Serum Androgen Levels as a Marker for the Severity of Preeclampsia
Serum Androgen Levels as a Marker for the Severity of Preeclampsia
this study will be conducted to confirm the hypothesis of the previous studies and to list
 the high androgen levels as a precipitating factor for preeclampsia
hypertensive disorders are one of the most important complications during pregnancy, which in
 combination with hemorrhage and infections make a dangerous triad, making them the major
 cause of maternal morbidity and mortality in 3.7-5% of all pregnancies.

 Hypertensive disorders during pregnancy are classified into 4 categories, as recommended by
 the National High Blood Pressure Education Program Working Group on High Blood Pressure in
 Pregnancy:

 -  Chronic hypertension

 -  Preeclampsia-eclampsia

 -  Preeclampsia superimposed on chronic hypertension

 -  Gestational hypertension (transient hypertension of pregnancy or chronic hypertension
 identified in the latter half of pregnancy). This terminology is preferred over the
 older but widely used term "pregnancy-induced hypertension" (PIH) because it is more
 precise .

 In 2008, the Society of Obstetricians and Gynecologists of Canada (SOGC) released revised
 guidelines that simplified the classification of hypertension in pregnancy into 2 categories,
 preexisting or gestational, with the option to add "with preeclampsia" to either category if
 additional maternal or fetal symptoms, signs, or test results support this .

 Chronic hypertension is defined as blood pressure exceeding 140/90 mm Hg before pregnancy or
 before 20 weeks' gestation. When hypertension is first identified during a woman's pregnancy
 and she is at less than 20 weeks' gestation, blood pressure elevations usually represent
 chronic hypertension.

 In contrast, new onset of elevated blood pressure readings after 20 weeks' gestation mandates
 the consideration and exclusion of preeclampsia .

 Chronic Hypertension Chronic hypertension is a primary disorder in 90-95% of cases and may be
 either essential (90%) or secondary to some identifiable underlying disorder, such as renal
 parenchymal disease (eg, polycystic kidneys, glomerular or interstitial disease), renal
 vascular disease (eg, renal artery stenosis, fibro-muscular dysplasia), endocrine disorders
 (eg, adreno-corticosteroid or mineralocorticoid excess, pheochromocytoma, hyperthyroidism or
 hypothyroidism, growth hormone excess, hyperparathyroidism), coarctation of the aorta, or
 oral contraceptive use. About 20-25% of women with chronic hypertension develop preeclampsia
 during pregnancy .

 Chronic hypertension occurs in up to 22% of women of childbearing age, with the prevalence
 varying according to age, race, and body mass index. Population-based data indicate that
 approximately 1% of pregnancies are complicated by chronic hypertension, 5-6% by gestational
 hypertension without proteinuria, and 1-2% by preeclampsia .

