Role of serum homocysteine levels in abruptio placentae and the fetomaternal outcome

Background and objective: High serum homocysteine level is considered as a risk factor for placental abruption. Placental development in early pregnancy may be negatively influenced by increased maternal homocysteine concentrations. Moderately elevated homocysteine concentrations may inducecytotoxic and oxidative stress, leading to endothelial cell. impairment. Additionally, exposure of trophoblast cells to homocysteine may increase cellular apoptosis and lead to inhibition of trophoblastic function. Maternal plasma homocysteine concentration at various stages during normal pregnancy tends to be lower than in nonpregnant women. Placentalabruption has been associated with an increase in the risk of stillbirth, preterm delivery, haemorrhage, need for hysterectomy, DIC and death. The aim of the study was to determine the role of serum homocysteine levels in patients with abruptio placentae and to study the fetomaternal outcome in these patients. Fetomaternal outcome is seen terms of mode of delivery whether vaginal of caesarean, period of gestation whether term or preterm, need of blood transfusion, stillbirths, early neonatal deaths and NICU admission.
Methods: In this observational study, 50 pregnant women with abruptio placentae were included. Eligible pregnant women were recruited from labour room and wards. Informed consent was taken, thorough clinical examination was done and history was taken, prior investigations like ultrasound were studiedand their serum homocysteine levels were measured by ELIZA method using commercially available kits. The obtained data was statistically analysed using Statistical Package for Social Science (SPSS) version 21.0.
Results: Serum homocysteine levels were found to be elevated in all cases, ranging from 32.0 µmol/L to 165 µmol/L and mean homocysteine level +-Std. deviation is 62.57 +- 21.79 µmol/L. The rate of caesarean section was 44%, preterm delivery was 64% and stillbirth was 38% in these cases with mean homocysteine levels of 65.1± 28.08µmol/L, 61.02 ± 18.12 µmol/L and 62.84 ± 23.89µmol/L respectively. Retroplacental clots were present in 60% of cases and blood transfusion was received by 96%. No significant association was seen between serum homocysteine levels and the different fetomaternal outcome.
Conclusion: Hyperhomocysteinemia is seen in cases with abruptio placentae. The rate of caesarean section, preterm delivery, stillbirth and need of blood transfusion is high but no significant association is seen.