Doppler velocimetry of uterine arteries in women with unexplained recurrent early pregnancy loss

الملخص EN

The aim of the study : was to evaluate the blood flow in the uterine arteries through estimation of uterine Doppler indices and comparison with other factors (oestradiol, progesterone, and antinuclear antibodies) of pregnant women and non- pregnant women with a history of early recurrent pregnancy loss.

Subjects and methods : One hundred and forty pregnant and non pregnant women attending the outpatients clinic of Obst.

And Gynecol.

in Al-Hussein Hospital Al-Azhar University between January 2009 to December 20011, with history of recurrent early pregnancy loss were enrolled in this study and classified into the following Four groups: Group 1 : Include 50 non-pregnant women with history of early recurrent pregnancy loos.

Group 2 : (1st control group) Include 20 non-pregnant normal women with no history of recurrent pregnancy loos.

Group 3 : Include 50 early pregnant women with history of early recurrent pregnancy loos.

Group 4 : (2nd control group) Include 20 early normal pregnant women with no history of recurrent pregnancy loos.

Results : There was a highly significant difference between group 1 and group 2 (1st control group) as regard to midluteal estradiol and progesterone with level of midluteal estradiol (154.7 ± 23.8, 113.4 ± 10.52) (p = 0.001) and level of midluteal progesterone (9.34 ± 1.55, 14.41 ± 2.33) (P = 0.001) respectively (Table 1).

In the present study there were the uterine arterial PI, RI in RPL groups 1 & 3 (3.05 ± 0.64, 0.94 ± 0.05) (2.8 ± 0.63, 0.9 ± 0.06) respectively were significantly higher than that in the control groups 2 & 4 (2.04 ± 0.25, 0.83 ± 0.07) (1.74 ± 0.29, 0.8 ± 0.08) respectively (table 8, 9).

Whereas there was non significant difference between PI, RI in RPL respectively .The cut off value of PI in group 1 and group 2 was 2.33 which have the highest sensitivity (0.92 %) and specificity (0.80 %) while the PI in group 3 and group 4 was 1.92 which have the highest sensitivity (0.96) and specificity (0.70 %).

The cut off value of RI in group (1) and group (2) was 0.87 which has the highest sensitivity (0.90 %) and specificity (0.80 %), while the cut off value of RI in group (3)and group (4) was 0.81 which has the highest sensitivity (0.98 %) and specificity (0.60 %).

A high uterine arterial PI, RI was observed in women with +ve ANAs in RPL groups (1 & 3) than in the control groups (2 & 4) ( table 4 & 7).

There was a significant difference between the uterine artery PI, RI before and after administration of dydrogesterone for the cases of the first control group (Table 10).

Conclusions : uterine artery is considered the best vessel to reflect the impaired uterine perfusion during the early period of pregnancy.

The decrease uterine artery Doppler indices (PI, RI) should be considered as predictor of good fetal outcome but the increase in (PI, RI) values are suggestive for pregnancy outcome.

Administration of dydrogesterone in the luteal phase decrease the uterine artery PI, RI with subsequent increase in uterine perfusion.