Prediction of pre-eclampsia and neonatal outcome by the combined use of early second trimester maternal serum homocysteine and uterine artery doppler velocimetry

ABSTRACT

To evaluate the value of combining early second trimester maternal serum homocysteine and uterine artery doppler velocimetry in the prediction of pregnancies that subsequently develop pre-eclampsia as well as neonatal outcome. This prospective observational study was conducted on eighty seven pregnant mothers [in their 16-19 gestational weeks] at risk to develop pre-eclampsia. All enrolled women should have one or more risk factors to develop pre-eclampsia. Mothers with medical disorders during the current pregnancy were excluded. All participants were investigated with maternal serum homocysteine assay and Doppler analysis of both uterine arteries. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated for homocysteine levels, uterine artery resistance index, diastolic notch [unilateral, bilateral], and for the combination of both homocysteine levels and uterine artery Doppler studies. Pre-eclampsia had occurred in 28 out of the 87 participants [32.18%] of whom 17 cases were diagnosed as mild pre-eclampsia [19.54%] and 11 were diagnosed as severe disease [12.64%]. The mean +/- SD of uterine RI for all cases who developed severe pre-eclampsia was 0.62 +/- 0.09 while it was 0.58 +/- 0.06 in those who did not develop the disease all over their pregnancies and the difference was statistically significant [p=0.016]. Early diastolic notch was detected in 11 out of the 28 mothers who developed pre-eclampsia [39.29%; 5 unilateral and 6 bilateral] versus 4 out of the 59 women who passed uncomplicated pregnancies [6.78%; 2 unilateral and 2 bilateral]. This revealed a statistically significant different [p=0.001]. Serum levels of homocysteine was also significantly higher in cases who developed pre-eclampsia than controls. The median [range] of serum homocysteine in mothers who developed pre-eclampsia [mild and severe disease] was 6.24 [1.9 - 23.4] micro mol/l while in women passed uncomplicated pregnancy it was 5.1 [1.6-19.9] micro mol/l [p=0.024]. Out of all delivered neonates of preeclampsia mothers [31 neonates from 28 mothers], 9 neonates were classified to have poor prognosis [29.03%] all of them were from severe preeclamptic mothers. No early neonatal deaths were recorded. This prospective study confirms the value of combining early second trimester maternal serum homocysteine and uterine artery Doppler velocimetry in the prediction of pregnancies that subsequently develop pre-eclampsia as well as neonatal outcome: