Prevalence, causes, and factors associated with obstructed labour among mothers who gave birth at public health facilities in Mojo Town, Central Ethiopia, 2019: A cross-sectional study

Tarekegn Girma; Wubishet Gezimu; Ababo Demeke

doi:10.1371/journal.pone.0275170

Peer Review History

Original SubmissionAugust 19, 2021
27 Jun 2022 Decision Letter - Jianhong Zhou, Editor PONE-D-21-26867Magnitude, Causes and Factors associated with Obstructed Labour among Mothers who Gave Birth at Public Health Facilities in Mojo Town, Mojo, Central Ethiopia, 2019PLOS ONE Dear Dr. Gezimu, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Specifically, the reviewers have multiple concerns including English language and missing details on methodology. Please have those concerns addressed point-by-point. Please submit your revised manuscript by Aug 08 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. 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We will update your Data Availability statement to reflect the information you provide in your cover letter. 3. We note that you have stated that you will provide repository information for your data at acceptance. Should your manuscript be accepted for publication, we will hold it until you provide the relevant accession numbers or DOIs necessary to access your data. If you wish to make changes to your Data Availability statement, please describe these changes in your cover letter and we will update your Data Availability statement to reflect the information you provide. 4. Please ensure that you refer to Figure 1 in your text as, if accepted, production will need this reference to link the reader to the figure. 5. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Partly Reviewer #3: No ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: No ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: No ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: No ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Review Comments to the Author 1. Needs English language correction. 2. It is a good effort and may help in reduction of such complications Reviewer #2: 1) The area studied is of great clinical importance. Unfortunately, many women still experience labour complications and these contribute to the maternal morbidity and mortality. 2) The manuscript is relevant, it has numerous grammatical and typographical errors that need to be corrected. 3) The background/introduction has many sentences constituting paragraphs. Please coalesce most of them into relevant paragraphs and stratify them as follows: a) Important definitions such as Obstructed labour, including the burden of obstructed labour globally, in Africa/sub-Saharan Africa and in Ethiopia b) The causes of obstructed labour c) The factors associated with obstructed labour N.B: Not sure that the last sentence in the background about this being a pioneer study is relevant here. Which databases did the authors search to come to this conclusions? 4) In the methods, the use of the term cephalo-pelvic disproportion is misleading. What exactly caused the disproportion is the real cause of obstructed labour. Please, if possible, unpack the cephalo-pelvic disproportion variable. 5) Under birth weight, you write that a high birth weight is when the weight of baby at birth is 400gm and above. This is wrong. 400gm is too low to be a high fetal weight. I guess you meant 4000gm! Please correct this anomaly! The normal birth weight range is also not 2500gm-399gm but 2500-3999gm! Also correct this anomaly! 6) In the analysis part, please state how categorical and continuous variables were analysed instead of clamping everything together. 7) In results, in Table 1 you state under occupation that the category "other" meant daily labour worker. Were there any other considerations under that category? If not, then just write daily labour worker directly in the table. Under APGAR SCORE, what was the rationale of using the ranges the author uses? If possible, please stratify your APGAR SCORE as follows: 7–10: Reassuring 4–6: Moderately abnormal 0–3: Low 8) Under discussion, the content is there but needs to be improved. Please write your discussion as follows: State your results, then results from comparable studies and the possible explanation for the similarities or differences between your study results and the quoted studies. Otherwise your study is of great importance. Reviewer #3: Review summary Thank you very much for giving me the opportunity to review this paper. I agree that obstructed labour is an important clinical and public health problem in low resource settings. So, I don’t see what new information this manuscript is adding to scholarship on obstructed labour. The methods described by the authors are not sound, and the manuscript is not well-written. I have a couple of issues regarding this work. Major issues 1. Use of the word magnitude in the title is not specific enough, because this is very difficult to measure. The authors should consider revising this to prevalence. 2. The introduction is very shallow and not informative because the authors have not reviewed and distilled the available literature on obstructed labour, yet it is a well-studied subject. 3. Subsequently, the gap/problem as well as the justification is not clearly defined in the introduction. 