الفهرس 
Pre-eclampsiaOnly 14 pages are availabe for public view
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Abstract
Pre-eclampsia is a serious and common hypertensive complication of pregnancy that is a leading cause of maternal and neonatal mortality and morbidity, which is characterized by new onset hypertension, generally appearing after the 20th week of gestation. It is characterized by hypertension, proteinuria, vascular abnormalities, and often intrauterine growth retardation.
Worldwide, the incidence of pre-eclampsia ranges between 2% and 10% of pregnancies. The incidence of eclampsia in developing nations varies widely, ranging from 1 case per 100 pregnancies to 1 case per 1700 pregnancies. Rates from African countries such as South Africa, Egypt, Tanzania, and Ethiopia vary from 1.8% to 7.1%.
Although the etiology of pre-eclampsia remains unknown, endothelial cell dysfunction plays an important role in its pathogenesis.
Furthermore, increased soluble CD40L and upregulated CD40/CD40L expression were detected in the whole-blood platelets and monocytes of women with pre-eclampsia.
The only effective treatment is delivery of the fetus and placenta.
The aim of this work is to assess the presence of an inflamatory response during pre-eclampsia by demonstration of CD40 ligand in pre-eclamptic pregnancies compared with normal pregnancies.
The current study was carried out at Obstetrics and Gynecology Department, University Hospital, Faculty of Medicine, Menoufiya University, in the duration between January 2010 and Augst 2013.
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This study included 103 subjects; 15 females (normal non- pregnant females) of apparently healthy, non pregnant females whose age ranged from 25-33 years old, 20 females (normal pregnant females) of apparently healthy, at gestational age after 20 weeks of pregnancy whose age ranged from 25-30 years old, and 68 pregnant females suffering from pre-eclampsia at gestational age after 20 weeks of pregnancy whose age ranged from 25-33 years old.
All subjects included in this study were subjected to the following:
- Thorough history taking with stress on history of headache blurring of vision, chronic diseases, and past history of pre-eclampsia.
- Complete clinical examination with stress on general examination including measurement of blood pressure.
- Laboratory examination as liver function tests including (AST, ALT, srum albumin, Prothrombin time and concentration), kidney function tests including (urea, creatinine), urine protein, CBC, and CD154 antigen (CD40L) by ELISA.
Statistical analysis of the results revealed:
- There were no significant statistical differences among all studied groups regarding age, (P>0.05).
- There were highly significant statistical differences between group III, and group II regarding systolic and diastolic blood pressure (P<0.001), with higher levels in groupIII compared to groupII.
- There were non significant statistical differences between group III, and group II regarding AST, and ALT (P>0.05). Meanwhile, mean values of serum albumin and prothrombin concentration
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showed high significant statistical differences between group III and group II with lower levels in group III compared to group II (P<0.001).
- There were highly significant statistical differences between group III, and group II regarding Urea, and Protein in 24 hours urine with higher levels in group III compared to group II, (P<0.001), and significant statistical differences between group III, and group II regarding creattinine with higher levels in group III compared to group II, (P<0.05).
- There were significant statistical differences between group III, and group II regarding platelets with lower levels in group III compared to group II, (P<0.05).
- According to he mean values of soluble CD40L in serum, there were significantly higher in group III, (1.64 ± 1.51ng/ml), than in group II, (0.33 ± 0.11ng/ml), (P<0.001), it also showed that the mean values of soluble CD40 ligand in serum there were significantly lower in group III (1.64 ± 1.51ng/ml) than in group I, (2.36 ± 0.78ng/ml), (P<0.001). ), it also showed that the mean values of soluble CD40 ligand in serum were significantly lower in group II (0.33 ± 0.11ng/ml ) than in group I (2.36 ± 0.78ng/ml ), (P<0.001).
- The Receiver Operating characteristic (ROC) curve for CD40 ligand in serum revealed that the best cut off level of CD40 ligand in serum is 0.57, where the sensitivity was 100%, specificity 95.0%, positive predictive value 98.6%, negative predictive value 100%, and diagnostic accuracy 98.9%, the area under the curve was 0.998.