Reversible Cerebral Vasoconstriction Syndrome in the Postpartum Period: A Systematic Review and Meta-Analysis

Round 1

Reviewer 1 Report

This is a very good review; however, the following points needs to be addressed.

 

1. Grammatical errors at several places.
2. Expand ICH and SAH in the abstract
3. IN Page 2, line 62 is it MRI? Or MRA? Correct and expand this.
4. Among postpartum females included in the review, how many of them were giving milk to the babies? Does it have any influence on RCVS? Please include this in the study.
5. IN page 8 and line 161, authors mentioned than compared to men women are older…. That sentence is not inconclusive or not meaningful. Please complete the sentence.

Author Response

Dear Reviewer thanks for all the suggestion, in the attachment we include all the suggestions made, and how we replied to them.

Please see attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

The authors present a systematic review and meta-analysis of RCVS in the post-partum period. Of the 108 records screened, they included 8 for analysis. They report a prevalence of ~12%. Of these females, roughly 50% have a hemorrhagic presentation with a five-fold higher likelihood of the hemorrhagic presentation being parenchymal rather than SAH. 

This is an interesting manuscript that is well presented. The prevalence is higher than one would anticipate but so is the hemorrhagic presentation. It is important to keep this entity in mind when assessing a PP patient with ICH. 

Author Response

Dear Reviewer we appreciated that you like the manuscript, we make the following corrections, if you have the time to see it.

On advance thanks for your time.

Author Response File: Author Response.pdf

Reviewer 3 Report

Authors need to check the English. Line 61 “The following criteria is required to diagnosed”  should be  “The following criteria are required to diagnose RCVS:”

Authors must include the bibliographic reference of the  “Meta-Analysis of Observational  Studies in Epidemiology (MOOSE) reporting guidelines.”

The bibliographic reference of the software used must be included. (Including URL)

The statistical technique used to perform the meta-analysis must be indicated. It is not enough to include the software reference.

The search should be done in at least one other database (e.g., web of sciences, Scopus, or scholar google)

Two authors should review the articles to decide the inclusion or not in order to avoid bias. Authors who review the articles should be identified with initials in the manuscript. (Material and method section)

To assess the quality of manuscripts is necessary, the cross-sectional version of the Ottawa Newcastle scale is suggested.

The results section should be commented on the countries where the selected studies have been conducted. Authors should be carried out an analysis by continent.

 

Author Response

The authors thanks for all the suggestions. We include the suggestion of the other reviewer, and we also changed the PRISMA flow chart, because there was a minor mistake.

We find very useful the suggestion of Ottawa Newcastle scale is suggested, to analyzed the bias.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

The authors have addressed my concerns

Author Response

Thanks for reviewing the manuscript we added the two bibliographic references as suggested (from the other reviewer). Additionally we did a detailed grammar check as well.

Kind Regards.

Fernando Ortiz.

Reviewer 3 Report

We thank the authors for incorporating all the bibliographic suggestions made during the review.

The article can be published as it is, but a few small corrections should be made first.

 

1) The Otawa Newcastle scale for risk assessment has been included in the tables. But it has not been indicated in the material and methods section that the Otawa-Newcastle Scale has been used. The Otawa Newcastle Scale should be included in the material and methods.

2) Reference to the Otawa-Newcastle Scale should be included in the bibliography.

Wells G, Shea B, O'Connell J, Robertson J, Peterson V, Welch V, et al. The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analysis. Available at http://www.ohri.ca/programs/clinical_epidemiology/oxfordasp.

 

3) The bibliography should include the bibliographic reference of the Open Metanalys program, indicating the version and including the URL. Probably the reference is this one, but please check it, as there are several programs with similar names.

Wallace, B.C., Dahabreh, I.J., Trikalinos, T.A., Lau, J., Trow, P. & Schmid, C.H. (2012) Closing the gap between methodologists and end-users: R as a computational back-end. Journal of Statistical Software, 49, 1–15.  (Software avalaible from http://www.cebm.brown.edu/openmeta/index.html

Author Response

Thanks for reviewing the manuscript we added the two bibliographic references as suggested (from the other reviewer). Additionally we did a detailed grammar check as well.