الفهرس 
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Abstract
•Type of the study:
A prospective clinical study.
•Aim of the study: *The main objective was:
To determine the effect of trans-dermal nitric oxide donor on the treatment of patients with pre-eclampsia. *Other objective were:
1-The effect of drug on fetal welfare.
2-The presence of possible maternal side effect of the drug.
3-Whether withdrawal of the drug is associated with recurrence of the clinical manifestation of the disease.
•Subjects:
- The study was carried out on 30 selected primigravidae who attended the obstetrics and gynecology department in Benha University Hospitals during the period from June 2000 to June 2002.
Selected primigravidae had a singleton pregnancy, 26-30 weeks’ pregnant, elevated blood pressure exceeding 140/90, proteinuria more than 0.3gm, and had elevated uterine artery impedance to flow as seen from the presence of bilateral early diastolic notch in the doppler velocity wave from.
•Methods:
- Thirty primigravidae were given nitric oxide donqr ”nitro-derm patch” daily for 10 days.
- The patient was given the medication for 18 hours daily and 6 hour free of patch to avoid drug tolerance.
- All the thirty patient continued the follow up. And each patient were evaluated :
(a) Before the start of the treatment.
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Summary
(b)24 hours after the start of treatment.
(c)72 hours after the start of treatment
(d)Ten days after the start of treatment
(e)One week after the stoppage of treatment - In each follow up the following procedures were done:
1-Clinical parameters: (weight, height, Bl. Pressure. Puls, Resp. rate and urine volume per 24 hours.
2-Biochemical parameters: (Albumin, Serum uric acid and serum creatnine).
3-Deppler study this was done for uterine, umbilical and fetal middle cerebral arteries.
• Results
During the period of the study we obtained the following :
1-Pulse rate rose from pretreatment level after 24 hours of the start of treatment and still significantly higher than pretreatment level after 72 hours. Then we found that ten days of treatment and one week after stoppage of treatment the pulse rate was not significantly different from pretreatment level.
2-Systolic blood pressure decrease from pretreatment level after 24 hours of the start of treatment and still significantly lower than pretreatment level after 72 hours and ten days of the start of treatment. Then one week after stoppage of treatment the systolic blood pressure was not significantly different from pretreatment level.
3-Diastolic blood pressure decrease from pretreatment level after 24 hours of the start of treatment and still significantly lower than the pretreatment level after 72 hours and ten days of the start of treatment. Then one week after stoppage of treatment the diastolic blood pressure was elevated but still significantly lower than pretreatment level.
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Summary
4-The mean arterial pressure decrease from pretreatment level after 24 hours of the start of treatment and still significantly lower than the pretreatment level after 72 hours and ten days of the start of treatment. Then one week after stoppage of treatment. The mean arterial pressure increased but still significantly lower than pretreatment level.
5-The respiratory rate increase but not significantly from the pretreatment level during the period of treatment and also not significantly different from the pretreatment level. One week after stoppage of treatment.
6-The 24 hours urinary albumin, serum uric acid and serum creatinine levels showed non significant changes during the period of treatment and after stoppage of treatment.
7-The urine output increase significantly from the pretreatment level during the period of treatment. Then one week after stoppage of treatment. The urine out put decrease but still significantly higher than pretreatment level.
8-Nitroglycerin application led to a significant decrease in uterine artery pulsatility index and resistance index after 24 hours of the start of treatment. Pulsatility index and resistance index continued to decrease until the last day of treatment then one week after removal of the last patch. The pulsatility index and resistance index non-significantly different from that pretreatment .
9-The umbilical artery pulsatility index decrease non- significantly from pretreatment level after 24 and 72 hours of the start of nitroglycerin application then ten days after nitroglycerin application the pulsatility index show significant DROP than pretreatment level then one week after stoppage of treatment the pulsatility index non-significantly different from that pretreatment.
10-Nitroglycerin application led to a significant decrease in the umbilical artery resistance index after 24 hours of the start of treatment. Resistance index continued to decrease until the last day of treatment.
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Then one week after removal of the last patch. The resistance index non-significantly different from that pretreatment.
11-Nitroglycerin application led to non - significant difference in the fetal middle cerebral artery pulsatility index and resistance index during the period of the treatment and also after stoppage of the treatment.
12-Seven cases out of 30 cases studied showed amniotic fluid index below the 10th percentile of the late mid trimester level (50 mm). when the patients reevaluated again after 24 hours those seven patients still showed diminshed amniotic fluid volume. After 72 hours only 4 cases showed signs of oligohydramnios after 10 days not a single case had AFI below 50 mm. after one week of stoppage of treatment two cases had AFI below 50 mm.
13-After the first application of nitroglycerin 17 patients reported headache not sever nough to necessitate discontinuation of treatment. Then headache decrease in intensity and did not necessitate analgesics and all patients continue the treatment. No other side effects were noted.