الفهرس 
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Abstract
Clinical Risk Prediction Of Preeclampsia In Egyptian Primigravidae.Type: Prospective, Clinical, Observational.Place: Department of Obstetrics and Gynecology, Zefta General Hospital, Gharbia, Egypt.Duration: from July 2017 To june 2019.AIM: To reassess the value of simple ,available and easy clinical and biophysical tests, which could be done during routine antenatal care in Egyptian primigravidae, at 28-32 weeks gestation, for the prediction of pregnancy-induced hypertension (PIH) and preeclampsia(PE).These tests include; blood pressure changes (systolic, diastolic, mean arterial blood pressure),isometric exercise tests (IET) and roll-over tests (ROT).
SUBJECTS and METHODS Subjects: Two hundred Egyptian Pregnant Primigravidae, from the same demographic area (around Zefta), 20 to 30 years old , 28 to 32weeks pregnant in a singleton pregnancy and fulfilled the selection criteria for the study.Methods:Complete history : Family, Personal and Present history.• Complete general, medical and obstetric examination, with - Careful measurement of BP (Systolic, diastolic , mean), that was less than 140/90mmHg.- Examination of a midstream , clean-catch urine sample that was negative for patients by a dip-stick method.•Performance of 3clinical vasoconstriction biophysical tests1. Roll over test (ROT)2. Standing up pressor test (SPT)3. Isometric exercise tests (IET)Follow up: Routine antenatal care visits (every 4 weeks till 32w gestation , then every 2 weeks till 36w and then weekly till delivery).• Primigravidae who remained normotensive in follow up visits , continued as such till delivery•If there was increase in BP>140/90 and /or detection of albuminuria (+1 or more , they were refered to an OB/GYN Specialist and /or Consultant in the Department for more senior assessment and /or management till delivery.
• Delivery was in the hospital , with an antenatal specialist attending during and after delivery to take care of the baby.All data on- Mode of delivery APGAR score at 5 m-Need for Neonatal ICU Were recorded till discharge.RESULTS Among the 200 primigravidae, 12 developed gestational hypertension (6%), 15 developed preeclampsia (7.5%) and 173 remained normotensive (86.5%).. Despite being normotensive and non proteinuric at baseline assessment, yet baseline values of mean diastolic and mean BP levels were significantly higher in women who developed GH and PE (P=0.18 for DBP and 0.029 for MAP). (Table 2)•In short women (<163 cm), compared to average height (164-171 cm) and tall (>171 cm); Incidence of GH did not increased (P=0. 39).Incidence of PE statistically significant increased (P=0.016).-Incidence of GH vs PE showed no statistically significant difference (P=0.17).( Table 2, 3A, 3B,3C)• In 12 women who developed GH; one had 3 tests ,5 had 2 tests and 6 had one test +ve. In 15 women who developed PE; 4 had 3 tests, 7 had 2 tests and 4 had one test +ve. PE had satistically significant more cases with 2 or 3 tests positive, compared to gestational hypertension (P=0.015). (Table 4)•Both ROT and IET showed that :-Sensitivity of 66.7% and 51.9%, respectively.-Specificity and +ve PV of 100%, in both tests.-Negative PV >90% (95.s% and 93.0%, respectively.These figures denote that both tests are good in predicting PE when +ve and refuting PE if –ve. (ROC 1, 2, 3, 4 Table No5, 6, 7, 8)• Outcomes measured showed that:-There was a statistically significant difference regarding less duration of pregnancy, fetal weight and Apgar score in PE , and GH, versus normotensive (P<0.001) and NICU admission (P=0.003) .- There was no statistically significant difference between the 3 groups regarding mode of delivery, being vaginal or c.s (P=0.74).(Table No 9)
• Results of the current study were Similar to other similar, comparable, tests done for the prediction of the development of Gestational hypertension and preeclampsia , regarding the validity of MAP, ROT and IET.