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

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.