The Trauma of Perinatal Loss: A Scoping Review

Round 1

Reviewer 1 Report

Dear Author(s),

Thank you for the opportunity to read your scoping review about trauma as a consequence of perinatal loss.

#Introduction

I would recommend starting the introduction with the aim of the scoping review and explaining why a scoping review is the best way to reach this goal.

Line 24-28: I am unsure about the causality of stated diseases like diabetes or cancer as a consequence of trauma after perinatal loss. I recommend rechecking this.

Line 46: For what country or population does the 60% hold true? The United States? Women? Men?

#Material and Methods

I would recommend checking the literature by Peters et al. 2017 for additional information on scoping reviews and recommended standards that can be included in this section. What is about the evidence part of scoping reviews in your paper?

Is “life-limiting fetal condition” and “loss of fetus” part of the search terms?

Why is the time frame of 10 years selected?

Is the country-context part of your selection strategy?

Includes the parent’s perspective, a joint perspective of both parents, a single perspective of both parents, or a perspective of at least one parent?

I would recommend presenting figure 1 in section 2 and table 1/2 in section 3.

The summary table of the reviewed articles could benefit from information about the country-specific background.

Are keywords of the found articles considered in the article selection process?

In figure 1, only databases Pubmed and CiNAHL are considered but in Section 2.2. PsycInfo is also mentioned. So, what is right?

 #Results

The results section could benefit from a graphical presentation of content categories found in the reviewed articles for a better overview.

Line 139: What do key milestones mean?  Maybe an extended description of the content in the section title would be helpful here.

Are findings different for women and men in the reviewed literature?

Do findings differ by the age of parents?

Do findings differ by country or country-specific characteristics (e.g., health care system)?

Do findings differ depending on the timing of perinatal loss? Before or after birth? In the first trimester of a pregnancy compared to higher trimesters when the fetus is already moving in the womb?

Did the results differ between parents who have other living children and those who have no living offspring?

#Discussion

What other research gaps can be identified based on this review besides adapting TIC models?

Again, to whom does the prevalence of 60% apply?

References

Peters MDJ, Godfrey C, Kahlil H, McInerney P, Baldini Soares C, Parker D. Chapter 11: Scoping Reviews; in: Aromataris E, Munn Z (Editors). Joanna Briggs Institute Reviewer's Manual. The Joanna Briggs Institute, 2017. (https://reviewersmanual.joannabriggs.org).

Author Response

Thank you for the thoughtful review. Please see the following responses:

Introduction

1. In accordance with standard manuscript structure and after reviewing the structure of several scoping reviews, the aims will remain at the end of the introduction.
2. The manuscript reads that these conditions have been found to be “associated with,” there are no statements of causality, only a statement of research findings supported by the references provided.
3. For clarity, the sentence has been changed to “Researchers in Australia, Europe, and the United States measuring symptoms of trauma in men and women following miscarriage, stillbirth, and neonatal death have reported that between 30-60% of the participants meet the clinical criteria for PTSD [8], [14], [15].”

Materials and Methods

1. Thank you for this valuable resource.
2. Search terms included were: “perinatal loss,” “trauma,” “parents experience,” “stillbirth,” and “miscarriage”
3. To explain the 10-year search period, the following sentence has been included: “Due to the paucity of literature focusing on perinatal loss, the search was expanded to include article published in the last 10 years.”
4. There were no exclusions based on country of publication.
5. All of the above – articles included a mix thereof, thus all were included. When articles found specifics based on gender, it was pointed out within the manuscript, otherwise the term “parents” was used.
6. I believe this is up to the editor?
7. This is a great suggestion, the country has been added into the table.
8. Yes, this is outlined in line 73-74
9. Great catch, Figure 1 has been updated to include PsycINFO

Results

1. A diagram has been created to help clarify the information.
2. “Key milestones” have now been defined upon mention in the manuscript.
3. When differences were found, they were pointed out in the manuscript.
4. Please see response to #3.
5. Please see response to #3.
6. Please see response to #3.
7. Please see response to #3.

Discussion

1. Addressing the vast gaps beyond TIC models are unfortunately many and beyond the scope of this manuscript.
2. Please see response to Introduction #3

Reviewer 2 Report

The article described the problem of parental trauma experience related to perinatal loss. The material is developed on the PRISMA model and well organised within following criteria. The article is based along-side description of 15 empirical articles.

I am slightly confuded that only 15 articles met criteria the author had formulated at the beginning within the 10 years perspective.

The text is well organized and clear, it is also wrote in very friendly but also very profession style what helped the reader to follow all detailes.

The author came to the very practical conclussion to be addapted by health care system to deal with PTSD in parents after perinatal loss.

Author Response

Thank you for the kind and thoughtful review of the manuscript. Please see the following response:

1. The small number of articles speaks to the need to further advance our understanding of trauma within the perinatal loss experience.
2. Thank you very much for the kind comment.
3. This conclusion is highly appreciated, thank you!