4. The stated objective is not SMART. 5. Generally, the methods are poorly reported, the authors should make use of the STOBE checklist to improve on the transparency of reporting. It will also help to make it more comprehensive. 6. Line 131- 132 is not clear, please check it and revise the grammar and sentence structure. Please do this for the rest of the document as well. 7. The primary outcomes are two, but they are not well defined. It is important to report how, who and when the diagnosis of labour was made? Are there any guidelines for diagnosis of obstructed labour in your facility? 8. You did not include a section on study procedures. So, it is not clear when, how and who collected the data. When was the consent obtained? Did you review patient files or interview participants for data collection? 9. The results are not well presented. For instance, in Table 2, why do you have three variables on the same factor of ANC? What are they showing? Generally, there is a big problem with the categorizations on several variables; it is so arbitrary and unconventional. In table 3, under partograph is another example of the same. 10. Table 4 is presenting outcomes of obstructed labour; this is not one of the objectives for this study. This is completely new and not acceptable. 11. In the discussion, it is hard to know what the key message is. This has also affected the conclusions and recommendations that have been advanced by the authors. Minor issues 1. Kindly pay attention to the grammatical errors and typos that are all over the document 2. Have a look at the references as well and ensure that they are more accurate. 3. Many sentences are either incomplete or not meaningful. 4. The paragraphs are not well structured, it is not proper to have one sentence standing alone as a paragraph. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: Yes: Dr. Joseph Ngonzi Reviewer #3: Yes: Milton Musaba ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0275170.r001
Revision 1
27 Jul 2022 Author Response Response to Reviewers Title: “Magnitude, Causes, and Factors associated with Obstructed Labour among Mothers who Gave Birth at Public Health Facilities in Mojo Town, Mojo, Central Ethiopia, 2019” Manuscript ID: PONE-D-21-26867 Dear, Editor and reviewers, we (authors) would like to thank you for your time and fruitful suggestions. We respond and corrected all raised comments. Hereunder we enclosed all the answers and corrections point by point. Response to Editor’s comments 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. Authors’ response: Dear Editor, Thanks a lot for your guidance with PLOS ONE's guidelines! We have corrected the entire manuscript as per PLOS ONE's requirements. 2. In your Data Availability statement, you have not specified where the minimal data set underlying the results described in your manuscript can be found. Authors’ response: Great! We have updated the data availability statement and included all the data used in the study as supporting information in the revised manuscript. 3. We note that you have stated that you will provide repository information for your data at acceptance. Should your manuscript be accepted for publication, we will hold it until you provide the relevant accession numbers or DOIs necessary to access your data. If you wish to make changes to your Data Availability statement, please describe these changes in your cover letter and we will update your Data Availability statement to reflect the information you provide. Authors’ responses: Dear, Thank you so much for your suggestion! We made changes to the data availability statement and described it in the cover latter. 4. Please ensure that you refer to Figure 1 in your text as, if accepted, production will need this reference to link the reader to the figure Authors’ response: Dear Editor, Thanks for reminding us of our mistake. We have referred to figure 1 under the study variable sub-section of methodology. 5. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Authors’ response: Thanks for reminding us! We have included supporting information and cited its corresponding captions in the text. Response to Reviewer #1 comments 1. Needs English language correction. Authors’ response: Dear reviewer, we are grateful for your suggestion. We have corrected all the language errors in our manuscript as highlighted in the track change file. 2. It is a good effort and may help in reduction of such complications Authors’ response: Thanks a lot for your constructive comments! Response to reviewer #2 comments 1. The area studied is of great clinical importance. Unfortunately, many women still experience labour complications and these contribute to the maternal morbidity and mortality Authors’ response: Dear Reviewer, Thank you so much for acknowledging our study outcome (obstructed labour), one of the causes of maternal mortality and morbidity. 