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Janoudi G, Uzun (Rada) M, Boyd ST, Fell DB, Ray JG, Foster AM, Giffen R, Clifford TJ, Walker MC. Do Case Reports and Case Series Generate Clinical Discoveries About Preeclampsia? A Systematic Review. Int J Womens Health 2023; 15:411-425. [PMID: 36974131 PMCID: PMC10039711 DOI: 10.2147/ijwh.s397680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 03/13/2023] [Indexed: 03/29/2023] Open
Abstract
Background Preeclampsia is a leading cause of maternal and perinatal mortality and morbidity. The management of preeclampsia has not changed much in more than two decades, and its aetiology is still not fully understood. Case reports and case series have traditionally been used to communicate new knowledge about existing conditions. Whether this is true for preeclampsia is not known. Objective To determine whether recent case reports or case series have generated new knowledge and clinical discoveries about preeclampsia. Methods A detailed search strategy was developed in consultation with a medical librarian. Two bibliographic databases were searched through Ovid: Embase and MEDLINE. We selected case reports or case series published between 2015 and 2020, comprising pregnant persons diagnosed with hypertensive disorders of pregnancy, including preeclampsia. Two reviewers independently screened all publications. One reviewer extracted data from included studies, while another conducted a quality check of extracted data. We developed a codebook to guide our data extraction and outcomes assessment. The quality of each report was determined based on Joanna Briggs Institute (JBI) critical appraisal checklist for case reports and case series. Results We included 104 case reports and three case series, together comprising 118 pregnancies. A severe presentation or complication of preeclampsia was reported in 81% of pregnancies, and 84% had a positive maternal outcome, free of death or persistent complications. Only 8% of the case reports were deemed to be of high quality, and 53.8% of moderate quality; none of the case series were of high quality. A total of 26 of the 107 publications (24.3%) included a novel clinical discovery as a central theme. Conclusion Over two-thirds of recent case reports and case series about preeclampsia do not appear to present new knowledge or discoveries about preeclampsia, and most are of low quality.
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Affiliation(s)
- Ghayath Janoudi
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | | | - Stephanie T Boyd
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Deshayne B Fell
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Children’s Hospital of Eastern Ontario (CHEO) Research Institute, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Joel G Ray
- Departments of Medicine, Health Policy Management and Evaluation, and Obstetrics and Gynecology, St Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - Angel M Foster
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | | | - Tammy J Clifford
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Canadian Institute of Health Research, Government of Canada, Ottawa, ON, Canada
| | - Mark C Walker
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- International and Global Health Office, University of Ottawa, Ottawa, ON, Canada
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, Canada
- Department of Obstetrics, Gynecology & Newborn Care, The Ottawa Hospital, Ottawa, ON, Canada
- BORN Ontario, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
- Correspondence: Mark C Walker, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice Changing Research, Box 241, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada, Tel +1 613-798-5555 x76655, Email
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Pham A, Rosenthal E, Roman A, Makhamreh M, Berghella V, Farhi F, Al-Kouatly HB. Preeclampsia resolution after fetal death in multifetal gestation: a systematic literature review. Am J Obstet Gynecol 2020; 222:385-389. [PMID: 31689382 DOI: 10.1016/j.ajog.2019.10.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 10/29/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Amelie Pham
- Department of Obstetrics and Gynecology, George Washington University School of Medicine and Health Sciences, Washington, DC.
| | - Emily Rosenthal
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Amanda Roman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Mona Makhamreh
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Vincenzo Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Farnaz Farhi
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Huda B Al-Kouatly
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
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Bij de Weg JM, de Groot CJ, Pajkrt E, de Boer MA. Recovery of second trimester pre-eclampsia after fetal reduction of a triplet. BMJ Case Rep 2019; 12:12/9/e227667. [PMID: 31537585 DOI: 10.1136/bcr-2018-227667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Women with a multiple pregnancy are at increased risk of developing hypertensive disorders of pregnancy. We describe a case of a dichorionic triamniotic triplet pregnancy complicated by severe hypertension, proteinuria and maternal symptoms, fitting with the diagnosis of pre-eclampsia, apart from the early gestational age of only 16 weeks. After reduction of the monochorionic pair, the disease resolved and pre-eclampsia was diagnosed again at 30 weeks of gestation, resulting in a delivery on maternal indication at 33 weeks of gestation. In a review of the literature, we found six papers including eight cases on multifetal pregnancy reduction on maternal indication. Multifetal pregnancy reduction resulted in a prolongation of pregnancy of two to 21 weeks and may be considered in extreme early onset pre-eclampsia in dichorionic multiple pregnancies.
