Stage 2: The Vaginal Flora in Women Undergoing Fetal Spina Bifida Repair and Its Potential Association with Preterm Rupture of Membranes and Preterm Birth

Round 1

Reviewer 1 Report

In the article entitled: „ The vaginal flora in women undergoing fetal spina bifida repair and its potential association with preterm rupture of membranes and preterm birth“ the authors describe the incidence of normal and abnormal pre- and post-surgical vaginal microorganisms in fetal spina bifida (fSB) patients and investigate potential associations between the type of vaginal flora and the occurrence of preterm rupture of membranes (PPROM) and preterm birth (PTB).

The entire manuscript is well-written and adequately illustrated.

However, some obstacles prevent manuscript .

These, among others, include:

The terms such as MOMS and ACOGs should be followed by their full names in parenthesis when mentioned for the first time in the manuscript text.

The numbers in Figures 2A and 2B should be checked and discrepancies explained.

A minor revision of the manuscript is advised.

Author Response

We thank the reviewer for this positive and interesting comment and for their help to improve our manuscript. This is in fact very interesting article discussing the association between the maternal levels of serum proprotein convertase subtilisin/kexin type 9 in pregnant women and fetal open neural tube defect. As our article does not discuss the physiopathology, diagnosis or screening of fetal spina bifida, we feel this reference may not be appropriate for this manuscript.   

Reviewer 2 Report

Tevaearai et al. have aimed to determine the incidence of normal-abnormal pre-postsurgical vaginal microorganisms in fetal spina bifida (fSB) patients and to investigate potential associations between the type of vaginal flora and the occurrence of preterm prelabour rupture of membranes (PPROM) and preterm birth (PTB). Moreover, they showed that a normal pre-operative distribution of a healty vaginal flora and there was no association between an abnormal vaginal flora treated antibiotically and PPROM and PTB. The study is orginal, well prepared and discused. In my opinion this paper has a potential to make a positive contribution to the co-existing literature. I have only some minor recommendations for the authors:
1- I think that serum proprotein convertase subtilisin/kexin type 9 (PCSK9) may be involved in the etiopathogenesis of open neural tube defects (NTDs) at the critical steps of fetal neuronal differentiation. Although it has limitations, PCSK9 may be used as an additional biomarker for the screening of NTDs. The study mentioned below may contribute to this article.

“Erol SA, Tanacan A, Firat Oguz E, Anuk AT, Goncu Ayhan S, Neselioglu S, Sahin D. A comparison of the maternal levels of serum proprotein convertase subtilisin/kexin type 9 in pregnant women with the complication of fetal open neural tube defects. Congenit Anom (Kyoto). 2021 Sep;61(5):169-176. doi: 10.1111/cga.12432. Epub 2021 Jun 23. PMID: 34128273.”

Author Response

We thank the reviewer for these comments. The terms MOMS and ACOGs are now followed by their full names in parenthesis.
The numbers in Figures 2A and 2B have been checked and modified. In fact, discrepancies appear between the two groups, pre- and postsurgical swabs. This is probably explained by the fact that postsurgical swabs where only taken on indication. There is therefore a selection bias as these indications include women with a prior abnormal swab after antibiotic therapy, women with common clinical symptoms of vaginal infection and directly after PPROM, thus explaining the discrepancies between the two groups. This difference is also explained by the fact that not every infection led to PPROM and/or PTB.