الفهرس 
PreeclampsiaOnly 14 pages are availabe for public view
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Abstract
Preeclampsia is a multi-system disorder characterized by hypertension and proteinuria in the last half of pregnancy. Although most affected pregnancies deliver at term or near term with good maternal and fetal outcomes, these pregnancies are at increased risk for maternal and/or fetal mortality or serious morbidity.
Preeclampsia is defined according to ACOG as hypertension (diastolic blood pressure> 90 mmHg, systolic blood pressure >140 mmHg) based on at least 2 measurements taken at least 4 hours apart and significant proteinuria (Proteinuria >300 mg\24 hours or at least +2 on dipstick.
The cause of preeclampsia is still unknown. A completely satisfactory, unifying hypothesis has not emerged. It is likely that there may be several etiologies or underlying predispositions with effects that result in preeclampsia.
Vasospasm or increased vascular reactivity and endothelial cell dysfunction may be the final common pathway of several different patholgic mechanisms.
Endothelial dysfunction is accompanied by elevated levels of inflammatory markers.
Hepcidin, a small polypeptide produced by hepatocytes is mainly expressed in the liver. Other possible sites of hepcidin are heart, brain, choroid plexus, lung and placenta .Hepcidin is the main regulator of iron absorption and its tissue distribution. The human hepcidin gene is located on chromosome 19q13.1, encodes a precursor protein of 84 amino acids (aa).
At present, four pathways control liver hepcidin production:
(i) Iron store-related regulation
(ii) Erythropoietic activity driven regulation
(iii) Inflammation related regulation, and
(iv) Mandatory signaling pathway.
All interact with hepatocytes to initiate/inhibit the production of sufficient hepcidin for iron homeostasis.
The purpose of this study was to to compare hepcidin levels in cord blood of neonates in pregnant women with preeclampsia.
This study was a Case control study that was conducted at Ain Shams University Maternity Hospital and El Galaa teaching Hospital during the period from September 2013 to July 2014.
The study was approved by the ethical committee of the Department of Gynecology and Obstetrics Faculty of Medicine Ain Shams University to compare serum hepcidin levels in cord blood in neonates of pregnant women with preeclampsia to the levels in neonates of normal pregnant women. It included one hundered and thirty four pregnant women who had attended the emergency department in labor aged 20 - 40 years, primigravida or multigravid, gestational age ≥37 weeks gestation, BMI ≥25 and all deleveries were by vaginal route either by spontaneous labor or by induction of labor and the cases group had criteria of preeclampsia as it defined before. Excluded were women with other medical disorders, congenital fetal malformations, intrauterine growth restriction due to any cause other than preeclampsia, meconium stained liquor and smoking. Divided into two groups:
group A) case group(: Consisted of 67 pregnant women with term gestations (≥37 completed week’ gestation) with preeclampsia to whom termination of pregnancy was done.
group B (control group): consisted of 67 normotensive pregnant women with no evidence of preeclampsia (≥37 completed weeks gestation) and in labor.
The cord blood samples were collected for assessment of Hepcidine level by ELISA technique.
The present study showed a statistical significant difference in systolic blood pressure. Mean (±SD) systolic blood pressure in preeclampsia group was 151(± 13) while in other normal group mean (±SD) systolic blood pressure was 113 (± 9) and this gives p value <0.001.
The current study showed a statistical significant difference in diastolic blood pressure. Mean (±SD) diastolic blood pressure in preeclampsia group was 96 (± 8) while in other normal group mean (±SD) diastolic blood pressure was 73 (± 7) and this gives p value <0.001.
The present study showed a statistical significant difference in age. Mean (±SD) in preeclamptic group was 28.9(5.7) while in normal group was 25.6(4.5). Also the study showed a statistical significant difference in BMI. mean (±SD) in preeclamptic group was 28.8(2.6)while in normal group was 26.9(2.0) and this gives p value <0.001.
Also there was a statistical significant difference in parity between the two groups. Median (interquartile range) parity in preeclamptic group was 2(0-3) while in other normal group median (interquartile range) was 1(0-2) and p value was 0.002.
As regard WBCs count there was statistical significant difference between both groups as mean (±SD)in preeclampsia group was 9.5(3.6) while in normal group was 7.1(2.6) and p value was <0.001.
As regard Protein in urine the present study showed a statistical significant difference between the two groups as number of patients (percentage) who had Protein in urine (+2) in preeclampsia group was 18 (26.9%) while in other normal group no women had Protein in urine (+2). also number of patients (percentage) who had protein in urine (+3) in preeclampsia group was 24(35.8%) while in other normal group no women had Protein in urine (+3) and this gives p value <0.001.
Cord blood Hepcidine level was statistically significantly higher in preeclampsia group. Median (interquartile range) cord blood Hepcidin level in preeclampsia group was 6.0 (3.6-8.5) while in other normal group was 0.7 (0.5-1.5) and P-value was 0.000.
The current study has shown that, there was a statistically significant correlation between cord blood Hepcidin level and systolic blood pressure Rho= 0.695, diastolic blood pressure Rho= 0.697, mean blood pressure Rho= 0.685, WBCs count Rho= 0.317, PT with Rho= 0.375 and BUN with Rho= 0.368.
There was strong correlation between cord blood hepcidin level and albuminuria Rho= 0.748.
The correlation with systolic blood pressure, diastolic blood pressure, mean blood pressure, WBCs count and protein in urine were positive.
Cord blood Hepcidin levels were higher in women with preeclampsia than in healthy pregnant women as there was statistically highly significant difference between preeclamptic and control (healthy pregnant women) groups as regarding the cord blood level (P < 0.001).
The receiver operating characteristic (ROC) curve showed that the best cut of value was at Hepcidin concentration>2 ng/ml, as at this point, sensitivity of 92.5% (95% CI, 83.4 - 97.5), a specificity of 89.6% (95% CI, 79.7 - 95.7%), a PPV of 89.9% (95% CI, 80.1 - 95.9%), and a NPV of 92.3% (95% CI, 83.0 - 97.5%).