الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 85 |  |  |
| | | from | 85 | | |
Abstract
Summary
Pre-eclampsia is one of hypertensive disorders with pregnancy which is a serious complication of human pregnancy, and is associated with significant maternal and perinatal morbidity and mortality. Pre-eclampsia is the second leading cause, after embolism, of maternal mortality.
It occurs in about 5% to 10% of all pregnancies and results in substantial maternal and neonatal morbidity and mortality.
Most consider hypertension and proteinuria to be the hallmarks of pre-eclampsia, but the clinical manifestations of this syndrome are very heterogeneous. Some women develop severe maternal disease requiring intensive care, whereas others remain asymptomatic with mild hypertension and proteinuria.
Preeclampsia can be classified into two types:
- Mild preeclampsia.
- Severe preeclampsia.
As Preeclampsia pathophsiology involves multisystem affection so there are diverse presentations, we can classify it according to system affection, as cerebral, visual, and renal symptoms.
Aims of management of preeclampsia are the following:
- Prevent convulsions
- Prevent complications, such as cerebrovascular hemorrhage, pulmonary edema, renal failure, abruptio placentae, and fetal death.
- Deliver a surviving child with minimal trauma to the mother
Magnesium sulfate is considered the standard agent for the prevention and treatment of eclamptic convulsions. The American College of Obstetricians and Gynecologists recommends the use of magnesium sulfate in every woman with a diagnosis of preeclampsia or eclampsia during labor and the postpartum period.
There are numerous clinical trials describing the use of various methods to prevent or reduce the incidence of preeclampsia. Because the etiology of the disease is unknown, these interventions have been used in an attempt to correct theoretical abnormalities in preeclampsia. In short, randomized trials have evaluated protein or salt restriction, calcium, zinc, magnesium, fish oil, or vitamins C and E supplementation and low dose aspirin. There is some suggestion from observational studies that heparin reduces recurrent preeclampsia in women with thrombophilias.
Activin-A is one of the Fetal and placental unit endocrinology dysfunction-related tests which is used to predict preeclampsia and its severity.
Activins are growth and differentiation factors belonging to the transforming growth factor- (TGF-) superfamily. Activins were originally isolated from follicular fluids based on their ability to stimulate pituitary follicle-stimulating hormone (FSH) secretion and were thought to be protein hormones involved in the feedback regulation of FSH.
However, it is now recognized that activins are produced by a variety of tissues and organs in the body and are involved in the regulation of many physiological and developmental processes.
There is evidence for increased proliferation of the underlying cytotrophoblast in preeclampsia. This may be due to repair of ischemic damage to the surface syncytiotrophoblast. These processes of damage and repair may cause the functional alteration of a surface layer of syncytiotrophoblast in the preeclampsia placenta and may explain the increase in concentration of these biochemical markers
Our case-control study was conducted at Beni suef University Hospital during the period between July 2016 and May 2017. A total of 130 pregnant women were included in the study, and were categorized into 3 groups:
- group I: [Severe PE Group] (n=30): including women having severe PE.
- group II: [Mild PE Group] (n=30): including women having mild PE.
- group III: [Control Group] (n=70): including normotensive non-proteinuric pregnant women.
The median serum Activin-A was significantly higher in women of group I [Severe PE Group] when compared to women of groups II [Mild PE Group] and III [Control Group]. The median serum Activin-A was significantly higher in women of group II [Mild PE Group] when compared to women of group III [Control Group].
There was significant positive correlation between serum Activin-A level and each of systolic blood pressure, diastolic blood pressure, mean arterial blood pressure, proteinuria grade by dipsticks, serum AST, ALT, creatinin. There was significant negative correlation between serum Activin-A level and each of platelet count, gestational age at delivery and birth weight.
The best cutoff value of serum Activin-A as diagnostic of PE was ≥ 188.55 pg/ml (sensitivity 85%, specificity 80%). The best cutoff value of serum Activin-A as diagnostic of sever PE was ≥ 327.3 pg/ml (sensitivity 80%, specificity 90%).