Can We Safely Decrease Early-Term Delivery and Cesarean Section Rate in Pregnancies Complicated by Fetal Transposition of Great Arteries?
Round 1
Reviewer 1 Report
Dear authors
congratulations it has been a huge pleasure for me to revise this paper
TGA is one of the most common CHD and i do agree early delivery ad CS are almost routine
i have minor revisions to suggest:
Introduction
- please add more information about the prenatal incidence and detection rate
- please give some sentences on how to diagnose it antenatally (read and cite PMID: 36786908)
- please add some immages that can help the reader to understand the type of CHD both US and a proper pictureù
Methods are fine
results well presented
discussion interesting
conclusions fine
Author Response
(1) Please add more information about the prenatal incidence and detection rate.
(1) As recommended, we have incorporated information about the disease's incidence and detection rate in the Introduction section.
(2) Please give some sentences on how to diagnose it antenatally (read and cite PMID: 36786908)
(2) As recommended by the reviewer, we have expanded the information concerning prenatal diagnosis in the introduction, incorporating, among other details, the suggested reference.
(3) Please add some images that can help the reader to understand the type of CHD both US and a proper picture
(3) Following the reviewer's suggestion, we have included two of our own images that illustrate the prenatal diagnosis of TGA.
Reviewer 2 Report
This retrospective study with only 17 cases failed to provide the strong evidence to support the conclusion that " Favoring full- term delivery, we can safely reduce early-term deliveries and caesarean section rate in prenatally diagnosed TGA"
Otherwise, only a prospective study with randomization and comparative groups would provide strong evidence for the optimal time of delivery in this vulnerable population
Author Response
(1) This retrospective study with only 17 cases failed to provide the strong evidence to support the conclusion that " Favoring full- term delivery, we can safely reduce early-term deliveries and caesarean section rate in prenatally diagnosed TGA"
(1) We appreciate the reviewer for their comment and contributions. We concur that, given the current design of the study, it is not feasible to extrapolate or generalize the results; rather, they can serve as a foundation to provide evidence for more ambitious studies. Therefore, to prevent any misunderstandings, we have amended the first sentence of the conclusion, emphasizing that these are the outcomes specific to our study: “In our study, favoring full-term delivery in prenatally diagnosed TGA, we can safely decrease the incidence of early-term deliveries, reduce the rate of cesarean sections, and lower the percentage of infants with low birth weight”.
We have further expanded the concluding paragraph of the study's discussion, elucidating the inherent limitations of this study type: “In our retrospective study, it's important to recognize its inherent limitations. Depending on existing data introduces potential inaccuracies, and the study's retrospective nature hinders the ability to establish causal relationships due to uncontrolled con-founding factors. Nonetheless, the study provides valuable historical insights, serving as a basis for future prospective research.”
(2) Otherwise, only a prospective study with randomization and comparative groups would provide strong evidence for the optimal time of delivery in this vulnerable population
(2) We agree with the reviewer that the most effective approach to contribute substantial evidence is through the conduction of a prospective study. Due to the limited number of cases, we have recently initiated a multicenter study on this matter, building upon the data and conclusions of the study submitted to this journal. Hence, the significance of its publication, as it could potentially lay the foundation for a larger study (currently under assessment by the local ethical committee).
