Abstract
Introduction and Aim: Preeclampsia (PE) results from impaired placentation, leading to placental hypoxia and dysfunction and abnormalities in the endothelial nitric oxide synthase (eNOS)-nitric oxide pathway. The present study was undertaken to estimate and compare maternal serum eNOS concentrations in women with PE and normal healthy pregnant women, to know the correlation of eNOS level with severity of PE, to find the best cut-off value for the diagnosis of PE and to study its association of eNOS levels with the birth outcome.
 Material and Methods: This was a case-control study, conducted at a tertiary care hospital. The study was approved by the Institutional ethics committee. Informed consent was obtained from all the participants. Primigravida (singleton) pregnant women aged 18-35 years, 20 or more weeks of gestation, diagnosed as PE and classified as mild/severe PE based on America college of obstetricians and gynecologists guidelines were selected for the study. eNOS was estimated by the ELISA method. All the participants were visited again to note the outcomes. 
 Results:The maternal serum eNOS in PE was significantly lower than the control group (p=0.019). The best cut-off value was 187.25pg/ml to diagnose PE, area under the ROC curve (AUC) 0.61, sensitivity 95.1%, specificity 37.5% and diagnostic accuracy was 66,67%. Birth outcomes did not have a significant correlation with eNOS.
 Conclusion: eNOS was significantly lowerer in PE, it can be used as a diagnostic marker with the best cut of value of 187.25 pg/ml.
Highlights
Introduction and AimPreeclampsia (PE) results from impaired placentation, leading to placental hypoxia and dysfunction and abnormalities in the endothelial nitric oxide synthase-nitric oxide pathway
The maternal serum endothelial nitric oxide synthase (eNOS) in PE was significantly lower than the control group (p=0.019)
Preeclampsia results from impaired placentation early in the beginning of the pregnancy, leading to placental hypoxia and dysfunction and abnormalities in the endothelial nitric oxide synthase-nitric oxide pathway [4,5,6]. eNOS is localized mainly in the plasma membrane, and a small amount is present in the cytosol
Summary
Preeclampsia (PE) results from impaired placentation, leading to placental hypoxia and dysfunction and abnormalities in the endothelial nitric oxide synthase (eNOS)-nitric oxide pathway. Preeclampsia results from impaired placentation early in the beginning of the pregnancy, leading to placental hypoxia and dysfunction and abnormalities in the endothelial nitric oxide synthase (eNOS)-nitric oxide pathway [4,5,6]. Nitric oxide is required for regulation of the vascular tone and maintains blood pressure. As NO is a highly reactive and short-lived molecule It is clearly not known whether eNOS deficiency plays an important role in pathogenesis of preeclampsia. Many studies suggest that insufficient nitric oxide synthesis or NO bioavailability, may contribute to increased blood pressure, systemic vascular resistance, and sensitivity to the pressors. Studies conducted among various ethnic groups, which resulted in mixed or inconclusive results [9,10,11,12]
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