الفهرس 
AcknowledgementOnly 14 pages are availabe for public view
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Abstract
Summary
Preeclampsia is major contributor to perinatal mortality and morbidity worldwide. It is characterized by impaired trophoblastic invasion of the maternal spiral arteries and their conversion from narrow muscular vessels to wide non–muscular channels (Odibo AO et al., 2002).
Pre-eclampsia (PE) is a multi-system disorder particular to pregnancy. It is characterised by widespread endothelial dysfunction, resulting in hypertension due to vasocons¬triction, proteinuria attributable to glomerular damage and oedema secondary to increased vascular permeability, occurring in 2-4% of pregnancies, cons¬titutes a major risk factor for maternal and fetal morbidity and mortality in developed countries (Vanessa A. Rodie, 2006).
Blood flow through the uteroplacental circulation can be studied non-invasively using Doppler ultrasound. The impedance to flow in the uterine arteries decreases with gestation in normal pregnancies, reflecting the trophoblastic invasion of the spiral arteries and their conversion into low-resistance vessels (Papageorghiou, 2005).
This was a prospective study for prediction of preeclampsia at an early stage in pregnancy to improve both maternal and fetal outcome
The aim was to assess the predictive value of serum Antithrombin III and 2nd trimester uterine artery Doppler waveforms for developing preeclampsia.
In our study 100 pregnant women at risk for developing preeclampsia (complete outcome data were available in 100 (100%) cases) attending for routine examination at 23-27 weeks at antenatal care clinic at benha University hospital and Ismailia general hospital during the period from june 2011 to may 2012 were included. the women were healthy and normotensive.The fetal growth was normal, and there were no obvious fetal anomalies.
Transabdominal uterine artery Doppler velocimetry was done, The pulsed Doppler was used to obtain blood flow velocity waveforms. the presence of an early diastolic notch (bilateral) in the waveform was noted, and the mean pulsatility index and resistance index of the two arteries were calculated. Antithrombin III was measured in all patients to detect any abnormalities
In this study group, 9% of cases developed preeclampsia and delivered earlier and in 91% of cases there is no increase in blood pressure, The results of our study show that there is no statistically significant difference could be detected between PE and normal group regarding age , gestational age, parity ,past history of PE , IUGR and family history of PE. There is statistically significant difference between PE and normal group regarding gestational age at delivery as all cases of preeclampsia delivered earlier than normal group and also There is statistically significant difference between PE and normal group regarding mode of delivery as most caase of PE delivered by CS. .
Also the results of the study show mean value of pulsatility index in PE group is (1.54) while it is (0.75) in normal group ,so there was statistically significant difference between PE and normal group regarding pulsatility index, 5of 9 of the cases who developed preeclampsia had bilateral uterine artery notches, mean value of resistance index in PE group is (0.69) while it is (0.37) in normal group ,so there was statistically significant difference between PE and normal group regarding resistance index.
Antithrombin III is found to be non significant in prediction of preeclampsia and it does not improve the sensitivity of second trimester uterine Doppler velosimetry.
Our results demonstrated that, a one-stage color Doppler screening program at 23-27 weeks identified most women who subsequently developed serious complications of impaired placentation associated with delivery before 34 weeks, and may aid in stratifying antenatal care.