الفهرس 
Introduction
PreeclampsiaOnly 14 pages are availabe for public view
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Abstract
Summary and Conclusion
Reliable prediction of preeclampsia, its complication and related clinical maternal and fetal adverse outcomes is a high medical need in pregnancy care. Diagnosis of preeclampsia depend on the measurement of blood pressure and proteinuria even though both measures are poorly predictive of adverse maternal and fetal outcomes and complications. Due to the unpredictable nature and probable severeity of adverse outcomes associated with preeclampsia, women with suspected preeclampsia may need to be hospitalized for nearby observation and monitoring (frequent laboratory testing and evaluation of fetal outcome) .However, some women with diagnosed preeclampsia carry pregnancy almost to delivery without complications.
The ability to rule out the probability of preeclampsia complications developing in at risk women through a negative predictive test would be an important advance in pregnancy care and would allow valuable resources to be directed to the patients who need them most. There is increasing recognition that preeclampsia is a systemic multi-organ condition for which clinical criteria alone are inadequate to predict adverse outcomes.
The aim of the present study was to evaluate changes in maternal serum sFlt-1 and NGAL concentrations in preeclampsia pregnancy women to predict the occurrence of complication and maternal-fetal outcome.
This prospective Cohort study consisted of 30 eclamptic, 30 severe preeclamptic and 24 healthy singlet on pregnancies, the proteomic work identified severeal novel results not previously been identified in Woman’s Health Hospital – Assiut University. Quantitative measurement of serum sFlt-1 and NGAL levels was done by enzyme linked immunosorbent assay technique using a sandwich enzyme-linked immunosorbent assay kit. Serum sFlt-1 and NGAL levels were compared between the groups. Diagnostic performance and clinical association of these markers were evaluated.. Maternal complications included IUGR, IUFD, HELLP syndrome and AKI. Maternal-fetal outcome assessment included Neonatal outcome fetus status, Apagar score, referral to PCU, and admission of ICU and duration of hospital stay.
SFlt-1 mean serum levels concentrations were significantly higher in complicated severe preeclamptic group than in those uncomplicated cases (120.2 vs. 72.2 ng/ml; Mann- Whitney U test p< 0.001) and complicated eclamptic group than in those uncomplicated cases (298.3 vs. 128.1 ng/ml; Mann- Whitney U test p< 0.001). Strong association with occurred of complicated severe preeclampsia and complicated eclampsia pregnant women types (Eta=0.873; p<0.001) and (Eta=0.953; p<0.001) respectively. SFlt-1 correlated with diagnosis of preeclampsia and it`s complication via systolic blood pressure, diastolic blood pressure, CBC indices, LDH mean, PT mean, liver function test and kidney function test (p<0.001). SFlt-1correlated with maternal-fetal outcome different from negative correlation with Apagar score (p<0.001) and positive correlation with stillbirth infant, referral to PCU, admission of ICU and more duration of hospital stay (p<0.001). Maternal complications were more common in the elevated sFlt-1 OR of 1.119 (95% CI 1.057-1.184), it`s clinically and statistically significant (p<0.001).In the current study calculated maximum sensitivity and specificity from ROC curve to determine suitable cut off point 102.60 (ng/ml) in which sensitivity 90% and specificity 80%.
NGAL mean levels cwere significantly higher in kidney complicated severe preeclamptic group than in those kidney uncomplicated cases (1388.6 vs. 899.9 ng/ml; Mann- Whitney U test p< 0.001) and kidney complicated eclamptic group than in those kidney uncomplicated cases (3751.5 vs. 1733.8 ng/ml; Mann- Whitney U test p< 0.001). Strong association with occurred of complicated severe preeclampsia and complicated eclampsia pregnant women types (Eta=0.764; p=0.008) and (Eta=0.763; p=0.004) respectively. NGAL correlated with diagnosis of preeclampsia and kidney complication via systolic blood pressure, diastolic blood pressure and kidney function test (p<0.001). NGAL correlated with maternal-fetal outcome different from no statistically significant difference with Apagar score and positive correlation with stillbirth infant, referral to PCU, admission of ICU and more duration of hospital stay (p=0.047) and (p<0.001)respectively. Maternal complications were more common in the elevated NGAL OR of 1.004 (95% CI 1.002-1.006), it`s clinically significant (p<0.001).
In the present study calculated maximum sensitivity and specificity from ROC curve to determine suitable cut off point 1099.39 (ng/ml) in which sensitivity 70% and specificity 76.6% for prediction of complicated preeclampsia in general but we calculated another cut off point 1243.50 (ng/ml) for prediction of occurring AKI in which sensitivity 91% and specificity 80%.
SFlt-1 and NGAL may be potential biomarkers for preeclampsia. Their levels increase significantly in preeclampsia and they are related to the severeity of the disease. These results are in agreement with the generalized endothelial damage and persistant inflammatory status in preeclampsia. The results of serum of sFlt-1 will provide evidence to date on the accuracy of short-term prediction of preeclampsia/eclampsia/HELLP syndrome/IUGR/IUFD. NGAL were potential biomarker for renal injury in preeclampsia. SFlt-1 and NGAL may be also an indicator for adverse maternal-fetal outcomes with decreased placental hypoperfusion.
Recommendations
It is recommended that this study be carried out in the first and second trimester of pregnancy to confirm the prediction of complications with preeclampsia so that sufficient time is available to treat preeclampsia its complications and reduce fetal-maternal complication.