الفهرس 
Pre-eclampsiaOnly 14 pages are availabe for public view
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Abstract
Pre-eclampsia develops in 5-8% of human pregnancy after 20 weeks of gestation.
The diagnosis of pre-eclampsia was made using the current American College of Obstetricians and Gynecologists (ACOG) guidelines, these guidelines defined pre-eclampsia as sustained pregnancy-induced hypertension with proteinuria. Hypertension was defined as sustained blood pressure reading of ≥ 140/90mmHg (with readings taking place ≥6 hours apart) or a sustained 15mmHg diastolic rise or increase in systolic blood pressure of 30mmHg above first trimester blood pressure values. The ACOG defined proteinuria as urine protein concentration of ≥ 30mg/dl (or 1+on a urine dipstick).
Pre-eclampsia can result in eclampsia when convulsions develop or manifest as the hemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome.Both eclampsia and HELLP syndrome are known to be associated with severe complications such as cerebral hemorrhage, renal insufficiency, lung oedema and liver hemorrhages.
Several etiologies have been implicated in the development of pre-eclampsia. Some of them include abnormal trophoblastic invasion of uterine blood vessels, immunological intolerance between feto-placental and maternal tissue, maladaption to cardiovascular changes or dietary deficiencies and genetic abnormalities.
Endothelial cell dysfunction and inflammation are considered to have a crucial role in the pathophysiologic mechanisms of pre-eclampsia. There is increasing interest in a possible link between infection-inflammation and endothelial dysfunction and between endothelial cell dysfunction in pre-eclampsia.
The complement system, a major component of the innate immune system, is comprised of different plasma proteins reacting with one another in a proteolytic cascade, generating active and powerful products that provide early defense mechanisms against pathogens. Opsonization, chemotaxis and lysis of microorganisms may result from activation of the complement cascade. Furthermore, the complement system has been attributed to modulate adaptive immunity through regulation of B and T cell responses, and its involvement in antiviral response has recently been suggested.
Complement levels (C3 and C4) may decrease with increased lupus activity, because these proteins are consumed in the inflammatory process.
In pregnancy, however, the complement levels may increase 10% to 50% in response to increased hepatic protein synthesis. Therefore, the utility of complement measurement in pregnancy is unclear.
Our recent studies and those of other investigators have demonstrated that complement proteins, particularly C1, C3, and C4, can bind to apoptotic cells and blebs, and thus may play an important role in maintaining immune tolerance by facilitating the clearance of autoantigen-containing apopotic bodies.
So this study tried to determine the levels of serum C3 and C4 in pre-eclampsia and their association with severity of the disease to investigate whether if C3 and C4 may be used as markers of severity of pre-eclampsia.
This study was carried in Ain Shams University Maternity Hospital in order to establish a reference data representing the value of measurement of maternal serum C3 and C4.
The study group was divided into two groups:
Group A (25 pregnant women): Pre-eclamptic patients.
Group B (15 normal pregnant women): Control group.
Serum C3 and C4 was significantly lower in pre-eclampsia than that of normotensive pregnant women. Serum C3 was non significantly decreased with severity of pre-eclampsia C3 (mean) (mild pre-eclampsia: 208.7+90 and severe pre-eclampsia: 203.6+73). Seum C4 was significantly decreased with severity of pre-eclampsia C4 (mean) (mild pre-eclampsia: 38.3+8 and severe pre-eclampsia: 31.7+10). There was statistical positive significant correlation between C3 and C4 versus each others and C3 versus gestational age. Receiver operating characteristic for C3 shows that the best cutoff value is 200 mg/dl which gives a sensitivity of 55% and specificity of 70% in pre-eclampsia. Receiver operating characteristic for C4 shows that the best cutoff value is 35 mg/dl which gives a sensitivity of 60% and specificity of 74 % in pre-eclampsia. The positive predictive value for serum C3 and C4 were 80%. The negative predictive value for serum C3 and C4 were 75%.