Maternal serum homocysteine and uterine artery pulsatility index as predictors of spontaneous preterm labor

Objective: The aim of this cohort study was to investigate the uterine artery Doppler indices and the maternal serum homocysteine concentrations as predictors of spontaneous preterm delivery (sPID).
Setting: Obstetrics and Gynecology Department, Benha University Hospital.
Materials and Methods: The study population included 200 singleton pregnant women with threatened preterm labor at 28-35 gestational weeks. The participants underwent uterine artery (UtA) Doppler examination, estimation of maternal serum homocysteine levels and routine management preterm labor. Participants were scheduled according to the gestational age at delivery into; preterm group (n= 45) and term group (n= 155). The diagnostic significance of both parameters for prediction of spontaneous preterm birth was calculated.
Results: Both maternal serum homocysteine (Hcy) and uterine artery pulsatility index (PI) were significantly higher in preterm group compared to term group (8.52± 2.36 vs. 4.62± 2.07; p < 0.0001 for Hcy and 1.18± 0.42 vs. 0.76± 0.29; p < 0.0001 for PI). For the prediction of sPTD, the maternal serum Hcy levels at a cut-off value 7.09 multiple of the median showed 55.56% sensitivity, 83.87% specificity, 50% PPV, and 86.67% NPV, and the UtA PI, the cut-off value of 0.99 showed 62.22% sensitivity, 83.87% specificity, 53.83% PPV, 88.44% NPV. However, both Hcy and UtA PI showed 71.11% sensitivity, 87.1% specificity, 61.54% PPV, 91.22% NPV for prediction of sPTD,
Conclusion: Maternal serum homocysteine levels and uterine artery pulsatility index are two promising predictors of spontaneous preterm delivery. The combination of the two parameters improves their diagnostic performance.