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Thank you for your thorough and detailed revisions. I have carefully reviewed your responses and the revised manuscript. You have clearly addressed all comments raised in the previous review round, including clarifying the study design, expanding the Methods and Discussion, improving statistical reporting, updating references, and correcting language and formatting issues.
Although only one reviewer responded during this round, their recommendation was for acceptance, and based on my own assessment, the current version satisfactorily meets the journal’s standards.
I am pleased to confirm that your manuscript is accepted for publication.
Congratulations on your careful and diligent work.
The revised manuscript is written in clear, and professional English.
The background section has adequate context, citing recent. Figures and tables are well structured, labeled, and consistent with the text.
The paper is self-contained, and the results are relevant to the hypothesis.
The study design and methods are now well described. The authors clearly define this as a within-subject diagnostic accuracy study, specifying inclusion/exclusion criteria, blinding procedures, and ultrasound device details (GE Voluson™ P8). The research question is explicitly stated and meaningful.
Statistical analyses are appropriate, and 95% confidence intervals for diagnostic parameters are added. Ethical approval and patient consent are documented. The investigation was conducted to a high technical and ethical standard.
The data are well controlled, and adequately analyzed. The conclusions logically follow the results and are limited to the findings. The comparison of transvaginal and transabdominal ultrasonography is supported by strong agreement (Cohen’s κ = 0.89) and clear diagnostic metrics.
The discussion appropriately situates the study within existing literature, highlighting consistency with previous large studies and meta-analyses. Limitations are acknowledged. The findings are valid and suitable for publication.
I commend the authors for their careful revision and recommend the paper for acceptance.
All 3 reviewers have asked for Major Revisions. Be sure to address all comments in detail
[# PeerJ Staff Note: It is PeerJ policy that additional references suggested during the peer-review process should *only* be included if the authors are in agreement that they are relevant and useful #]
[# PeerJ Staff Note: The review process has identified that the English language must be improved. PeerJ can provide language editing services if you wish - please contact us at [email protected] for pricing (be sure to provide your manuscript number and title). Your revision deadline is always extended while you undergo language editing. #]
The material method section of the study is explained very superficially, are the volunteers who underwent transvaginal ultrasonography and transabdominal ultrasonography the same people? What are the groups that make up the study? When we look at the title, you should say that you have two groups as TV USG and TA USG. If you compared these two groups, you need to create a comparison table that includes all the parameters. However, when we look at your tables, you have compared the transvaginal patient groups and the transabdominal patient groups according to whether there is a sliding sign or not. This does not fit the title and subject of your study. If your tables remain like this, you need to create a new title, subject and outcome report. Also, what was your solution to avoid bias in terms of the patient groups you included in the study?
The first paragraph of the discussion title is an important section and generally provides critical information for the study. However, this first paragraph seems to focus on keloids and strays away from the main purpose of the study. In addition, you stated in one sentence that the number of cesarean sections in the study was at most 2, but in the first paragraph, you stated in another sentence that most keloids had 3 or more cesareans. You should eliminate this contradiction. There is a sentence in the first paragraph of the discussion section: '. he more frequent the history of CS, the greater the possibility of finding a negative sliding sign on transvaginal ultrasound' ???You should correct it. In the discussion section, you should provide more examples of studies that explain the value of the sliding sign finding before cesarean section. You need to explain the concept of adhesion? Which situation you saw during surgery did you call adhesion and what was your source, how did you classify the adhesion?
no comment
This study seems to focus on a topic that is becoming increasingly popular. When we look at the literature, although there are many studies with similar frameworks, it has significant potential in terms of comparing two ultrasonographic methods. However, some issues need to be organized and clarified in the study.
You should write the statistical analyses performed under all tables and the abbreviations.
Dear Authors,
Thank you for your submission of the manuscript titled "Comparison of the Accuracy of Transabdominal and Transvaginal Sliding Sign for Predicting Intraabdominal Adhesion in Patients with History of Caesarean Section."
Your investigation into the accuracy of transabdominal and transvaginal ultrasound techniques in detecting intraabdominal adhesions among third-trimester pregnant women with a history of cesarean sections in Indonesia is commendable. The study's focus on predicting the presence of adhesions—common complications following cesarean deliveries that can impact future surgeries and pregnancies—contributes valuable insights to preoperative assessments and surgical planning within your local healthcare context.
Here are several recommendations that may enhance the clarity and impact of your manuscript:
1. Linguistic and Typographical Errors:
Upon review, I observed numerous linguistic and typographical errors that warrant revision (e.g., "ashesions" in line 193). Addressing these issues will significantly enhance the clarity of your work, both in the text and tables. Additionally, there are errors in all tables, such as the representation of numerical values like "40,0," which should be corrected for consistency and accuracy.
2.Current Sources:
More recent sources could be added to your manuscript. Updated references will enhance the relevance of your work and demonstrate engagement with the latest developments in the field.
1. Statistical Analysis:
Including confidence intervals for the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) would give a clearer picture of the reliability of your data.
