الفهرس 
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Abstract
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.
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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