2. The manuscript is relevant; it has numerous grammatical and typographical errors that need to be corrected. Authors’ response: Thank you for your fruitful comments! We have corrected all the typographic and grammatical errors 3. The background/introduction has many sentences constituting paragraphs. Please coalesce most of them into relevant paragraphs and stratify them as follows: a) Important definitions such as Obstructed labour, including the burden of obstructed labour globally, in Africa/sub-Saharan Africa and in Ethiopia b) The causes of obstructed labour c) The factors associated with obstructed labour N.B: Not sure that the last sentence in the background about this being a pioneer study is relevant here. Which databases did the authors search to come to this conclusions? Authors’ response: Great! We made significant changes to the introductory parts of our paper as per your suggestions. We stratified it as: definition and burden of OL, causes of OL factors associated, strategies that have been taken to prevent OL, and gaps in data about OL in the area. ‘This is a pioneer study which assessed causes of obstructed 91 labour in the Central Ethiopia’ just to express the limitation of evidence specifically, in our study setting. We have removed this section. 4. In the methods, the use of the term cephalo-pelvic disproportion is misleading. What exactly caused the disproportion is the real cause of obstructed labour. Please, if possible, unpack the cephalo-pelvic disproportion variable. Authors’ response: OH GREAT! Really, it is insightful suggestion. Thanks! According to different literatures and guidelines CPD is taken as the first and leading cause of obstructed labour (as cited in the background section). In fact, there are root causes of CPD which are described as risk factor for obstructed labour such as maternal age, fetal macrosomia (hydrocephaly), contracted pelvis, etc. 5. Under birth weight, you write that a high birth weight is when the weight of baby at birth is 400gm and above. This is wrong. 400gm is too low to be a high fetal weight. I guess you meant 4000gm! Please correct this anomaly! The normal birth weight range is also not 2500gm-399gm but 2500-3999gm! Also correct this anomaly! Authors’ responses: Dear, we are sorry for the mistake we made! It was a typing error! We meant 4000gm and 3999. We have corrected it. Thanks a lot for reminding us! 6. In the analysis part, please state how categorical and continuous variables were analysed instead of clamping everything together. Authors’ responses: Excellent! Dear, the majority of the independent variables handled in our study were categorical in form, and before analysis, we also categorized continuous variables such age, labour time, and estimated distance to healthcare facilities. 7. In results, in Table 1 you state under occupation that the category "other" meant daily labour worker. Were there any other considerations under that category? If not, then just write daily labour worker directly in the table. Under APGAR SCORE, what was the rationale of using the ranges the author uses? If possible, please stratify your APGAR SCORE as follows: 7–10: Reassuring 4–6: Moderately abnormal 0–3: Low Authors’ responses: I really appreciate your helpful suggestion. Of course, there is another factor under the other category of Table 1 that was overlooked when typing, namely "students." Dear, we have also changed the APGAR SCORE category in accordance with your recommendation. 8. Under discussion, the content is there but needs to be improved. Please write your discussion as follows: State your results, then results from comparable studies and the possible explanation for the similarities or differences between your study results and the quoted studies. Authors’ responses: Dear reviewer, thanks for your guidance! We wrote the discussion section as per your recommendations! Response to reviewer #3 comments Major issues 1. Use of the word magnitude in the title is not specific enough, because this is very difficult to measure. The authors should consider revising this to prevalence Authors’ responses: Dear Reviewer, We value your insightful suggestion. We have replaced the word "magnitude" with "prevalence" in the title section. 2. The introduction is very shallow and not informative because the authors have not reviewed and distilled the available literature on obstructed labour, yet it is a well-studied subject Authors’ responses: Great! We made thorough revision to the introduction part and incorporated all relevant data to our study’s outcome interest. Thanks in advance! 3. Subsequently, the gap/problem as well as the justification is not clearly defined in the introduction. Authors’ responses: Dear review, thank you for your concern over this important section! We have updated this section and we hope you will get the gaps and justification we articulated. Thanks! 4. The stated objective is not SMART. Authors’ responses: Dear, thanks once more! We have corrected this section. We have corrected the study objectives and made them SMART. 5. Generally, the methods are poorly reported, the authors should make use of the STOBE checklist to improve on the transparency of reporting. It will also help to make it more comprehensive. Authors’ responses: Dear, thank you in advance for your suggestions! We have filled and uploaded the STROBE checklist with supportive information. 6. Line 131- 132 is not clear, please check it and revise the grammar and sentence structure. Please do this for the rest of the document as well. Authors’ responses: Dear, Thanks a lot! We have corrected the grammar and sentence structures of the mentioned section and in all the rest of the document. 