الفهرس 
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Abstract
Preeclampsia is a common disease in Egypt and the whole world. It is one of the important causes of maternal and
neonatal morbidity and mortality. The disease manifestations
include hypertension, edema, proteinuria, impaired liver and
renal functions and also visual disturbances. The incidence of preeclampsia is 2-8% and reaches
3-10% in primigravida. The incidence is markedly
influenced by race, ethnicity, environmental and
socioeconomic factors. The incidence in developed
countries as United States is 5-8% while in developing
countries; it ranges from 4% to reach 18% in some parts
of Africa.
Many risk factors have been implicated which include:
advanced maternal age (more than 35 years), nulliparity, long
inter-birth interval (≥ 5 years), previous personal or family
history of preeclampsia, multiple pregnancy, obesity and
preexisting medical conditions (e.g. chronic hypertension,
chronic renal disease, etc.).
Many theories have attempted to explain the mechanism
of preeclampsia, but its exact pathogenesis remains unclear.
The current theory that attempts to explain the mechanism of
preeclampsia is the abnormal implantation which leads to
placental hypoxia that causes release of inflammatory mediators
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which act on the vascular endothelium causing altered vascular
reactivity and decreased intravascular volume. Another theory
is abnormal maternal adaptation towards pregnancy. This
abnormal immunological tolerance may provoke an immune
response against the placenta and even paternal antigens of the
fetus. Therefore, cytotrophoblastic invasion becomes defective
and suppressed. The genetic theory is also possible due to
increased incidence of preeclampsia in women with family
history of the disease but still there is the need for more
research to isolate the implicated genes.
Preeclampsia is diagnosed by signs which the mother is
usually unaware of them and when symptoms as headache or
visual disturbances occur, the disease is considered severe.
Therefore, there is the need for proper antenatal care and the
development of a reliable method for disease prediction.
Preeclampsia usually occurs after 20 weeks of
gestation and can be primary or superimposed on chronic
hypertension. It is diagnosed by hypertension which is
defined as systolic blood pressure ≥ 140 mmHg or
diastolic blood pressure ≥ 90 mmHg or both (It is
recommended that a diagnosis of hypertension requires at
least two determinations at least 4 hours apart, although
on occasion, especially when faced with severe
hypertension, the diagnosis can be confirmed within
minutes to facilitate timely antihypertensive therapy) inthe presence of proteinuria which can be measured either
quantitatively by 24-hours urine collection which should
contain ≥ 300 mg protein or qualitatively using dipstick
readings of ≥ +1. The qualitative method is less accurate
then the quantitative method and should be reserved for
use when quantitative methods are not available or rapid
decisions are required. Also, preeclampsia can be
diagnosed in the absence of proteinuria by the presence
of hypertension together with one of the following:
decreased platelet count, impaired liver function,
impaired renal function, pulmonary edema or visual
disturbances.
Various methods have been proposed for
prediction of preeclampsia as: family history, previous
history of preeclampsia, parity, Doppler ultrasound of
uterine artery, serum uric acid, urinary calcium/creatinine
ratio, PAPP-A, sFlt-1 and VEGF but still there is the
need for the development of a more reliable and costeffective
method for disease prediction.
Kuc et al. (2011) observed that Doppler ultrasound
of the uterine artery had high specificity for detection of
preeclampsia (90%) but its sensivity varied from 29-83%
as it depends strongly on the person who performs the
ultrasound examination. On the other hand, serum CA-
125 assessment is a simple blood test which doesn’t have
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that marked degree of variation in sensitivity as it is not
operator dependant.
Meads et al. (2008) examined data from five
studies (514 women) and found that seum uric acid had
sensitivity of 36% and specifity of 83% for detection of
preeclamptic pregnancies. They concluded that serum
uric acid is not sufficiently accurate to suggest its routine
use in clinical practice. On the other hand, serum CA-125
is highly specific (97.2%) and has a better sensitivity
(63.9%) according to our study.
CA-125 is one of the tumor marker in hybridoma family,
the most widely used serum marker in the detection of ovarian
tumor from surface epithelium. Threshold concentrations of
CA-125 in healthy person are below 35 IU/ml. CA-125 levels
are increased in 80%-85% of women in the advanced stages of
ovarian cancer and in 50% of women with stage I disease.
Elevated serum levels of CA-125 are found in physiological
conditions as menstruation and pregnancy and levels also
increased in pathological conditions as endometriosis, fibroid,
pelvic inflammatory disease, ovarian hyperstimulation
syndrome, end-stage liver disease and a variety of
gynecological and non-gynecological neoplasms.
In pregnancy, serum CA-125 levels are increased in early
pregnancy and immediately after birth implicating the
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disintegration of the maternal decidua (i.e., blastocyst
implantation and placental separation) as a possible source of
the tumor marker elevation.
Methods:
This study reviewed a total of 72 primigravid women
with singleton pregnancies. These participants were categorized
into two groups: control (n = 36) and preeclampsia (n = 36).
Results:
By statistically analyzing data which included maternal
age, gestational age at time of delivery, systolic blood pressure,
diastolic blood pressure, platelet count and serum CA-125, a
positive correlation was found between preeclampsia and
systolic blood pressure, diastolic blood pressure and serum CA-
125 level. A negative correlation was found between
preeclampsia and both gestational age at time of delivery and
platelet count. We found no significant correlation between
preeclampsia and maternal age.
Serum CA-125 levels correlated positively with diastolic
blood pressure and maternal age. We found no significant
correlation between serum CA-125 levels and gestational age at
time of delivery, systolic blood pressure and platelet count.
When the cut-off point for serum CA-125 concentration was
accepted as 51.38 IU/ml, the sensitivity and specificity of this
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biochemical marker were, respectively, 63.9% and 97.2% for
the detection of preeclamptic pregnancies. On the other hand,
positive and negative predictive values for CA-125 were 95.8%
and 72.9%, respectively.
Conclusion:
We concluded that CA-125 can be considered a
promising test for diagnosis and prediction of preeclampsia but
still, further research reviewing more population is required for
the accurate establishment of a certain CA-125 value which would deliberately distinguish women who are to develop
preeclampsia.