The Challenge of the Non-Compliant Patient: A Case of Caesarean Section Scar Ectopic Pregnancy

Review Data

Q: Is the topic relevant to the journal area of interest? Is it contemporary and interesting for

researchers?

A: Good

Abstract & Keywords

Q: Are all required components included in the abstract? Are the keywords appropriately chosen?

A: Very Good

Goal

Q: Is the goal explicitly stated in the Introduction? Is its formulation clear and unambiguous?

A: Very Good

Structure

Q: Is the paper's structure coherent? Is it in coherence with the goal of the paper?

A: Good

Tools and Methods

Q: Are methods the author uses adequate and well used?

A: Good

Discussion & Conclusion

Q: Is it related to the results presented before? Do you consider them as coherent?

A: Good

Comments: The Discussion establishes that an abdominal scar after any invasive gynaecologic procedure such as a caesarean section or hysterectomy creates a favourable environment for ectopic blastocyst implantation. The Discussion highlights that to prevent adverse events associated with caesarean section scar ectopic pregnancy accurate location and dating of early pregnancy are crucial.  It illustrates that the treatment plan should depend on the gestational age and size, location of implantation, the mother’s current situation and stability and her future desire for pregnancy. Resection and aspiration both are highly effective and avoid the risk of slow resorption and medical complications associated with methotrexate. Relevant literature has been cited to support the discussion. The study concludes that if the patient had complied with the follow-up plan, it would have been evident that she would require an additional dose of the drug or even a timely surgical procedure. Thus, the risks of significant preoperative blood loss or death could have been avoided.

Literature

Q: Does the author utilize relevant literature?

A: Good

Author's knowledge

Q: What is the level of the author’s knowledge? Does the author utilize all recent contributions relevant to the topic?

A: Good

Length

Q: Is the length of the paper adequate to the significance of the topic? Do you suggest shortening the paper without losing its value?

A: Good

Figures & Tables

Q: Does the author use them suitably? Are legend and notations clear?

A: Good

Comments: The word “sagittal” has been misspelled in the figure legend of Figure 2.

Writing style

Q: Is it clear and understandable?

A: Good

Further comments on the paper

Comments: The case report presents the case of an ectopic caesarean scar pregnancy in a 31-year-old female with a history of multiple pregnancies. The patient previously had one caesarean section delivery. Studies have shown that the risk of caesarean scar pregnancies is directly proportional to the number of caesarean deliveries. Since the patient had refused surgical management, pharmacological management was initially used. However, the patient’s non-compliance to close follow-up led to a ruptured uterus. Thus, emergency laparotomy with supracervical hysterectomy was performed as a life-saving procedure which the patient tolerated well. However, the patient never turned up for clinical follow-up. The study concludes that if the patient had been compliant with the follow-up treatment then the risks of significant preoperative blood loss or death could have been avoided.

Q: Would you recommend this manuscript for further publication?

A: Yes - Suitable to be published

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Science Repository Team