7. The primary outcomes are two, but they are not well defined. It is important to report how, who and when the diagnosis of labour was made? Are there any guidelines for diagnosis of obstructed labour in your facility? Authors’ responses: Dear reviewer, Thank you so much for your perceptive comments! The two outcomes of this study, Prevalence of obstructed labour and causes of obstructed labour were diagnosed by physicians. In Ethiopia, physicians use the Federal guideline for diagnosis and management of obstetrics cases. (Federal Democratic Republic of Ethiopia Ministry of Health: Management Protocol on Selected obstetrics topics, January, 2010). 8. You did not include a section on study procedures. So, it is not clear when, how and who collected the data. When was the consent obtained? Did you review patient files or interview participants for data collection? Authors’ responses: Great! Dear reviewer, we have described the study procedures in the ‘data collection tools and procedure’ sub-section of methods and material. � The data were collected by two BSc Midwives (who works out of the study area) and a supervisor from 10 November to 30 December 2019. � Consent was taken from each participant before interview. � Great! We have used both interview and patient file review. � After data collectors taken consent, they interviewed study participants and reviewed the respective clinical information from medical record. 9. The results are not well presented. For instance, in Table 2, why do you have three variables on the same factor of ANC? What are they showing? Generally, there is a big problem with the categorizations on several variables; it is so arbitrary and unconventional. In table 3, under partograph is another example of the same. Authors’ responses: Dear reviewer, Thank you so much for your insightful comments! Dear, we have unpacked the category of having ANC information and left having ANC follow-up and frequency of ANC follow-up. Because, evidence shows that frequency of ANC has association with obstructed labour. Mostly, those mothers who had less ANC follow-up were risky for OL. We have corrected all of the commented sections. 10. Table 4 is presenting outcomes of obstructed labour; this is not one of the objectives for this study. This is completely new and not acceptable. Authors’ responses: Dear, we appreciate you for your intellectual suggestion! Of course, outcome of obstructed labour was not our study objective but we included the feto-maternal outcome of participants in the study area as an explanatory variable. Because, as literatures shown, feto-maternal outcomes such as birth weight affects labour outcomes. Dear, to make it more clear and attractive for readers, we have merged the important feto-maternal outcome variables to the obstetrics characterises section of the findings. 11. In the discussion, it is hard to know what the key message is. This has also affected the conclusions and recommendations that have been advanced by the authors. Authors’ responses: Dear, thanks for your helpful suggestion! We revised the discussion section. We concluded what we found and forwarded as per our findings. Thanks in advance again! Minor issues 1. Kindly pay attention to the grammatical errors and typos that are all over the document Authors’ responses: Dear reviewer, thanks for your constructive comments! We have corrected all the grammatical errors and typos throughout the document. 2. Have a look at the references as well and ensure that they are more accurate. Authors’ responses: Thank you! We have checked and corrected it. 3. Many sentences are either incomplete or not meaningful. Authors’ responses: Thank you dear! We have checked and corrected all the sentence errors all over the manuscript. 4. The paragraphs are not well structured, it is not proper to have one sentence standing alone as a paragraph. Authors’ responses: We greatly appreciate you! All of the paragraphs have been rearranged, and we have fixed all the mentioned errors. Attachments Attachment Submitted filename: Response to reviewers.docx https://doi.org/10.1371/journal.pone.0275170.r002
8 Sep 2022 Decision Letter - Gulzhanat Aimagambetova, Editor PONE-D-21-26867R1Prevalence, causes, and factors associated with obstructed labour among mothers who gave birth at public health facilities in Mojo Town, Central Ethiopia, 2019PLOS ONE Dear Authors, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. ============================== ACADEMIC EDITOR: The introduction part sounds clear and provides the study rationale well. However, I suggest rewriting the last paragraph (lines 95-101 in the revised document). The issue is that you write "the aim of this study was" (singular), however below you stated THREE aims (plural). So, this should sound more clear. Moreover, the writing style should be improved in this paragraph to be closer to the academic writing style. It is better to remove the numbering (1,2,3) and present it in plain text. In the Methods part, you described "Operational definition" (singular), but in the text there are many definitions, so the subheading should be "Operational definitions". Please make sure you've followed the PLOS ONE journal's requirements https://journals.plos.org/plosone/s/submission-guidelines ============================== Please submit your revised manuscript by October 8, 2022. