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Other Comments:
Well written scientific communication that has managed to highlight not only the hospital prevalence of cervical incompetence but assess its management at one of the largest referral hospitals in the East and Central Africa region. However, there are multiple grammatical errors including use of the word 'Cervical imcopetence' where I think the authors meant to say 'Cervical cerclage' (Paragraph 1 Introduction line 4 ..........The efficacy of cervical incompetence, as well as its need have been discounted, with Althuisius1, terming it an unnecessary intervention in 50% of the cases.). In the discussion, paragraph 1 line 2 and 3.............According to the PRAMS study10, majority of the women who develop cervical cerclage fall under 20 years of age
It is not possible to establish a causal relationship between the cervical cerclage and IUFDs among other complications from the study method used. The incidence reported for these could just represent the incidence in the general population regardless of the intervention. A case-control would be more appropriate in making this conclusion that IUFDs are underreported.
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Invited by the author to review this article? :
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Have you previously published on this or a similar topic?:
No
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References:
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Experience and credentials in the specific area of science:
I have undergone basic and clinical training in this area. Have also published other papers in the subject area
- How to cite: Kimani S M.Impressive[Review of the article 'Outcome And Complications In Women Undergoing Cervical Cerclage In A Tertiary Hospital In Kenya ' by Geoffrey M].WebmedCentral 2011;1(11):WMCRW00139
Emperical cerclage insertion is a new terminology unlike elective and emergency cerclage that is universally known. Unfortunately, majority 72.5% (143 of 199) were in the empirical group. These women did not have a previous history of spontaneous mid-trimester abortion, or bulging fetal membranes and cervical dilatation in the pregnancy in which the cerclage was inserted. This implies the cerclage insertion is not justified. Its no surprise, therefore, the high preterm delivery rate and urinary tract infection in this sub-group.
Only 55 women had indication for either elective or emergency cerclage insertion during the 9 year period. The implication of this on table 4 is the present study would then rank forth in terms of sample size when compared to previous referenced studies.
By convention, insertion of cerclage is done between 14-16 weeks. In this study no reasons were given for insertion of cerclage at 7 weeks gestation and for late insertions after 20 weeks gestation. More so, the reporting on complications would be better appreciated if was related to gestation age at cerclage insertion as complications are more with insertion after 16 weeks gestation age.
Table 1 was uncalled for because age isn’t responsible for the complications, rather, the women’s occupation, level of education, parity should have been presented as this would have given insight to their socio-economic status.
Table 2 should be deleted as this is a repetition of the results section of the article.
Table 3 says it all! It shows that more complications occurred in the women who had no justification for the procedure (empirical group). This is particularly so, because the need for cerclage insertion in women with previous spontaneous second trimester abortion is still in question.
I have done a retrospective evaluation of cervical cerclage insertion which will be published soon
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Good experience