First trimestric Bio-chemical analysis of maternal serum homocysteine and uterine artery doppler as a new modality for early prediction of perinatal outcome

Background: Routine prenatal care focuses on the detection of women at increased risk, aiming for appropriate intervention. appropriate combinations of some markers can serve as an indicator for early prediction of any adverse pregnancy outcome. Patients and methods: This is a prospective cohort study that was conducted at Obstetrics and Gynecology department, Al-Azhar University Hospital (New-Damietta). About 200 singletons, low risk pregnant women were included in the study. Both ultrasound examinations and bio-chemical analysis of serum homocysteine were performed at 11-14 weeks of gestation. Results: Total homocysteine ranged from 2.5 to 11 µmol/l and there was statistically significant decrease of total homocysteine levels in non-complicated group when compared to complicated group. There was statistically significant difference between different scores as regard to total homocysteine (the lowest level was observed in zero score (5.20±0.80) and the highest in score three (7.62±2.21). There was significant moderate proportional correlation between ultrasound score and total homocysteine. Combining both ultrasound score (any of scores 1, 2, 3 or 4) with hyper-homocysteinemia revealed that, 165 cases were negative for this combination and 35 cases were positive. Predictive power of hyper-homocysteinemia alone was 75.0%; while abnormal ultrasound alone had predictive power of 0.67 and finally both abnormal ultrasound with hyper-homocysteinemia had a predictive power of 100.0% Conclusion: The combination of homocysteine levelwith uterine artery doppler in the first trimester can be used as an early indicator in predicting adverse perinatal outcome.