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Affiliation(s)
- Jeske M Bij de Weg
- Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Christianne J de Groot
- Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Eva Pajkrt
- Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marjon A de Boer
- Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Okumura M, Fushida K, Francisco RPV, Schultz R, Zugaib M. Triploid twin gestation with single fetal demise associated with partial mole and pre-eclampsia. Australas J Ultrasound Med 2017; 20:174-177. [PMID: 34760492 DOI: 10.1002/ajum.12064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Both partial mole and twin gestation are conditions associated with the risk of the early onset of pre-eclampsia. In cases of twin gestation, the death or selective termination of a severely growth-restricted fetus may lead to the reversal of maternal pre-eclampsia because of the involution or death of the pathological placenta, as has been reported by some authors. This case demonstrates that in a twin triploid gestation, in spite of the demise of one of the fetuses, the respective partial molar placenta can continue to grow and may contribute to the development or to the worsening of the pre-eclampsia.
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Affiliation(s)
- Maria Okumura
- Department of Obstetrics Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
| | - Koji Fushida
- Department of Obstetrics Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
| | | | - Regina Schultz
- Division of Pathology Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
| | - Marcelo Zugaib
- Department of Obstetrics Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
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Balcı S, Bodur T, Tohma YA, Okyay RE, Saatli B, Altunyurt S. Do preeclampsia symptoms resolve after intrauterine death of a fetus? Turk J Obstet Gynecol 2016; 13:103-105. [PMID: 28913102 PMCID: PMC5558336 DOI: 10.4274/tjod.84770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 02/20/2016] [Indexed: 12/01/2022] Open
Abstract
We present two cases of twin pregnancies without resolution of preeclamptic symptoms after intrauterine death of one twin. Case 1: A nulliparous woman aged 37 years was referred at 26 weeks of gestation because of arterial hypertension, edema, and growth restriction in one twin. Three weeks later the restricted twin died. During the following three weeks, ultrasound examinations showed a reduced growth velocity of the surviving fetus and reversed umbilical flow. At the end of the 34th week of gestation, cesarean section was performed and a healthy female infant was delivered. Case 2: A nulliparous woman aged 33 years with a 27-week twin pregnancy was referred because of arterial hypertension and discordant growth. The restricted twin died at 31 weeks of gestation. Following the death, within two weeks the growth of the co-twin started to slow down and reversed end diastolic flow presented. At the end of the 33rd week of gestation, cesarean section was performed and a healthy female infant was delivered. The interesting point of these cases was the secondary effects on the co-twins. During the time after intrauterine deaths of one twin, the surviving fetuses started to show a reduced growth velocity and reversed umbilical flow and mothers had increased blood pressure and proteinuria again. We think that both cases are evidence of late on-set systemic maternal effects (such as systemic maternal endothelial activation and/or systemic maternal inflammatory response) depends on preeclampsia.
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Affiliation(s)
- Serdar Balcı
- Başkent University Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Taylan Bodur
- Muğla Yücelen Hospital, Clinic of Obstetrics and Gynecology, Muğla, Turkey
| | - Yusuf Aytaç Tohma
- Başkent University Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Recep Emre Okyay
- Dokuz Eylül University Faculty of Medicine, Department of Obstetrics and Gynecology, İzmir, Turkey
| | - Bahadır Saatli
- Dokuz Eylül University Faculty of Medicine, Department of Obstetrics and Gynecology, İzmir, Turkey
| | - Sabahattin Altunyurt
- Dokuz Eylül University Faculty of Medicine, Department of Obstetrics and Gynecology, İzmir, Turkey
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