2. Ultrasonography Details:
It would be beneficial to include information about who performed the ultrasonography and to specify the brand and model of the ultrasound machine used in the study. This detail enhances the credibility of your findings and aids in the reproducibility of the research. Additionally, clarify whether the evaluation of the sliding test was conducted by a single operator or multiple operators.
1. Video Clips:
Consider including video clips demonstrating the sliding sign evaluation, as this could enhance the manuscript's content and provide valuable visual context.
1. Consider providing more context on the implications of intraabdominal adhesions beyond surgical planning. Discuss potential impacts on patient quality of life and future reproductive outcomes to underscore the significance of your study.
2. Discussion Section:
While there is extensive literature on this topic, the manuscript would benefit from integrating more relevant studies. Strengthen your discussion by comparing your findings to other studies in greater depth, highlighting discrepancies and offering potential explanations for any alignment or divergence from existing literature. This will situate your research within a broader context and emphasize its significance.
I appreciate your efforts in conducting this important research.
Best regards
Fairly good English but need to make some modifications in some of the sentences as later outlined in subsequent reviews below.
Study design is not comprehensive enough.
MATERIALS AND METHODS :
Your study design is not clearly and comprehensively spelt out here. It's not exhaustive at all. For instance, I'll ask you :
a. How did you recruit the subjects, from where and how?
b. Do you have any inclusion and exclusion criteria at all?
3. Did you do any "Blinding"? Don't you think "Blinding" would've been important to validate and strengthen your findings in the study?
4. What are your research questions?
RESULTS :
You suddenly started telling us about "Keloids" and emphasizing on it as if Keloids was part of what you set out to study, why? Isn't that introducing confusion in your study?
Please did you factor in the BMI of the pregnant women as an important Confounder ?
TITLE :
This is a good title, but is not attractive and does not easily predict the content of the research paper, or readily capture the reader's attention.
I therefore suggest a modification like :
A Single-center Study : Comparing the Accuracy of Transabdominal and Transvaginal Sliding Sign in Predicting Intraabdominal Adhesion In Patients with history of Caesarean section.
ABSTRACT:
Background - I suggest you add this to the sentence on
lines 19-20: ... especially when complications arise "or are anticipated".
INTRODUCTION :
Page 7. Lines 51-52: the second sentence here is ambiguous. What do you mean by ... "It studies the predominant primary surgical procedure in numerous nations"? Please make yourself clear here and say exactly what you mean.
Lines 53-54: please back up this statement with a reference.
Lines 56-57: Please back up statement with reference(s). Also note that Lines 58-59 ought to be continuous with this 56-57 lines in writeup, as they have the same thought content.
Lines 58-59 : statement here is not supported by the study you sited in your reference number 4. In that study, their work was restricted to those with only 1-2 previous caesarean section. So please cross check well.
Lines 66-67: your quoted figures of 97.8% sensitivity and 94.4% specificity of transvaginal sliding sign for predicting adhesions is at variance with the figures 86.3% and 92.6% in your sited study in your reference number 7. So please check well again.
Lines 69-71: Please clearly state your Aim(s) and Objective(s) without any ambiguity. Is it to "evaluate and compare" or only to "evaluate"?
What is or are your outcome measures for this study? It's not well stated.
Generally, it should be noted that the Introduction as currently is too sketchy, and has not highlighted the key issues of this particular study. For instance, at least two or three sentences should've been dedicated to reminding the audience of the burden of intraabdominal adhesions especially regarding prolongation of surgery time, injuries to intraabdominal visceral organs like the gut, and possibility of excessive intraoperative hemorrhage in the course of possible adhesiolysis. Justification for this study also ought to be well highlighted here, so as to enable the audience see the gap in knowledge that the study has set out to fill.
RESULTS :
You suddenly started telling us about "Keloids" and emphasizing on it as if Keloids was part of what you set out to study, why? Isn't that introducing confusion in your study?
Please did you factor in the BMI of the pregnant women as an important Confounder ?
DISCUSSION :
You use the word "Sample" at one time and at other points you use "Subjects", why? I suggest stick to one especially Subject, which is the most appropriate in this instance.
Generally, your discussion is not well streamlined at all. The reason is not farfetched - it's simply because you're not clear on your Aims and Objectives. Usually, discussions are done around the positive and negative findings following the aims and objectives. So, essentially one is expected to discuss results as it relates to the Aims and Objectives, and consequently relate them to findings of previous related works sited in the literature reviews.
Lines 141: please edit the sentence here. Something seems missing here apart from writing "he" instead of "the".
Lines 164 - 167:
Please review your discussion here and write exactly what you intend to communicate especially regarding the work you sited in reference 12. For instance you suddenly mentioned "trocar" and "padhesia", and your sentence in line 165 started with small letter "s" for Studies have....
REFERENCES :
I noted that most of your references are old. Meanwhile there are a lot of related recent works you would've sited, including even Systematic reviews and Meta-analysis by Vinda Shafti, Alireza Azarboo, Marjan Ghaemi published in August 2023 in EU J Obstet Gynaecol Reprod Biol, and many others.
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