الفهرس 
Hypertensive Disorders of PregnancyOnly 14 pages are availabe for public view
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Abstract
C
opeptin, the C-terminal part of A.V.P precursor (C-T. pro A.V.P) which is consisted of 39 amino acids glycopeptides, copeptin together with vasopressin co-synthesized and co-secreted from posterior pituitary.
Copeptin is produced in 1:1 ratio to AVP .Therefore, it mirrors the amount of vasopressin in the circulation, but, copeptin is more stable in plasma and serum because it has longer biological half life.
In recent years, copeptin has being studied as a diagnostic and prognostic biomarker in various diseases for example, acute myocardial infarction, diabetes insipid us and pre-eclampsia.
Pre-eclampsia is a serious complication of pregnancy. It continues to be a major cause of maternal mortality &perinatal morbidity and mortality.
Pre-eclampsia is characterized clinically by complex of symptoms including maternal hypertension and proteinuria with or without pathological edema that usually occurs after the 20th week of gestation and the symptoms may range between mild, moderate and severe.
Pre-eclampsia continues to be a leading cause of preterm birth and IUGR who defines as baby weights are less than fifth percentile and pathological blood flow in the umbilical arteries in combination with oligohydramnios which defines as a 4- quadrant amniotic fluid index < or =6 cm. So, ultrasongoraphic Doppler velocimetry is used in the obstetric field as a non-invasive method for evaluating placental circulation hence, in the diagnosis of IUGR.
Aim of the Work
The Aim of This Study was:
It was for the estimation of maternal serum copeptin level in normal (control) and pre-eclamptic pregnant women using ultrasound& Doppler velocimetry associated with presence or absence of IUGR.
And to compare between neonates with IUGR delivered to pregnant women complicated with pre-eclampsia and high level of serum copeptin with IUGR neonates delivered from non complicated women having normal level of serum copeptin.
All cases of the present study were selected from Ain- Shams University Maternity Hospital. The study was carried out on 159 pregnant women with singleton pregnancy. It was included patients suffering from pre-eclampsia mild or severe and a control group of normal pregnant females& the cases were divided into 3 equal groups: Group A ”Control group”, group B ”Mild pre-eclampsia” &Group C ”Severe pre-eclampsia”.
Patients selected for this study fulfilled the following inclusion criteria: Maternal age was (18-38years old), gestational age was (20 to 39 weeks) &patients with singleton pregnancy.
The following patients were excluded:
Patients with GDM, chronic hypertension, diabetes mellitus, previous renal disease, multiple pregnancies, active labor, premature rupture of membrane and inflammation.
After the informed consent, all patients were subjected to: full history, full clinical, abdominal examination and certain investigations such as: complete urine analysis, complete blood count, SGOT, SGPT, urea, creatinine, uric acid and prothrombine time & concentration.
Blood samples were taken and centrifuged to separate the serum then examined by ELISA technique for serum copeptin value.
Serum copeptin level was significantly higher in pre-eclamptic patients than non pre-eclamptic pregnancies and more in severe pre-eclampsia than in mild preeclampsia. The maternal s.copeptin in the severe pre eclampsia group was (614.70±414.806) compared to the mild pre eclampsia group was (352.15±93.482) and the control group was (223.70±102.308) (P value = < 0.001).
There was significant correlation between serum copeptin and the severity of pre-eclampsia and, according to the ROC analysis, the best cut off value of s. copeptin was 297 ng/ml with sensitivity was 85.8% & Specificity was 75.5%.
Also, there was positive correlation between serum copeptin with Umb. Artery RI &Ut. artery PI in pre-eclamptic patients.
FGR that could present by the development of pre-eclampsia, IUGR had statistically significant difference among pre-eclampsia groups.
As, they were 11 (20.8%) in the severe pre eclampsia group compared to mild pre eclampsia 6(11.3%) &the control group 3 (5.8%) (P value = 0.021).
The NBW was significantly lower in severe pre-eclampsia group (2436.42±614.908) compared to the mild pre eclampsia group (2587.83±365.830) and the control group (2895.09±332.673) (P value = < 0.001).
The ROC curve to define the best cut off value for copeptin to detect IUGR. The best cut off value of s. copeptin was 484.50 ng/ml with sensitivity was 85% & Specificity was 92%.
from all this, we concluded that, maternal serum copeptin was increased in pre-eclamptic pregnant women than non pre-eclamptic pregnant women and more in severe pre-eclamptic pregnancies than mild pre-eclamptic pregnancies.
FGR that was higher in severe pre-eclamptic pregnancies than non pre-eclamptic pregnancies having high levels of maternal serum copeptin.
And, maternal serum copeptin was correlated with umbilical artery RI & uterine artery PI by the development of pre-eclampsia.