الفهرس 
Chlamydial InfectionOnly 14 pages are availabe for public view
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Abstract
Preeclampsia is a serious complication of the second half of human pregnancy, which can have harmful effects on the immediate and long-term health of the mother and the baby.
Preeclampsia is a heterogeneous disorder affecting 5-8% of pregnancies worldwide. For the fetus, preeclampsia can result in small for gestational age infancy, preterm delivery, hypoxic neurologic injury or death. For the mother, complications of preeclampsia include renal failure, HELLP syndrome, seizures, liver failure, stroke or death. Women with preeclampsia often later develop cardiovascular disease and hypertension, another source of significant morbidity.
Preeclampsia can be considered a two stage disorder, with the first Stage involving abnormal placentation and the second being the abnormal maternal adaptation to the pregnancy that results in systemic dysfunction. Past, persistent or recurrent infection with Chlamydia pneumoniae may contribute to abnormal vascular function, atherosis and the abnormal placental perfusion that marks the first stages of Preeclampsia.
The cause of the abnormal placentation is uncertain; it may be immunological, inflammatory or genetically determined. There is clinical and biochemical evidence of endothelial cell dysfunction during preeclampsia. Altered levels of NO, elevated thromboxane-A2/ prostacycline ratio, deficiency of antithrombotic factors and platelet activation all are found in preeclampsia and are mediated by injured endothelial cells.
Whether Chlamydia pneumoniae may have a role in the pathogensis of preeclampsia is uncertain. However it is postulated that Chlamydia pneumoniae may be implicated in preeclampsia through many ways. It may be involved in abnormal placentation seen in preeclampsia. Also it may be responsible for atherosis frequently seen in placenta vessels by mechanisms resemble those occurring in atherosclerosis.
Many studies were done considering the relation between Chlamydia pneumoniae infection and Preeclampsia. Some of these studies were found a positive correlation between Chlamydia pneumoniae and Preeclampsia and some of them found a negative correlation between Chlamydia pneumoniae and Preeclampsia.
This study was designed in a prospective manner to search for the Link between Chlamydia infection (particularly Chlamydia pneumoniae) and development of Preeclampsia among Egyptian primigravidae, and the role of antichlamydial treatment in decreasing the rate of development of preeclampsia.
The study population was 1200 pregnant women between 16 to 20 weeks gestational age and followed up to term or developing of preeclampsia.
They were divided into two groups treated group (600) cases and placebo group (600) cases.
There were significant statistical differences between the treated group and non treated group as regards maternal age and gestational age.
There were no significant statistical differences between the treated and non treated (placebo) groups as regards maternal body mass index, fetal outcome and preterm birth at sample drawing. On the other hand, there were significant statistical differences between the treated and non treated groups as regards development of preeclampsia.
These results point out that Chlamydia pneumoniae infection may be a precipitating factor or an aggravating factor but not a sole etiological factor in the development of preeclampsia.
Although based upon a prospective population based cohort, this study still has some limitations. A larger multi-centric, more population based, double-blinded studies including more women with different socioeconomic backgrounds and with a better recruitment system should be conducted in order to cast more light on this issue.
A further prospective randomized controlled study is recommended to confirm the relation between preeclampsia and chlamydial infections especially Chlamydia pneumoniae and to determine the time of infection that may be implicated the pathogensis of preeclampsia and possible role of antichlamydial therapy in prevention of the disease.