الفهرس 
Recurrent Pregnancy LossOnly 14 pages are availabe for public view
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Abstract
Sufficient uteroplacental blood flow is essential for normal pregnancy outcome and is accomplished by the coordinated growth and remodeling of the entire uterine circulation, as well as the creation of a new fetal vascular organ: the placenta.
The process of remodeling involves a number of cellular processes, including hyperplasia and hypertrophy, rearrangement of existing elements, and changes in extracellular matrix. In this review, we provide information on uterine blood flow increases during pregnancy, the influence of placentation type on the distribution of uterine vascular resistance, consideration of the patterns, nature, and extent of maternal uterine vascular remodeling during pregnancy, and what is known about the underlying cellular mechanisms.
This review describes the current use of Doppler ultrasound to examine blood flow in the uterus and ovaries in infertile patients and during early pregnancy.
The aim of this study was to evaluate and compare the resistance to blood flow in the uterine arteries of women with and without history of unexplained RPL with the use of pulsed Doppler ultrasonography, as well as to correlate these observations with other parameters associated with endometrial vascularity and receptivity, like age, endometrial thickness.
This study was conducted in Ain Shams Maternity hospital (outpatient clinic for RPL) during the period between July 2011 and February 2012. 40 non-pregnant patients with a history of three or more consecutive unexplained 1st- and 2nd-trimester miscarriages before 20 weeks.
All patients have no history of diabetes mellitus, thyroid disorders, hyperprolactinemia with no documented uterine anomalies& negative markers of antiphospholipid antibody syndrome
In this study the mean age of included women of group I [RPL Group] was 27.6 ± 4.63 years (range: 19 – 35 years). On the other hand, the mean age of included women of group II [Control Group] was 29.08 ± 3.91 years (range: 22 – 38 years).
In the current study most of the patients (50%) had 3 previous miscarriages, 22.5% had 4 previous miscarriages, 17.5% had 5 previous miscarriages, while 10% had more than 5 previous miscarriages
In the current study,the mean values of the resistance index (RI) of the right and left uterine arteries were significantly higher in women of group I [RPL Group] when compared to women of group II [Control Group] [0.89 ± 0.09 vs. 0.79 ± 0.11, p<0.001; and 0.9 ± 0.09 vs. 0.81 ± 0.11, p<0.001; respectively].
The mean values of the pulsatility index (PI) of the right and left uterine arteries were significantly higher in women of group I [RPL Group] when compared to women of group II [Control Group] [2.45 ± 0.53 vs. 1.94 ± 0.6, p<0.001; and 2.71 ± 1.26 vs. 2.08 ± 0.62, p=0.006; respectively]
In this study, the women with a history of RPL had a higher blood flow impedance than the controls
The theoretical implication of uterine vascular impairment in the pathogenesis of ‘unexplained’RPL seems to be quite logical; an adequate uterine circulation is essential for the normal early pregnancy development and maintenance and therefore, any impairment could be harmful. The results of this study support this interesting theory revealing a significantly increased PI in the uterine arteries of women with unexplained RPL compared to women without such a history. In the same population, no significant differences were observed regarding other factors, which are traditionally associated with endometrial receptivity, like endometrial thickness and age.
In conclusion, impaired uterine circulation, as indicated by increased uterine blood flow impedance, may serve as a pathogenetic background in cases of unexplained RPL