الفهرس 
Risk Factors For Pre-EclampsiaOnly 14 pages are availabe for public view
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Abstract
Rowe et al. (2001) stated that there are a number of possible circulating factors that could be implicated in the pathogenesis of pre-eclampsia. One of them is VEGF.
VEGF is a potent angiogenic growth factor including endothelial cell proliferation, chemotaxis and new blood vessel formation (Ferrara et al., 1992).
Some researchers found that serum levels of VEGF increase significantly in pre-eclampsia (Baker et al., 1995). Other researchers found that serum VEGF are significantly reduced in pre-eclipse (Lyall et al., 1997).
Some researchers mentioned that VEGF has a relationship with uterine and umbilical artery Doppler alterations in pre-eclampsia (Crispi, 2006).
Therefore we conducted a study to try and demonstrate whether there is a relationship between serum levels of VEGF pre-eclampsia. We also tried to establish whether there is a relationship between the level of VEGF in the serum and uterine and umbilical artery changes in cases of pre-eclampsia.
We conducted the study in Al Gala Teaching Maternity Hospital over a period of two years.
The study design consisted of obtaining consent from 60 normotensive pregnant patients, 80 mild pre-eclamptic patients and 80 severe pre-eclamptic patients.
The inclusion criteria were: Gestational age 28-40 weeks, singleton pregnancy, nulliparas and maternal age 20-40 years.
The exclusion criteria were: chronic hypertension, diabetes mellitus and any chronic medical disorders.
For each case we conducted full general, abdominal and vaginal examination. We also measured VEGF antenatally for all cases and 48 hours and one week postpartum for the pre-eclamptic cases. We also measured serum Hb, Platelets, ALT, Urate and creatinine for each case antenatally and postnatally. We measured uterine artery and umbilical artery Dopplers for all the cases antenatally.
The data were statistically analysed and results were put in tables for comparison and on graphs using multivariate analysis to exclude any confounding factors.
The results showed that VEGF increased exponentially according to the severity of pre-eclampsia. It also showed that the higher the VEGF the more incidence of IUGR and low neonatal birth weight. Serum VEGF and other biochemical parameters returned slowly to normal levels at 48 hours postpartum in mild and severe pre-eclampsia and almost to complete normal levels at one week post delivery. The return to normal levels was quicker in mild pre-eclampsia and slower in severe pre-eclampsia. The results also showed that there is a definite relationship between the serum levels of VEGF and uterine and umbilical artery Dopplers. The higher the serum VEGF the more impedance to placental blood flow demonstrated by high uterine artery resistance index and absent or reversed umbilical artery end diastolic flow.
Some studies agreed with our findings including Baker et al. (1995) who found that serum levels of VEGF increase in pre-eclampsia.
El-Salahy et al. (2001) showed similar findings to our study as VEGF was higher in the pre-eclamptic group than the normotensive group.
Buhemschi et al. (2005) study showed low platelets level and higher Urate the higher the serum VEGF which agrees with our study.
Our study also agreed with Crispi et al. (2006) who showed IUGR and low birth weight were higher in severe pre-eclampsia when there were high levels of VEGF.
Sclembach et al. (2007) agreed with our study as they showed that maternal serum FLT-1 was significantly higher in pre-eclamptic patients.
However, Lyall et al. (1997) study disagreed with ours in that it showed reduced serum VEGF in pre-eclampsia.
Livingston et al. (2000) disagreed with our study in that it showed low levels of VEGF in pre-eclampsia while normotensive patients had detectable levels of VEGF.
Simmons et al. (2000) findings agreed with our study in that they found that the higher the VEGF is the higher the uterine artery resistance index.
Also, Crispi et al. (2006) showed that the higher the VEGF in pre-eclampsia the more impedance in uterine artery flow demonstrated by increased uterine artery resistance index.
We therefore conclude that there is a definite correlation between the serum levels of VEGF and pre-eclampsia. We have shown that the more severe the pre-eclampsia is the higher the VEGF. The serum levels of this substance decline after delivery more solely in the severe cases. We also conclude that the higher the VEGF is the more impedance to placental blood flow demonstrated by increased uterine artery resistance index and absent or reversed umbilical artery end diastolic flow.