Birth Trauma: Incidence and Associated Risk Factors: A Case–Control Study

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for the opportunity to review this very interesting research. 

 

That said, I wondered why the authors chose Futures for disseminating their work. I imagine their research would reach a wider audience that were they to publish in a more specialized ob/gyn or international public health journal. 

 

The authors go to great lengths to avoid naming their research site. I wasn’t clear as to why. In my experience the site of an empirical study is always identified. 

 

They did a generally good job with the Limitations section. However, among their interesting findings was the lack of association between birth trauma and standard risk factors (e.g. maternal age, maternal BMI). It could be that their sample was too small to detect such associations. Perhaps this could be mentioned.

 

I’d be interested in a fuller discussion of the significance of the “fertility treatment” variable.

 

Below are specific comments: 

 

Line 10 the authors write “preventing risk factors…” when I think they mean “limiting” risk factors

 

L 32 It wasn’t clear to me what was meant by “there are lesions”..

 

Line 253 word missing

 

Writing generally good although some sentences in the Discussion are much too long and difficult to understand (e.g. lines 227-229) d An adequate control of the gestation with a timely diagnosis of risk situations is the obstetrician's fundamental tool for shared decision-making with the  family regarding the optimal method of carrying out the delivery, considering the ind vidual maternal and fetal risk factors in each particular situation; lines 230- 236 Although the current measures of birth injuries cannot be considered valid indicators of the quality of obstetric care due to the lack of precision and reliability in their measurement, the continuous monitoring and evaluation of their incidence and characteristics in a particular setting could 233 be an important tool to evaluate care and influence clinical practice and develop, in the long run, valid measures of quality of care, which contribute to reducing the incidence of  preventable birth injuries. 

 

I lack expertise to comment on the supplementary data but there is a problem with the English on the first page the supplementary figure.

 

Comments on the Quality of English Language

comments are above

Author Response

Reviewer 1.

• I wondered why the authors chose Futures for disseminating their work. I imagine their research would reach a wider audience that were they to publish in a more specialized ob/gyn or international public health journal. 

Thank you for the comment. We tried more specialized journals before, but without success. We finally accepted a suggestion from MDPI to publish our work open in "Future", which is a good option for us.

 

• The authors go to great lengths to avoid naming their research site. I wasn’t clear as to why. In my experience the site of an empirical study is always identified. 

Thank you. The name of the institution is given with the authors affiliation in the title page and also appears in the first page of the manuscript.  

 

• They did a generally good job with the Limitations section. However, among their interesting findings was the lack of association between birth trauma and standard risk factors (e.g. maternal age, maternal BMI). It could be that their sample was too small to detect such associations. Perhaps this could be mentioned.

Thank you for this observation. We completely agree with the reviewer in this point. A comment in this sense has been added in the limitation section (highlighted).

 

• I’d be interested in a fuller discussion of the significance of the “fertility treatment” variable.

The variable “fertility treatment” has been changed in table 2 to the more precise “Adjusted reproductive Technologies”.

 

Below are specific comments: 

• Line 10 the authors write “preventing risk factors…” when I think they mean “limiting” risk factors.

Thank you for the suggestion. The word has been changed.

• L 32 It wasn’t clear to me what was meant by “there are lesions”..

Thank you. The sentence has been rephrased to clarify: “Some injuries persist over time…” (in contrast to those that disappear spontaneously).

• Line 253 word missing

Thank you. The word “trauma” has been added.

• Writing generally good although some sentences in the Discussion are much too long and difficult to understand (e.g. lines 227-229) d An adequate control of the gestation with a timely diagnosis of risk situations is the obstetrician's fundamental tool for shared decision-making with the  family regarding the optimal method of carrying out the delivery, considering the individual maternal and fetal risk factors in each particular situation; lines 230- 236 Although the current measures of birth injuries cannot be considered valid indicators of the quality of obstetric care due to the lack of precision and reliability in their measurement, the continuous monitoring and evaluation of their incidence and characteristics in a particular setting could 233 be an important tool to evaluate care and influence clinical practice and develop, in the long run, valid measures of quality of care, which contribute to reducing the incidence of  preventable birth injuries. 

Thank you very much. The whole paragraph has been rephrased. The first part in two shorter sentences and the second part in three (highlighted).

• I lack expertise to comment on the supplementary data but there is a problem with the English on the first page the supplementary figure.

Thank you very much for the comment. Unfortunately, we couldn't find the error. Please tell us which one you are referring to and we will have no problem correcting it.

Reviewer 2 Report

Comments and Suggestions for Authors

The Autors give and overview about obstetric trauma in the University of Las Palmas during the year 2021. They found an incidence of birth injury 2,28 %.

In this context it would be interesting to know the their obstetical management- cesarean section rate, in case of instrumental delivery- they only perform forceps?. What about breech delivery? how many cases do they have? mode of delivery? birth trauma can also occur in case of cesarean section. 

Comments on the Quality of English Language

In this context it would be interesting to know the their obstetical management- cesarean section rate, in case of instrumental delivery- they only perform forceps?. What about breech delivery? how many cases do they have? mode of delivery? birth trauma can also occur in case of cesarean section. 

Author Response

• In this context it would be interesting to know their obstetrical management:

Thank you for the comment. As shown in table 3, in the control population the rate of C-section during the study period was 7.8%, and higher (11.7%) in the group of birth trauma. Altogether, the rate of C-section in our center is around 9 to 11% every year.

Instrumental deliveries are performed almost always by forceps (rates also given in the table). Vacuum is exceptional.

Breech deliveries are attempted vaginally in first instance, if no contraindications. In our general population, the rate of breech presentation is around 1% (0.7% in 2021, as shown in the table). That year, 28 patients were born in breech presentation, of which 5 had birth trauma and 23 did not. These data, referring to the total number of patients born in the year (3,381 full-term newborns), are not included in the results to avoid confusion to the readers. The 5 breech patients in the group with obstetric trauma (cases) and one breech patient in the control group are included, in accordance with the study design.

 

Reviewer 3 Report

Comments and Suggestions for Authors

Usually spinal cord injuries are very rare. Spinal cord injury was high in your hospital please explain what is the cause.

Comments for author File: Comments.pdf

Author Response

• Usually, spinal cord injuries are very rare. Spinal cord injury was high in your hospital please explain what is the cause.

In reality, this is a single case during the year of the study. This was an unfortunate case that made us review the topic of this study. We have searched our files for other cases of spinal cord injuries and have not found any in the last 10 years.