PONE-D-24-17196Risk factors for emergent delivery before 36 weeks among pregnant women with placenta accreta spectrum disorderPLOS ONE

Dear Dr. Petpichetchian,

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.

Reviewers appreciated the manuscript. However, some concerns are present. The main point regards adopted inclusion and exclusion criteria. The exclusion of cases who underwent elective CS before 36 weeks removed a population that may have worse characteristics from the study. A description of these cases and a comparison with the included population may be helpful. Second, a better description of methods, particularly US evaluation, is needed. 

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PLOS ONE

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Additional Editor Comments:

Reviewers appreciated the manuscript. However, some concerns are present. The main point regards adopted inclusion and exclusion criteria. The exclusion of cases who underwent elective CS before 36 weeks removed a population that may have worse characteristics from the study. A description of these cases and a comparison with the included population may be helpful. Second, a better description of methods, particularly US evaluation, is needed.

• I would suggest a language revision to improve some typos and grammatical errors.

• The introduction is well-written and clearly supports the study rationale.

• Methods. I would suggest providing some examples of conditions unrelated to PAS.

• Methods. Why did the authors exclude women who underwent planned delivery between 34-36 weeks? May this group represent patients without unplanned cesarean section?

• How was the list of patients retrieved, and eligible patients identified? Was a register of PAS cases present?

• Lines 135-140 highlight the cut-off of 36 weeks as the limit considered appropriate for all pregnancies with PAS. This questions why some patients underwent planned CS between 34-36 weeks. Because these patients were excluded, more severe cases would have been removed and representativeness reduced. I would suggest discussing this limitation of the study.

• Which is the source of data presented in lines 144-146?

• Lines 133-135. I would suggest clarifying the results of this evaluation. How were cases classified, and based on which criteria?

• Multivariable NOT multivariate

• Results. Lines 154-156. I would suggest providing some details regarding patients who underwent CS between 34-36 weeks and comparing them with the study population.

• Lines 166-167. Did the authors observe differences in the concordance rate based on the type of placental pathology?

• Table 1. What do the authors mean by the Number of PUCs? Number of episodes?

• Table 2. The Placenta previa is missing.

• I would suggest providing the definition for all US parameters in text or supplementary material to allow the study to be reproduced.

• Comparing outcomes between those who delivered before and after 36 weeks, considering that before 36 weeks, we only have emergent vs. both emergent and elective CS after, may introduce some biases.

• Providing the reasons for emergent CS of included cases would help understand whether these cases were mandatory. Moreover, comparing cases of those who had undergone elective CS before 36 weeks would allow for a more complete view.

• Discussion. Supporting that provided results would help identify patients who may benefit from an early elective CS around 34 weeks and require all emergent CS after 34 weeks. What is the mean gestational age at emergent CS?

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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: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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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

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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

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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: Thank you for a well written and researched article. However, I have a few minor corrections for better clarity

a. Page 10, lines 81-82: Cancel ‘s recent committee opinion’ as it is a repetition

b. Page 10, line 93: Cancel ‘and’

c. Page 11, lines 106-108, please clarify; Not clear

“, where delivery timing must be planned at approximately 34 weeks of DA to extend the pregnancy beyond 36 weeks

Reviewer #2: his is an extremely interesting retrospective study on the timing of delivery in pregnant women with placental abnormalities. The text is written in proper English, the statistical analysis appears methodologically sound, and the data presented in the results are consistent with the discussion. Overall, the study highlights possible risk factors that increase the likelihood of emergent preterm delivery in the patient category under study. It would be valuable to validate these findings by conducting a prospective study, which could help reduce the risk of bias.

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Reviewer #1: No

Reviewer #2: No

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Risk factors for emergent delivery before 36 weeks among pregnant women with placenta accreta spectrum disorder

PONE-D-24-17196R1

Dear Dr. Petpichetchian,

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.

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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,

Simone Garzon

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

The manuscript and the reviewers’ comments were carefully evaluated. The Reviewers appreciated the manuscript and the improvements. Now it can be accepted. Compliments!

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 #2: All comments have been addressed

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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 #2: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

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 #2: Yes

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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 #2: Yes

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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 #2: I believe that the author has made the necessary revisions to the manuscript in accordance with the feedback and recommendations provided by both the editor and the reviewers. I highly appreciate the effort put into addressing these points, and I find the revised version to be significantly improved and more aligned with the required standards.

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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 #2: No

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