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Korean Journal of Obstetrics & Gynecology 2002;45(10):1785-1793.
Published online October 1, 2002.
Efficacy of midtrimester amniotic fluid 8-isoprostane measurement in the prediction of severe preeclampsia.
So Ra Kim, Pil Ryang Lee, Bon Sang Koo, Jong Soo Kim, Ji Youn Chung, Hye Sung Won, Ahm Kim
Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Abstract
OBJECTIVE
The objective of this study is to investigate whether the amniotic fluid 8-isoprostane levels at the time of genetic amniocentesis is a marker for severe preeclampsia. METHODS: A case-control study was conducted to compare mid-trimester concentrations of amniotic fluid 8-isoprostane in women with normal pregnancies (n=22) and in those who subsequently developed severe preeclampsia (n=22). Amniotic fluid was also obtained by amniocentesis from another women who already developed severe preeclampsia (n=22) after 20 weeks of gestation. The 8-isoprostane levels were measured by enzyme-linked immunoassay. For statistical analysis, nonparametric tests and receiver-operating characteristic curves were used where appropriate. Statistical significance was considered when probability was <0.05. RESULTS: The levels of midtrimester amniotic fluid 8-isoprostane were found to be significantly decreased in the women who subsequently developed severe preeclampsia in comparison with those who underwent normal pregnancies (P<0.05). The levels of 8-isoprostane in preeclamptic amniotic fluid were found to be significantly decreased with respect to that in midtrimester amniotic fluid (P<0.05). No relationship was found between the midtrimester amniotic fluid 8-isoprostane levels and preeclampsia with small-for- gestational-age. After the onset of severe preeclampsia, however, the amniotic fluid 8-isoprostane levels were significantly decreased in women with small-for-gestational-age. The midtrimester amniotic fluid 8-isoprostane level of 170 pg/ml had a sensitivity of 72.7% and a specificity of 63.6% in the prediction of severe preeclampsia. CONCLUSION: The midtrimester amniotic fluid 8-isoprostane levels may predict the later occurrence of severe preeclampsia. This study not only presents a new information that 8-isoprostane is detected in human amniotic fluid, but also provides a convincing evidence that a subclinical process from faulty placentation in early gestation is important for the occurrence of preeclampsia. Further studies are warranted to determine which mechanism causes such decrease in amniotic fluid 8-isoprostane in preeclampsia.
Key Words: 8-isoprostane, preeclampsia, amniotic fluid, predictive marker


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