Submited on: 30 Dec 2013 08:54:39 PM GMT
Published on: 31 Dec 2013 07:11:33 AM GMT
 
Abdominal Pregnancy > 20 weeks: A review of live births 2008-2013
Posted by Dr. Everett F Magann on 03 Jan 2014 10:10:56 PM GMT Reviewed by WMC Editors

  • What are the main claims of the paper and how important are they?

    Claim was made that when preeclampsia occurs with an  advanced abdominal pregnancy that this then dispels the hypothesis that uterine distension is necessary for preeclampsia.

    Second claim was that males are more vulnerable with an advanced abdominal pregnancy


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    I am not aware that uterine distension is a component of preeclampsia. The authors needs to reference this hypothesis and what literature is available to support or not support this hypothesis. This claim was made in the introduction but was not discussed further in the manuscript and in the methods their was no mention of women having or not having preeclampsia

    To vallidate the claim about a sex selection for live births would need to have all of the revelant data, there were only 38 cases reported and the authors state that the sex of the fetus was not given in all cases. Very little data to support this claim, what was the finding in the literature prior to 2008, was their a sex selection in that data set?


  • Are the claims properly placed in the context of the previous literature?

    No, see above, these hypothesis need to be developed by presenting what is currently known in the literature with appropriate references and then use this research to either vallidate or refute the information in the literature.


  • Do the results support the claims? If not, what other evidence is required?

    There is no real evidence presented to support either claim, no cited references.


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    N/A


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    N/A


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    Just need to reference the claims made by the authors


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    Very limited paper, review from 2008-2013 with 38 cases.


  • Other Comments:

    N/A

  • Competing interests:
    None
  • Invited by the author to review this article? :
    Yes
  • Have you previously published on this or a similar topic?:
    No
  • References:
    None
  • Experience and credentials in the specific area of science:

    Have done a review article on abdominal pregnanies at < 20 weeks published on Obstet Gynecol Invest

  • How to cite:  Magann E F.Abdominal Pregnancy > 20 weeks: A review of live births 2008-2013[Review of the article 'Live births resulting from advanced abdominal extrauterine pregnancy, a review of cases reported from 2008 to 2013 ' by Masukume G].WebmedCentral 2014;5(1):WMCRW002912
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I thank Dr. Everett F Magann for his review of my article; his review is found here (https://webmedcentral.com/Article_Review_View/2912).

 

He writes, “I am not aware that uterine distension is a component of preeclampsia. The authors needs to reference this hypothesis and what literature is available to support or not support this hypothesis. This claim was made in the introduction but was not discussed further in the manuscript and in the methods their was no mention of women having or not having preeclampsia”


“There is no real evidence presented to support either claim, no cited references.”

 

This hypothesis (uterine distension and preeclampsia) is referenced in the introduction, reference [7], which I have reproduced below:


Moodley J, Subrayen KT, Sankar D, Pitsoe SB. Advanced extra-uterine pregnancy associated with eclampsia. A report of 2 cases. S Afr Med J. 1987; 71(7):460-1.

(This paper goes into detail about the hypothesis.)

 

As will be noted this is a reference from 1987 (almost 30 years ago). In those days and prior, uterine distension was considered a likely component in the etiology of preeclampsia; of course nowadays this hypothesis would seem bizarre. Cases of preeclampsia occurring with an abdominal pregnancy helped discard the notion that uterine over distension was a component of preeclampsia’s etiology because with an abdominal pregnancy, the uterus is empty (myometrium not over stretched) but preeclampsia can still occur. In other words, the uterus is not necessary for preeclampsia to occur, a fact which was revealed by cases of preeclampsia occurring with abdominal pregnancies.


Abdominal pregnancies thus helped clarify some aspects about preeclampsia’s etiology that we now know today and consider to be common knowledge.

 

The preeclampsia example was to show that abdominal pregnancies serve as a useful model to confirm or refute certain hypothesis about pregnancy related conditions. In my opinion there is no further need to mention preeclampsia in the manuscript because the central idea was to prove that abdominal pregnancies are a useful model.

 

“To vallidate the claim about a sex selection for live births would need to have all of the revelant data, there were only 38 cases reported and the authors state that the sex of the fetus was not given in all cases. Very little data to support this claim, what was the finding in the literature prior to 2008, was their a sex selection in that data set?”

 

There is no need to have all the relevant data. A sensitivity analysis was done i.e. even if all the missing cases (data) were male, the sex ratio at birth would still be in favor of fewer males. This is mentioned in the paper’s discussion. I provided the full data set (Additional file) and anyone can verify for themselves.

 

Prior to my paper, to the best of my knowledge the sex ratio at birth has not been considered in relation to live births from advanced abdominal pregnancy – I concede that a more thorough look must be given to the literature prior to 2008. Nevertheless, it is a well established fact that males are more vulnerable than females from conception, I provided a reference [40], which I reproduce here:


Grant VJ, Irwin RJ. A simple model for adaptive variation in the sex ratios of mammalian offspring. J Theor Biol. 2009; 258(1):38-42.


It is also evident that abdominal pregnancy is a hostile environment for the fetus given the high perinatal morbidity and mortality. Once again I provided references [1] and [5] which I reproduce below:


Nkusu Nunyalulendho D, Einterz EM. Advanced abdominal pregnancy: case report and review of 163 cases reported since 1946. Rural Remote Health. 2008; 8(4):1087.

Stevens CA. Malformations and deformations in abdominal pregnancy. Am J Med Genet. 1993; 47(8):1189-95.

 

The finding of fewer live male births compared to females with advanced abdominal pregnancy is thus consistent with a known biologic fact (that males are more vulnerable than females from conception).


In the manuscript, however, I remain cautious and essentially write that males may be more vulnerable, I do not say “males are more vulnerable with an advanced abdominal pregnancy.”

 

Dr. Magann implies that there are only 38 cases (“very limited paper”) – live births from advanced abdominal pregnancy are extremely rare and 38 cases (over about 5 years) is the most comprehensive review available devoted to the topic to the best of my knowledge.

 

Advanced abdominal pregnancies can be viewed as a ‘useful’ model of ‘hostile’ pregnancy with a consequent reduction in the proportion of live male births.

 

Once again, I thank Dr. Everett F Magann for his time and comments on my paper, I greatly appreciate. I will take his views into consideration during revision of my manuscript.

 

Kindest regards,

Gwinyai


Responded by Dr. Gwinyai Masukume on 06 Jan 2014 09:08:42 AM