الفهرس 
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Abstract
P
reeclampsia is a pregnancy-specific multi-system disorder that is characterized by development of hypertension and proteinuria after 20 weeks of gestation, resolving by 6-12 weeks postpartum in a previous normotensive woman. It occurs in about 5% to 10% of all pregnancies and results in substantial maternal and neonatal morbididty and mortality.
The etiologic factors causing this disease are still not completely clear, although evidence support involvement of genetic, immune, angiogenic, and other mechanisms.
Most consider hypertension and proteinuria to be the hallmark of preeclampsia, but the clinical manisfestations of this syndrome are very heterogenous. Some women develop severe maternal disease requiring intensive care, whereas others remain asymptomatic.
Preeclampsia can be classified into two types:
- Mild preeclampsia
- Severe preeclampsia
As preeclampsia pathophysiology involves multisystem affection, as cerebral, visual, and renal symptoms.
Aims of management of preeclampsia are the following:
Prevent convulsions, prevent complications, such as cerebrovascular hemorrhage, pulmonary edema, renal failure, abruption placentae, and fetal death, deliver a surviving child with minimal trauma to the mother.
Magnesium sulfate is considered the standard agent for the prevention and treatment of eclamptic convulsions. The American College of Obstetricians and Gynecologists recommends the use of magnesium sulfate in every women with a diagnosis of preeclampsia or eclampsia during labor and the postpartum period.
Randomized trials have evaluated protein or salt restriction, calcium, zinc, magnesium, fish oil, or vitamin C and E supplementation and low dose aspirin. There is some suggestion from observational studies that heparin reduces recurrent preeclampsia in women with thrombophilias.
The need of early detection and prediction of preeclampsia is the main initiator of us and many other researchers to explore the novel biomarker Pentraxin 3. The long PTX3 gene is generated in tissues that cope with excessive or deregulated cell death and inhibits the cross presentation of cell associated antigens. We examined whether PTX3 is expressed during pregnancy and possibly involved in the development of preeclampsia.
Pentraxin (PTX3) is a recently described inflammatory molecule that belongs to the same family of the well known C-reactive protein(CRP). PTX3 differs from CRP in terms of cellular origin, molecular inducers, and kinetic of production. It is expressed by different cells like endothelial cells, monocytes, macrophages, and fibroblasts exposed to inflammatory stimuli. PTX3 plasma levels increase dramatically during endotoxic shock, sepsis, or other inflammatory conditions. Recent studies suggest that PTX3 plays an important role in innate immunity, female fertility, inflammatory process and preeclampsia.
There is evidence of different studies that encouraged us to introduce PTX3 as a suitable predictor for preeclampsia:
1. PTX3 is unrelated to maternal demographic characteristics.
2. Independence of PTX3 levels from various risk factors in the first trimester.
3. PTX3 levels do not change significantly through out pregnancy.
4. PTX3 levels rise significantly in preeclamptic patients.
Our case control study was conducted at Ain Shams University Hospital during the period from January 2013 to December 2013. A total of 85 pregnant women were included in the study, and were categorized into 3 groups:
-group I: Control group(n=40) non complicated pregnancies
-group II: Mild preeclampsia(n=20) patients having mild preeclmapsia
-group III: Severe preeclampsia(n=25) patients having severe preeclampsia.
There was significant positive correlation between the preeclamptic and the control group showing high systolic pressure, diastolic pressure, pitting lower limb edema, proteinuria, platelet count and liver function enzymes in patients with preeclampsia. They also presented with headache.
It was recorded that preeclamptic patients delivered at a smaller gestational age with no labour pain, and the urgency of CS was performed for the maternal and fetal safety.
Otherwise no significant difference was recorded in the rest of the collected data between the three groups. Mild and severe preeclampsia didn’t show any detectable difference in our research.
The median serum Pentraxin 3(PTX3) was significantly higher in women of group II [Mild PE Group] and group III [Severe PE Group] when compared to group I[Control Group].Yet there was no significant difference in the PTX3 serum level between mild and severe PE.
The best cutoff value of serum Pentraxin 3 as a predictor of PE was ≥ 6.157 ng/ml (sensitivity 66.67 %, specificity 87.88 %).