Subspecialty Influence on Scientific Peer Review for an Obstetrics and Gynecology Journal With a High Impact Factor.

OBJECTIVE: To evaluate whether quality of peer review and reviewer recommendation differ based on reviewer subspecialty in obstetrics and gynecology and to determine the role of experience on reviewer recommendation. METHODS: We performed a retrospective cohort study of reviews submitted to Obstetrics & Gynecology between January 2010 and December 2014. Subspecialties were determined based on classification terms selected by each reviewer and included all major obstetrics and gynecology subspecialties, general obstetrics and gynecology, and nonobstetrics and gynecology categories. Review quality (graded on a 5-point Likert scale by the journal's editors) and reviewer recommendation of "reject" were compared across subspecialties using χ, analysis of variance, and multivariate logistic regression. RESULTS: There were 20,027 reviews from 1,889 individual reviewers. Reviewers with family planning subspecialty provided higher-quality peer reviews compared with reviewers with gynecology only, reproductive endocrinology and infertility, gynecologic oncology, and general obstetrics and gynecology specialties (3.61±0.75 compared with 3.44±0.78, 3.42±0.72, 3.35±0.75, and 3.32±0.81, respectively, P<.05). Reviewers with gynecology-only subspecialty recommended rejection more often compared with reviewers with a nonobstetrics and gynecology subspecialty (57.7% compared with 38.7%, P<.05). Editorial Board members recommended rejection more often than new reviewers (68.0% compared with 41.5%, P<.05). Increased adjusted odds of manuscript rejection recommendation were associated with reproductive endocrinology, female pelvic medicine and reconstructive surgery, and gynecology-only reviewer subspecialty (adjusted odds ratio [OR] 1.23 [1.07-1.41], 1.21 [1.05-1.39], and 1.11 [1.02-1.20]). Manuscript rejection recommendation rate was also increased for reviewers who had completed the highest quintile of peer reviews (greater than 195) compared with the lowest quintile (one to seven) (adjusted OR 2.85 [2.60-3.12]). CONCLUSION: Peer review quality differs based on obstetrics and gynecology subspecialty. Obstetrics and gynecology subspecialty and reviewer experience have implications for manuscript rejection recommendation. Reviewer assignment is pivotal to maintaining a rigorous manuscript selection process.

Evidence to inform decisions about maternal-fetal surgery: technical brief.

OBJECTIVE: To summarize the state of research in maternal-fetal surgery regarding the surgical repair of abnormalities in fetuses in the womb. DATA SOURCES: We searched MEDLINE from 1980 to 2010 for studies of maternal-fetal surgery for the following conditions: twin-twin transfusion syndrome, obstructive uropathy, congenital diaphragmatic hernia, myelomeningocele, thoracic lesions, cardiac malformations, and sacrococcygeal teratoma. METHODS OF STUDY SELECTION: We used pilot-tested data collection forms to screen publications for inclusion and to extract data. We compiled information about how fetal diagnoses were defined, maternal inclusion criteria, type of surgery, study design, country, setting, comparators used, length of follow-up, outcomes measured, and adverse events. TABULATION, INTEGRATION, AND RESULTS: Two reviewers independently extracted data and discordance was resolved by a third party. Of 1,341 articles located, we retained 258 (comprising 166 unique study populations). Three studies were randomized controlled trials; the majority of the evidence was observational (116 case series [70%], 36 retrospective [22%], and 11 prospective [7%] cohorts). Twin-twin transfusion is the most studied condition, with 84 studies including 2,532 pregnancies. Fewer than 500 pregnancies are represented in the literature for each of the other conditions except congenital diaphragmatic hernia (n=503). Inclusion criteria were poorly specified. Outcomes typically measured were survival to birth, preterm birth, and neonatal death. Longer-term outcomes were sparse but included pulmonary, renal, and neurologic status and developmental milestones. Maternal outcome data were rare. CONCLUSION: Although developing rapidly, maternal-fetal surgery research has yet to achieve the typical quality of studies and aggregate strength of evidence needed to optimally inform care.

Maternal-fetal surgery: where are we and how did we get here?

Using the criteria proposed in 1982 to justify consideration of in utero surgical treatment of fetal disorders, the development of maternal-fetal treatment is described, and an assessment of current status is provided. Significant issues remain, and many questions are unanswered. By using three different disorders, congenital diaphragmatic hernia, open spina bifida, and twin-to-twin transfusion, the complexity and sophistication of the field are explored, as well as the existing gaps in understanding.

The National Institutes of Health Workshop on Fetal Treatment: needs assessment and future directions.

The National Institute of Child Health and Human Development and Office of Rare Diseases convened a multidisciplinary group of experts on August 16-17, 2004, for a workshop entitled ''Fetal Treatment: Needs Assessment and Future Directions.'' The purpose of the workshop was to develop a plan for the surgical, obstetric, neonatal, and maternal-fetal fields for the evaluation and dissemination of maternal-fetal surgical innovations and to further the scientific evaluation of maternal-fetal surgery. This article highlights the discussions and outlines recommendations for the future. An overarching recommendation was for the formation of a cooperative group of investigators and clinicians to help set a national agenda for research and clinical progress, as well as emphasize ethical issues.

Evidence-based medicine and fetal treatment: how to get involved.

The Management of Myelomeningocele Study is a multicenter randomized controlled trial of in utero compared with postnatal repair of isolated spina bifida. Referral of potential patients to the Management of Myelomeningocele Study trial will provide the pregnant woman with substantial information about the fetal condition as well as the trial. The referral rate has been very slow. Possible reasons for this are physicians' and the public's belief that in utero surgery has already been proven to be better than postnatal repair or conversely to offer no benefit over standard therapy; that the trial does not address fundamental issues of maternal and fetal outcomes and safety; and that trial is not well designed. These beliefs are ill-founded. The practicing obstetrician has a fundamental role to inform potential patients about this and other research trials.

Impact of maternal-fetal surgery for myelomeningocele on the progression of ventriculomegaly in utero.

OBJECTIVE: Intrauterine myelomeningocele (MMC) repair decreases hindbrain herniation and the need for postnatal ventriculoperitoneal shunting. We examined the impact of intrauterine repair on the progression of ventriculomegaly in utero. STUDY DESIGN: Fetuses with MMC were identified through computerized databases from June 1988 to April 2003. A retrospective cohort design was used to evaluate the impact of intrauterine repair on ventricular progression with a multivariate linear regression model that included baseline ventricle measurement, gestational age, level of lesion, and gender. RESULTS: Fourteen fetuses with intrauterine repair and 39 fetuses with postnatal repair were identified. The natural history of progression of ventricular diameter increased in a linear fashion throughout gestation (0.57 mm/week). After adjusting for confounding variables, no transient or sustained difference was observed in the rate progression of ventriculomegaly between intrauterine and postnatal repair (0.27 +/- 0.35 mm/week; P=.45). CONCLUSION: Intrauterine MMC repair does not impact the progression of ventriculomegaly.