Do Case Reports and Case Series Generate Clinical Discoveries About Preeclampsia? A Systematic Review

Ghayath Janoudi,1,2 Mara Uzun (Rada),3 Stephanie T Boyd,1 Deshayne B Fell,2,4 Joel G Ray,5 Angel M Foster,6 Randy Giffen,7 Tammy J Clifford,2,8 Mark C Walker1,2,9– 12 1Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; 2School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada; 3Independent Researcher, Ottawa, ON, Canada; 4Children’s Hospital of Eastern Ontario (CHEO) Research Institute, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada; 5Departments of Medicine, Health Policy Management and Evaluation, and Obstetrics and Gynecology, St Michael’s Hospital, University of Toronto, Toronto, ON, Canada; 6Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada; 7IBM Canada, IBM, Toronto, ON, Canada; 8Canadian Institute of Health Research, Government of Canada, Ottawa, ON, Canada; 9International and Global Health Office, University of Ottawa, Ottawa, ON, Canada; 10Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, Canada; 11Department of Obstetrics, Gynecology & Newborn Care, The Ottawa Hospital, Ottawa, ON, Canada; 12BORN Ontario, Children’s Hospital of Eastern Ontario, Ottawa, ON, CanadaCorrespondence: 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 mwalker@toh.caBackground: 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.Keywords: hypertensive disorders of pregnancy, eclampsia, HELLP syndrome, study design

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