الفهرس 
PRE-ECLAMPSIAOnly 14 pages are availabe for public view
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Abstract
SUMMARY AND CONCLUSION
I- SUMMARY
Preeclampsia is the most common serious pregnancy complication, affecting 3-7% of all pregnancies. It is a hypertensive syndrome, which if left untreated can develop into Eclampsia, an extremely dangerous and often fatal condition characterized by blood-clots and seizures.
Preeclampsia is characterized by high blood pressure (hypertension), fluid retention (oedema) and excessive protein levels in the urine (proteinuria). These symptoms are not evident during the early stages of pregnancy and as such preeclampsia can be difficult to diagnose. It is only detectable by regular antenatal checks on maternal blood pressure and urine, and as such women without access to adequate healthcare services are particularly at risk.
The aetiology of preeclampsia is multifactorial including vasospasm, endothelial dysfunction, inflammation and improper angiogenesis. Recent research has indicated that the poor development of placenta may be responsible, preventing the transfer of nutrients from mother to baby that are essential to its healthy development.
Apelin is defined as the endogenous ligand of the human APJ receptor encoded by the gene AGTRL1. The APJ system is strongly expressed within the vasculature of most organs including the placenta. Apelin is synthesized as a highly conserved pre-pro-peptide (77 amino acids), which is then converted into various active smaller peptides.
Apelin has been shown to be involved in vessel formation, where it exerts a pro-angiogenic role and in the regulation of cardiovascular function, by reducing arterial blood pressure, via stimulation of nitric oxide-mediated vasorelaxation.
Studies on the role played by this system in normal and high-risk pregnancies, including preeclampsia, have been limited, but some reports indicate that the levels of this adipocytokine are altered in both pregnant and preeclamptic women.
Through our research we aim to investigate specifically the clinical utility of maternal serum apelin in women with preeclampsia compared to those in normal pregnant women, and to evaluate the level of serum apelin in relation to the severity of pre-ecalmpsia.
Our study was conducted on fifty seven pregnant women with singleton pregnancy attending the Obstetrics emergency department of Ain Shams University suffering from pre-eclampsia during the third trimester of pregnancy; Twenty eight Patients with mild pre-eclampsia and twenty nine patients with severe pre-eclampsia. In addition to thirty healthy pregnant controls of the same gestational age and age of patient group.
All the studied individuals were subjected to full history taking and complete clinical examination. Blood samples were collected for determination of ALT, AST, RBS, creatinine, CBC and serum apelin, while random urine samples were collected for determination of total urinary proteins. Assay of serum apelin was carried out using an enzyme linked immunosorbent assay technique (ELISA).
The results of our study revealed that pre-eclamptic patients had statistically significant lower serum levels of apelin when compared to the normal pregnant females. However, our results also revealed that there is no significant difference between serum levels of apelin in mild and severe pre-ecalmptic patient groups.
Our study also showed a statistically significant decrease in the birth weight of the newly born babies of the pre-eclamptic mothers group compared to the newly born babies of the normal pregnant ones. Our correlation studies revealed a positive significant correlation between apelin and birth weight in normal pregnant women. We found also that there is no correlation between apelin and birth weight in pre-ecalmptic patient groups.
Assessment of the diagnostic performance of adjusted apelin in discriminating pre-eclamptic patients group versus healthy pregnant group revealed a diagnostic sensitivity of 87.7 %, specificity 66.7 % positive predictive value 83.3% and negative predictive value 74.1% and the best diagnostic cut off level was 0.7 ng.mL.
The results of this study demonstrated decreased serum apelin concentrations in women with preeclampsia compared to the levels found in women with normal pregnancies and demonstrated also that there is no significant difference between serum levels of apelin between mild and severe pre-eclamptic patients groups.