in detail and is reproducible. Some problems with study design have already been mentioned above.


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    The authors may add the following information to improve their study results.

    1. Authors may calculate the sample size applicable to their analysis.

    2. D-I interval should also be compared according to indication of CS.

    3. Neonatal cord blood pH and gases values if available should be included in the comparison.

    4. Maternal outcome measures should be the part of comparison.

    5. Long term neonatal outcome is also important in this comparison but is not possible with a retrospective study design and the authors should acknowledge it as a limitation of their study. 


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    The results of this paper have clinical and medicolegal significance.


  • Other Comments:

    None

  • Competing interests:
    .
  • Invited by the author to review this article? :
    Yes
  • Have you previously published on this or a similar topic?:
    No
  • References:
    None
  • Experience and credentials in the specific area of science:

    I am a professor of Obs & Gyn with a clinical experience of 36 years in the field

  • How to cite:  Aslam M .Does the Decision-to-incision Time Affect Neonatal Outcomes in the Emergency Cesarean Section?[Review of the article 'Does the Decision-to-incision Time Affect Neonatal Outcomes in the Emergency Cesarean Section? ' by Kim M].WebmedCentral 2016;7(12):WMCRW003353
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