الفهرس 
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Abstract
SUMMARY AND CONCLUSION
Pre-eclampsia is a pregnancy specific disorder
complicating 5% to 7% of pregnancies, and characterized by
hypertension, proteinuria, edema and activation of the haemostatic system. Pre-eclampsia is one of the major causes of maternal and prenatal morbidity and mortality (Sibai et al,
1994).
The pathogenesis of pre-eclampsia remains obscure, insufficient placentation has been implicated as the underlying cause of the disease (Redman, 1991). In the development of maternal manifestations of pre-eclmapsia, dysfunction of the vascular endothelial cells is considered to play a major role (Roberts et al, 1989).
It is known that there is insulin resistance in normal pregnancy (Catalano et al, 1991). As well as an association between the degree of insulin elevation and hypertension during the lird trimester (Bauman et al, 1982). It has been suggested that insulin resistance might be common etiologic factor causing hyperinsulinemia, hypertension, hypertriglyceri-daemia and low serum HDL-C, a cluster of risk factors for coronary artery disease also designated ”syndrome X (Reaven, 1988) or insulin resistance syndrome (Ferrannini et al, 1991).
femininity and Conclusion - 8I -
Lorentzen et al, (1994), hypothesized that alteration in circulating lipids may contribute to the induction or endothelial dysfunction in patient c. with pre-eclampsia
Schiff et al, (1994), hypothesized that increased TN11-(x production may be associated with pre-eclampsia, if not as casual factor, then possibly as a mediator of subsequent pathophysiological changes. The aim of this work was to investigate the serum levels of insulin and tumour necrosis factor - alpha and their role of pathogenesis in pregnancy induced hypertension evidenced by histopathological changes
of the placenta.
The study included 40 women with pregnancy induced hypertension and 40 normotensive pregnant women as control in the third trimester of pregnancy. They were subjected to complete history taking, general, obstetrical examination, measuring serum levels of insulin and tumour necrosis factor-alpha (TNF-a) via radioimmunoassay and histopathological examination of the placentae after delivery. The results \ ere
studied statistically.
In the present work, the pre-eclamptic women showed statistically significant elevation of serum insulin and TN k-u compared with healthy pregnant women. Pre-eclamptic women showed necked eye and histopathological changes of the placenta. Serum insulin levels showed no statistically
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Summary and Conclusion - 82 -
significant changes between different age and gestational age groups in control and study cases also no significant changes were detected when different age and gestational age groups of
control and study cases are compared. Serum TNF-a levels showed no statistically significant changes between different
age and gestational age groups in control and study cases, however serum TNF-a levels were significantly elevated in
age groups I 20 years) and II (21-25 years) of study cases
compared with control cases. Also TNF-a levels were significantly elevated in study cases at gestational age groups II (31-35 weeks) and III (> 35 weeks) compared with control
cases.
Increased plasma TNF-a has been implicated in the pathophysiology of pre-eclampsia. TNF-a can induce adipocyte lipolysis, promote de-novo-hepatic fatty acids (FA) synthesis and impair hepatic FA oxidation and ketogenesis -the result is increased hepatic triglyceride synthesis. Furthermore the significantly higher TNF-a and TNF-R levels reported in patients with HELLP syndrome further support a role for TNF-a in liver dysfunction.
TNF-a also reduces lipoprotein lipase activity thereby impairing removal of triglycerides rich lipoproteins from the circulation. Stark (1993) emphasized the ability of TNF-a to induce oxidative stress and lipid peroxidation at the mitochondria’ level, phenomena that have been suggested as
Summuly and Conclusion
possible factors in the pathophysiologic mechanisms of pre-eclampsia. from this study it is concluded that, TNF-u and insulin have a role in the pathogenesis of pregnancy induced hypertension through causing endothelial cell changes of the placental blood vessels.