Fibronectin as an Early Predictor of Gestational Hypertension/Preeclampsia.

Hypertensive disorders complicate 2% to 8% of pregnancies globally. They are one of the leading causes of maternal mortality responsible for 16% of maternal deaths. Preeclampsia is a pregnancy specific syndrome whose pathophysiologic features have not been clearly established, but research during past two decades has suggested that maternal endothelial damage and improper placental development are involved in the genesis of preeclampsia. Fibronectin is known to be a marker of endothelial dysfunction, which occurs in early gestation in women who develop preeclampsia in later gestation and hence levels of fibronectin may vary in first trimester itself in such women. We wanted to examine the usefulness of single biomarker ‘plasma fibronectin’ in screening of pregnant women for gestational hypertension/preeclampsia, study the difference in fibronectin levels in early versus late onset gestational hypertension/preeclampsia and evaluate its levels in preeclampsia with severe features.METHODS200 antenatal women with singleton pregnancy, who were normotensive were enrolled in the study and plasma fibronectin levels were measured at 10-12 weeks of gestation. Women were followed throughout pregnancy and 12 weeks postpartum. Plasma fibronectin levels were compared between normotensive women and women who developed gestational hypertension/preeclampsia.RESULTSThe mean values of plasma fibronectin are significantly higher in group who developed gestational hypertension/preeclampsia compared to group who remained normotensive (167+/-81 vs 114+/-58; p<0.05). The mean value in group with early onset disease as well as preeclampsia with severe features is higher than that of group with late onset disease and preeclampsia without severe features respectively. But the difference is not statistically significant.CONCLUSIONSStudy showed that plasma fibronectin could be used as a marker for early prediction of gestational hypertension/ preeclampsia.

Role of Uterine Artery Doppler in 11-14 Weeks Scan as a Predictor of Preeclampsia

Background: Preeclampsia (PE) is a disease in pregnancy involving interplay of multiple genetic, immunologic and environmental factors. The primary pathology of PE is related to abnormal placentation. Uterine artery doppler in the first trimester is a promising screening test for prediction of PE. Objective: To study the role of first trimester uterine artery doppler in prediction of preeclampsia. Methods: A prospective study was carried out to evaluate the role of uterine artery doppler in the 11- 14 week scan for prediction of preeclampsia and associated IUGR. A total number of 200 women who met our selection criteria were included in the study. Uterine artery doppler was done as part of the 11-14 weeks scan and mean uterine artery PI was calculated. Results: Among the women in the study, PE was detected in 21 women with incidence of 11 %. The sensitivity, specificity, positive predictive value and negative predictive values of mean uterine artery PI for development of PI were 76%, 86%, 39% and 96% respectively. Conclusions: Early identification of pregnancies at high-risk of early onset PE and undertaking the necessary measures to improve placentation can reduce the burden of the disease by using prophylactic aspirin. Effective screening for early onset PE can be achieved in the first-trimester of pregnancy with maternal history, uterine artery doppler and biochemical markers. Biochemical screening for preeclampsia needs to become cheaper and easily accessible for better prediction of PE in first trimester.