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Correlation of serum soluble endoglin to the severity of pre-eclampsia and its effect on the pregnancy outcome

Tamer Mamdouh Abd El-Dayem, Ahmed Samy Elagwany, Mohammed Yosry Khamis, Eman Soliman Kamha, Ahmed Mohammed Mohammed Hassan.

Abstract
Background: Preeclampsia is a major obstetric problem and a significant source of maternal and neonatal morbidity and mortality. Preeclampsia is associated with increased risks of placental abruption, acute renal failure, cerebrovascular and cardiovascular complications, disseminated intravascular coagulation, and maternal death. Consequently, early diagnosis of preeclampsia and close observation are imperative. In these cases of preeclampsia, combination of Doppler flowmetry and circulating angiogenic factors levels are recorded. Stepan et al examined endoglin, a cell-surface co-receptor for transforming growth factor in patients with Doppler flow patterns of preeclampsia at 19-24 weeks. Soluble endoglin levels were elevated in second trimester pregnancies with abnormal uterine perfusion in women who experienced preeclampsia. The aim of this study was to test if there is correlation between the level of serum endoglin in pregnant women with severe preeclampsia to the maternal and fetal outcome.
Methods: This study was conducted on a group of 90 pregnant women attended to the Antenatal clinic and selected from the preeclampsia unit of EL- Shatby Maternity University Hospital, The selected patients were subdivided in two groups. Group A (control group): 30 cases of normotensive pregnant ladies. Group B (case group): 60 cases of severe preeclamptic pregnant ladies. Routine investigations, maternal serum soluble endoglin and ultrasound results were analysed and compared for both groups.
Results: Significant correlation was found between severe preeclampsia and high level soluble endoglin. Significant correlation was found between high level of soluble endoglin and the occurrence of IUGR among the severe preeclamptic patients. Positive correlation was found between serum level of soluble endoglin and uterine artery PI and uterine artery RI, the higher the serum level of soluble endoglin the higher the uterine artery pulsatility and resistance index. Significant correlation was found between high level of soluble endoglin and the occurrence of specific complications, the higher the level of soluble endoglin the higher the risk of exposure to preeclampsia complications as the occurrence of eclamptic fits, the development of HELLP syndrome, the admission to the ICU, the admission of the baby to the NICU, and the fetal death.
Conclusions: From our study, it is evident that serum endoglin rises during normal as well as preeclamptic pregnancy and that the rise in preeclampsia is much higher, the rise in endoglin levels may occur as early as the first trimester in pregnancies which later develop preeclampsia. Hence, used alone or in combination with uterine artery Doppler flowmetry, the measurement of soluble serum endoglin has the potential for use as a predictive clinical test for preeclampsia risk assessment and could potentially improve the outcome of pregnancy.

Key words: Serum soluble endoglin, Pre-eclampsia, Pregnancy outcome



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