الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Background: preeclampsia is an exclusive complication of pregnancy that can be diagnosed by the presence of hypertension and proteinuria after 20 weeks of gestation. It is the third most common cause of maternal mortality worldwide. Neurological complications are quite common and contribute to poor prognosis in these patients. Raised intracranial pressure (ICP) is one of the main consequences of preeclampsia that can be reflected by a change in the optic nerve sheath diameter as a clinical and radiologic sign. Aim of the work: The aim of the study was to evaluate the correlation between ultrasonographic measurement of ONSD and severity of preeclampsia and to evaluate the incidence of raised ICP in preeclampsia. Patients and methods: This prospective observational study was conducted at the intensive care unit (ICU) of Mansoura University Hospital from July 2019 to June 2020. One hundred fifty postpartum females aged between 18 and 45 years old were enrolled and allocated into 3 groups according to severity of preeclampsia as defined by the guidelines of the American College of Obstetricians and Gynecologists ( ACOG ): group (1) that included 50 normotensive pregnant females as a control group. group (2) that included 50 preeclamptic patients without severe features. group (3) that included 50 patients with severe preeclampsia. Patients were managed according to our institution protocol. Demographic data of the patients were recorded. Laboratory markers for severity of preeclampsia were measured daily for 48 hours. Blood pressure measurement along with median ultrasonographic ONSD for both eyes were recorded every 6 hours for 48 hours. Results: There was a significant difference in the mean basal values of ONSD between the three groups. The mean basal values were 4.85±0.32 mm, 6.05±0.096 mm and 6.67±0.25 mm in the control, preeclampsia without severe features and severe preeclampsia groups respectively. Serial recording of ONSD every six hours showed a descending trend along with blood pressure in the severe preeclampsia and preeclampsia without severe features groups while it showed a static trend in the control group. 40% of preeclampsia without severe features group had ONSD values higher than 5.8 mm and 64% of eclamptic patients had such high values which had shown a significant correlation with raised ICP more than 20 mmHg in previous studies. Receiver Operating characteristics (ROC) curve analysis showed that the best cut off value of ONSD that would predict the risk of preeclampsia was 5.61 mm and the value that would predict the risk of eclampsia was 6.26 mm. Conclusion: Ultrasonographic measurement of optic nerve sheath diameter (ONSD) provides a non-invasive, quick and readily accessible tool for evaluation of raised intracranial pressure (ICP). The results of our study showed that there was a correlation between higher ONSD measurements and severity of preeclampsia. Using a cut off value of ONSD, we can predict the risk of preeclampsia and eclampsia. It should be emphasized that ONSD should be a part of multimodal approach for the management of these patients and not a sole driving factor for decision making for better outcome.