MATERIALS AND METHOD
After receiving approval from Ethics Committee of Dokuz Eylul University, Faculty of Medicine, (Approval date: 14.02. 2011, Number: 2013/03-05) we planned our study as a prospective case-controlled study between May 2011 and June 2013. Informed consent forms were received from all pregnant participants. 104 pregnant women complicated by preeclampsia, 110 healthy pregnant women were recruited in the study. Preeclampsia diagnosis was made with hypertension (TA >140/90) and with the identification of 300 mg or more proteinuria in 24-hour urine. In severe cases of the disease there may be red blood cell breakdown, a low blood platelet count, impaired liver function, kidney dysfunction, swelling, shortness of breath because of fluid in the lungs, or visual disturbances. The patient group we included in the study was in the class of mild preeclampsia, and we did not include the patients with these findings in the study.
Singleton pregnancies between 34-42 weeks of gestational with a normal fetal anatomy were included. Exclusion criteria were as follows; chorioamnionitis, abnormal fetal karyotype, smoking, alcohol or drug abuse. All patients were undergoing prenatal doppler ultrasonography and fetal biometric measurement, and they were assigned to our clinic for normal vaginal birth during the 34-42 weeks of gestational or emergency or planned cesarean section (C/S). All of the Doppler measurements were taken by using Voluson 730 (GE Medical Systems, USA) with a 3.5-MHz convex transabdominal probe by only one researcher (FA). Doppler measurements were received from the umbilical artery (UA) and middle cerebral artery (MCA). Then, systole/diastole ratio (S/D), pulsatility index (PI) and resistance index (RI) were calculated. A decrease below 2 standard deviations (SD) in MCA PI, an increase above 2 standard deviations in S/D ratio in umbilical artery, was accepted as an abnormal doppler finding. The brain sparing impact was defined by the fact that umbilical artery PI/MCA PI being over 1,08.
Among all the patients included in the study, when the cervical dilatation reached 5 cm in patients who are expected to have normal vaginal delivery, maternal venous blood samples were taken into non-heparinized tubes and centrifuged for IMA measurement. After the samples had been left for 30 minutes of coagulation, it was centrifuged for 10 minutes in 3500 rpm. Following the centrifuge, the samples were kept in -80 oC. Measurement of IMA level was made with a commercial enzyme-linked immunosorbent assay (ELISA) kit according to the manufacturer’s instructions (CusoBio Biotech, China). The absorbance was measured at 450 nm using a microplate reader. IMA concentrations in the sample were determined by drawing a standard graph of the standards in 6 different dilutions.  The IMA results were expressed in IU per milliliter (IU/ml).
30-minute cardiotocography monitorization of all the patients was recorded before delivery. The NST data was divided into 2, being normal and abnormal. The cardiotocography whose heart rate is between 120-160 beats per minute, beat to beat variability between 5-25 and where there is no deceleration were accepted to be normal.
The presence of fetal hypoxia/acidosis was analyzed by conducting post-natal umbilical cord blood gas examination and 1-5 minutes of APGAR scoring. The classification for cord blood gas was made as; pH ≤ 7,0 , base excess (BE) ≤16 severe acidosis; pH: 7,01-7,15, BE:15,9-10 moderated acidosis. The classification related with APGAR score was made concerning study that Li et al. (29), carried out respecting APGAR scoring and its effect on the neonatal, postnata mortality velocities and 5th minute Apgar score was accepted as: 7-10; high, 4-6; low, 1-3; very low.
Because the primary purpose of the power analysis evaluation was to predict fetal hypoxia, the groups were divided into 2, those whose 5th minute APGAR score is less than 6 and those over 6. The mean IMA level of the group 1 is 14,15 IU/ml standard deviation value is 1,54, while the IMA level of group 2 is 8,24 IU/ml and standard deviation value is 1,64. Because of the strength analysis evaluation made considering these data, the power of the study was determined as 100%.
Independent t-test was used in the average’s comparison of independent samples, in defining statistical methods (average, standard deviation, median, minimum and maximum) serum IMA level, and the correlation of this value with NST and Doppler ultrasonography, the comparisons among control and patient groups.Area under the curve (AUC)() was calculated according to the pH value of fetal cord blood. SPSS version 15.0 was used for statistical analyzes. The value p < 0,05 was accepted as statistically significant.