الفهرس | Only 14 pages are availabe for public view |
Abstract The present study was designed to elucidate the vascular changes that occur in women with recurrent abortion, and identify women with poor uterine perfusion, compared uterine artery pulsatility index (PI) and subendometrial blood flow, in pregnant women at 7th to 12th weeks with a history of unexplained RPL before and after treatment by heparin. We hypothesized that, increasing uterine artery and subendometrial blood flow by any anti-coagulant like heparin improving the condition of recurrent unexplained first trimester abortion and lead to continue of pregnancy. Fifty participants were included in the present study. They were selected from outpatient clinic in Ain shams maternity hospital; during the period from March 2014 through December 2014. They were 50 cases with history of recurrent miscarriage who received heparin treatment (5000IU/every 12 hours/day) at the time of initial recruitment from the seventh to the twelfth weeks of pregnancy. All patients to be recruited gave an informed consent and were subjected to complete history taking; general, abdominal and pelvic examination; pelvic examination to assess uterine size and the presence or absence of adnexal masses. Then vascular uterine artery indices and endometrial thickens were assessed initially at recruitment and after heparin treatment.Results of the present study revealed the following results: In the present study, age ranged from 20 to 32 years with a mean of 28.68±2.79 years As regard to number of previous abortions it ranged from 3 to 5 with a mean of 3.36±0.52. The week of last abortion was ranged from 7 to 9 weeks with a mean of 7.42±0.6 As regard to basal hormone profile; values were in normal range. e.g, FSH ranged from 6.90 to 8.50 with a mean of 7.45±0.27; E2 ranged from 49 to 82 with a mean of 56.64±4.85; LH ranged from 4.50 to 5.90 with a mean of 4.84±0.29; prolactin ranged from 24 to 28 with a mean of 25.22±0.99; testosterone ranged from 0.25 to 0.36 with a mean of 0.321±0.027 and finally progesterone at 7th day after ovulation ranged from 9 to 14 with a mean of 11.30±0.83 As regard to length of follicular phase; it ranged from 10 to 18 days with a mean of 14.74±1.21 days; while length of luteal phase ranged from 12 to 19 days with a mean of 15.18±1.08 days. As regard to basal vascular indices; PI ranged from 1.60 to 2.50 with a mean of 2.23±0.16. VI ranged from 1.20 to 3.60 with a mean of 2.16±0.49. In addition, FI ranged from 14 to 26 with a mean of 18.94±2.46. Finally, VFI ranged from 0.3 to 1.20 with a mean of 0.59±0.19. These values reflected that, PI and VI were increased than normal values and FI and VFI were decreased when compared to normal values. As regard to endometrial thickness, it ranged from 9.90 to 10.80 with a mean of 10.32±0.15. After treatment, PI ranged from 1.30 to 2.10 with a mean of 1.65±0.18; while VI ranged from 2.20 to 3.10 with a mean of 2.63±0.16. In addition, FI ranged from 20 to 30 with a mean of 23.26±2.62 and VFI ranged from 1.0 to 1.90 with a mean of 1.30±0.23. In study group, PV significantly decreased after treatment when compared to their values before treatment (2.23±0.16 vs 1.65±0.18 respectively). On the other hand, there was significant increase of VI, FI and VFI after treatment when compared to their corresponding values before treatment (2.63±0.16, 23.26±2.62 and 1.30±0.23 vs 2.16±0.49, 18.94±2.46 and 0.59±0.19 respectively). The best cut off of PI is 1.85 with sensitivity of 98.0% and specificity of 94.0%; the area under the curve is 0.99 denoting good sensitivity of the test in diagnosis or prediction of miscarriage The best cut off of VI 2.15; with sensitivity of 90.0% and specificity of 52.0%; the area under the curve is 0.76 denoting good sensitivity in prediction of miscarriage, but it is less than PI. The best cut off point of FI is 19.50 with a sensitivity of 100.0% and specificity of 70.0%. Area under the curve is 0.92 indicating good sensitivity for prediction of miscarriage. Again, it is less than PI. The best cut off of VFI is 0.95; with sensitivity of 98.0% and specificity of 96.0%; the area under the curve is 0.99 denoting good sensitivity for diagnosis or prediction of miscarriage. It is equal to PI. |