الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
PE with a high prevalence in the first pregnancy is associated with the highest maternal and foetal morbidity and mortality, The possibility of prediction of preeclampsia (PE) at 11-13±6 weeks of pregnancy is a fairly new concept in recent years,the objective of this study to assess role of uterine artery Doppler and late first trimester maternal serum pregnancy associated plasma protein A in early prediction of preeclampsia.
Material &Methods: prospective observational clinical study was done at the Department of Obstetrics & Gynecology , Benha university, with 200 pregnant women attending OPD at 11-13±6 weeks of gestation, approved by IRP, blood pressure was recorded, uterine aretery Doppler was done, blood sample for PAPP-A was drawn, uterine artery Doppler pulsatility index (pi) at 11-13±6 weeks of pregnancy was found to be agood screening method for prediction of preeclampsia. The data was analyzed using STATA/SE version 11.2 statistical analysis software.
Results: uterine artery Doppler pulsatility index (pi) at 11-13±6 weeks of pregnancy was found to be agood screening method (sensitivity 87%, specificity 96%) for prediction of preeclampsia.Conclusion:This study concluded that uterine artery Doppler was good screening method at 11-13±6 weeks of gestation for prediction of development of pre-eclampsia & mean pulsatility index was more valid than PAPP-A in prediction of early pre-eclampsia .
Preeclampsia (PE) is a pregnancy-specific condition characterized by hypertension and proteinuria that remits after delivery. PE with a high prevalence in the first pregnancy is associated with the highest maternal and foetal morbidity and mortality, preterm birth, perinatal death, and intrauterine growth restriction (1)
Preeclampsia is a multisystem maternal disorder specific to human pregnancy and occurs usually after 20 weeks of gestation. The prevalence of preeclampsia in developing countries ranges from 1.8% to 16.7% (2)
The exact pathogenesis of preeclampsia remains unknown but inappropriate trophoblast invasion and an imbalance between angiogenic factors, such as vascular endothelial growth factor (VEGF) and placental growth factor (PlGF), and factors inhibiting angiogenesis, such as solublefms-like tyrosine kinase (Flt)-1, are closely related to the pathogenesis of preeclampsia (3)
In normal pregnancy, the fetus must receive sufficient oxygen and nutrients via the maternal spiral arteries. To ensure this the spiral arteries should undergo conversion from low capacity, high resistance blood vessels to high capacity, low resistance vessels (4) .This vascular remodeling requires extravillous trophoblast cells to invade the decidual part of the spiral arteries at 8–12 weeks of gestation. This process of vascular remodeling begins in the late first trimester of pregnancy and ends by 18–20weeks of gestation(5)
In pregnancies complicated by preeclampsia, the vascular remodeling of the maternal spiral arteriesis restricted to the superficial portion of the decidua. Hence the placenta in preeclampsia is under perfused and hypoxic. The high resistance in the maternal spiral arteries can be detected with uterine artery Doppler velocimetry (UADV) from as early as 11thweek of gestation(6) .
The uterine artery Doppler measurements show the impendence to flow in uterine arteries which normally decrease in normal pregnancy and increase in preeclampsia(7)).
Pregnancy associated plasma protein-A (PAPP-A) is 1628 amino acid peptide linked by disulphide bonds mainly produced by the trophoblastic cells. It is said to have a role in regulating foetal growth due to its action of cleavage of insulin like growth factor binding proteins.(8)
There is recent evidence that low first-trimester maternal serum PAPP-A in chromosomally normal pregnancies is associated with an increased risk for subsequent development of PE(9) .Since insulin –like growth factor is believed to play a significant role in trophoblast invasion, it is not surprising that low–serum PAPP-A is associated with a higher incidence of PE (10).
Results
Eclampsia was investigated using the Receiver Operator characteristic curve. The best cut-off and the corresponding sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and the Area Under the Curve (AUC) were estimated.
Out of 200 women enrolled in our study, 14 women developed preeclampsia.
In present study , all women were Egyptian , primigravida, had asingleton pregnancy, none of the women enrolled were diabetic or had arenal disease , or had age more than 39 years.
In the present study the median of serum PAPP-A was lower in cases that developed pre-eclampsia than in cases that did not develop pre-eclampsia (1.1 and 2.3 respectively). All the differences were statistically significant. The findings of this study have confirmed the results of several previous studies that low-maternal serum PAPP-A concentration at 11–14 weeks is associated with increased risk for subsequent development of PE
In the current study the mean pulsatility index (PI) of the uterine arteries was higher in cases that developed pre-eclampsia than in cases that did not develop pre-eclampsia (2.97+0.2 and 1.7+0.5 respectively). All the differences were statistically significant.
This study concluded that uterine artery Doppler & PAPP-A were good screening methods at 11-13±6 weeks of gestation for prediction of development of pre-eclampsia & mean pulsatility index was more valid than PAPP-A in prediction of pre-eclampsia.