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Gulzhanat Aimagambetova Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: (No Response) Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: No Reviewer #2: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Overall a good effort in writing the manuscript, however the comparison with other studies should have been presented in a standard way. Recommendation must mention the strategies to prevent obstructed labour in hospital settings such as training of birth attendants to monitor and identify cases who may land up in obstructed labour. Reviewer #2: The author has addressed the comments raised by the reviewers. The manuscript reads much better than before. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: Yes: Dr. Joseph Ngonzi ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0275170.r003
Revision 2
10 Sep 2022 Author Response Response to Reviewers PONE-D-21-26867R1 Prevalence, causes, and factors associated with obstructed labour among mothers who gave birth at public health facilities in Mojo Town, Central Ethiopia, 2019: A cross-sectional study Dear Dr. Gulzhanat Aimagambetova (Editor) and reviewers, we appreciate your valuable time with our article. Thanks for your intellectual comments and suggestions. We have revised our article and responded point-by-point to all the editor and reviewers comments and suggestions hereunder. ACADEMIC EDITOR: The introduction part sounds clear and provides the study rationale well. However, I suggest rewriting the last paragraph (lines 95-101 in the revised document). The issue is that you write "the aim of this study was" (singular), however below you stated THREE aims (plural). So, this should sound more clear. Moreover, the writing style should be improved in this paragraph to be closer to the academic writing style. It is better to remove the numbering (1,2,3) and present it in plain text. Authors’ response: Dear Editor, Thank you so much for your intelligent suggestion. We have changed ‘aim’ to ‘aims’ and ‘was’ to ‘were’ in the mentioned section. Also, we have removed the numbering from the objectives of the study and presented it in plain text (highlighted on page no. 5; line no. 92-94). In the Methods part, you described "Operational definition" (singular), but in the text there are many definitions, so the subheading should be "Operational definitions". Authors’ response: Dear Editor, Thanks once again. We have changed "Operational definition" to be "Operational definitions"(highlighted on page no. 7 and line no. 141). Please make sure you've followed the PLOS ONE journal's requirements Authors’ response: Dear Editor, we have followed the PLOS ONE journal's requirements. Review Comments to the Author Reviewer #1: Overall a good effort in writing the manuscript, however the comparison with other studies should have been presented in a standard way. Authors’ response: Dear reviewer, thank you so much for your concern on this important section. We have corrected the mentioned section (highlighted on Page number 17; line number 290 and 291). Recommendation must mention the strategies to prevent obstructed labour in hospital settings such as training of birth attendants to monitor and identify cases who may land up in obstructed labour. Authors’ response: Dear reviewer, thank you so much for your valuable suggestions. We have mentioned the strategies to prevent obstructed labour in hospital settings as per your suggestion (highlighted on page number 17; line number 295 and 296). Reviewer #2: The author has addressed the comments raised by the reviewers. The manuscript reads much better than before. Authors’ response: Dear reviewer, thank you for your time with article. Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Authors’ response: Dear, we have revised the reference lists and completed and corrected some of missed contents of the references such as sure name, page number, DOI, Journals, and publishers. Additionally, we have replaced Reference no. 41 by a new relevant reference. The previous reference was incorrect and unintentionally placed during automated citing by Mendeley library. Thanks all for your time! Attachments Attachment Submitted filename: Response to Reviewers.doc https://doi.org/10.1371/journal.pone.0275170.r004
13 Sep 2022 Decision Letter - Gulzhanat Aimagambetova, Editor Prevalence, causes, and factors associated with obstructed labour among mothers who gave birth at public health facilities in Mojo Town, Central Ethiopia, 2019: A cross-sectional study PONE-D-21-26867R2 Dear Authors, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Gulzhanat Aimagambetova Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0275170.r005
Formally Accepted
14 Sep 2022 Acceptance Letter - Gulzhanat Aimagambetova, Editor PONE-D-21-26867R2 Prevalence, causes, and factors associated with obstructed labour among mothers who gave birth at public health facilities in Mojo Town, Central Ethiopia, 2019: A cross-sectional study Dear Dr. Gezimu: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Gulzhanat Aimagambetova Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0275170.r006

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