 Differential Diagnosis

 -  Antiphospholipid Antibody Syndrome and Pregnancy

 -  Antithrombin Deficiency

 -  Aortic Coarctation

 -  Autoimmune Thyroid Disease and Pregnancy

 -  Cardiomyopathy, Peri-partum

 -  Common Pregnancy Complaints and Questions

 -  Cushing Syndrome

 -  Diabetes Mellitus and Pregnancy

 -  Disseminated Intravascular Coagulation

 -  Eclampsia

 -  Encephalopathy, Hypertensive

 -  Fetal Growth Restriction

 -  Gastrointestinal Disease and Pregnancy

 -  Glomerulonephritis, Acute

 -  Glomerulonephritis, Chronic

 -  Graves' Disease

 -  Hashimoto Thyroiditis

 -  Hematologic Disease and Pregnancy

 -  Hemolytic-Uremic Syndrome

 -  Hydatidiform Mole

 -  Hyper-aldosteronism, Primary

 -  Hyperparathyroidism

 -  Hypertension

 -  Hypertension, Malignant

 -  Hyperthyroidism

 -  Hypothyroidism

 -  Nephrotic Syndrome

 -  Normal Labor and Delivery

 -  Preeclampsia

 -  Protein C Deficiency

 -  Protein S Deficiency

 -  Pulmonary Disease and Pregnancy

 -  Systemic Lupus Erythematosus

 -  Systemic Lupus Erythematosus and Pregnancy

 -  Teratology and Drug Use During Pregnancy

 -  Thrombotic Thrombocytopenic Purpura Gestational Hypertension Gestational hypertension
 refers to hypertension with onset in the latter part of pregnancy (>20 weeks' gestation)
 without any other features of preeclampsia, and followed by normalization of the blood
 pressure postpartum. Of women who initially present with apparent gestational
 hypertension, about one third develops the syndrome of preeclampsia. As such, these
 patients should be observed carefully for this progression. The pathophysiology of
 gestational hypertension is unknown, but in the absence of features of preeclampsia, the
 maternal and fetal outcomes are usually normal .

 Gestational hypertension may, however, be a harbinger of chronic hypertension later in life
 Furthermore, hypertension before pregnancy or during early pregnancy is associated with a
 twofold increased risk of gestational diabetes mellitus. Transient hypertension of pregnancy
 (ie, the development of isolated hypertension in a woman in late pregnancy without other
 manifestations of preeclampsia) is associated strongly with later development of chronic
 hypertension .

 Although maternal diastolic blood pressure greater than 110 mm Hg is associated with an
 increased risk for placental abruption and fetal growth restriction, superimposed
 pre-eclamptic disorders cause most of the morbidity due to chronic hypertension during
 pregnancy .

 Preeclampsia is defined as the new onset of hypertension and either proteinuria or end organ
 dysfunction after 20 weeks of gestation in a previously normotensive woman. In 2013, the
 American College of Obstetricians and Gynecologists removed proteinuria as an essential
 criterion for diagnosis of preeclampsia. They also removed massive proteinuria (5
 grams/24hours) and fetal growth restriction as possible features of severe disease because
 massive proteinuria has a poor correlation with outcome and fetal growth restriction is
 managed similarly whether or not preeclampsia is diagnosed. Oliguria was also removed as a
 characteristic of severe disease.

 Hypertension before 20 weeks' gestation is almost always due to chronic hypertension;
 new-onset or worsening hypertension after 20 weeks' gestation should lead to a careful
 evaluation for manifestations of preeclampsia .

 Signs suggesting a secondary medical cause of chronic hypertension Centripetal obesity,
 "buffalo hump," and/or wide purple abdominal striae suggest glucocorticoid excess; other
 clinical signs may demonstrate hyperthyroidism, hypothyroidism, or growth hormone excess. In
 addition, a systolic bruit heard over the abdomen or in the flanks suggests renal artery
 stenosis, whereas radio femoral delay or diminished pulses in the lower versus upper
 extremities suggests coarctation of the aorta .

 Women with chronic hypertension in pregnancy should be monitored for the development of
 worsening hypertension and/or the development of superimposed pre-eclampsia (the risk is
 approximately 25%). Laboratory investigations for pre-eclampsia should be repeated if the
 patient's blood pressure increases or if she develops signs or symptoms of preeclampsia .
Inclusion Criteria:

 -  Pregnant women (primigravidas).

 -  Age between 20 and 35 years old.

 -  Live fetus.

 Exclusion Criteria:

 -  Women younger than 20 years old and older than 35 years old

 -  Intrauterine fetal death.

 -  History of pre-gestational hypertension.

 -  History of hormonal disorders (thyroid gland disorders and hyperprolactinemia).

 -  Smoker.

 -  Polycystic ovary syndrome.

 -  Signs or symptoms of hyper-androgenism (hirsutism, acne, oily skin, etc.).

 -  Diabetes mellitus.

 -  Drug use except ordinary supplementation (iron, folic acid).