Midluteal Assessment of Uterine Artery Doppler and Serum Progesterone Level in Women with Unexplained Recurrent Miscarriage

Document Type : Original Article

Authors

Obstetrics and Gynecology department, Faculty of Medicine, Beni-Suef University, Egypt.

Abstract

Objective: To investigate the blood flow and progesterone levels in non-pregnant women with a history of unexplained recurrent pregnancy loss (RPL) in comparison to normal fertile women. Patients and methods: This case control study was done at Department of Obstetrics and Gynecology in Beni-Suef University from October 2020 to April 2021. Cases with history of unexplained RPL (n = 55), and controls with no history of miscarriage and at least one term delivery (n = 55). Serum progesterone measurement and transvaginal uterine artery Doppler were conducted to all participants in the midluteal phase to assess the uterine artery pulsatility index (PI), resistance index (RI) and serum progesterone level. Results: Uterine artery PI and RI were significantly higher in the study group (p < 0.001). On the other hand, there was no significant difference in serum progesterone level between the two groups(p=0.855). The cut-off value of uterine artery RI > 0.85 and the cut-off value of uterine artery PI > 2.3 were significantly associated with unexplained RPL. Conclusions: This study concluded that serum progesterone had no role in prediction of unexplained RPL. Uterine artery PI and RI had a role in prediction of unexplained abortion, but the PI is better than RI in the prediction of unexplained RPL.

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References

  1. Jukic, A. M. Z., McConnaughey, D. R., Weinberg, C. R., Wilcox, A. J., & Baird, D. D. (2016). Long-term recall of time to pregnancy. Epidemiology (Cambridge, Mass.), 27(5), 705.
  2. RCOG (2011). "The investigation and treatment of couples with recurrent firsttrimester and second-trimester miscarriage." RCOG: London, UK(59): 36-44 .
  3. Homer, H., 2018. Modern management of recurrent miscarriage. Australian and New Zealand Journal of Obstetrics and Gynaecology, 59(1), pp.36-44.
  4. Shahine, L. and Lathi, R., 2015. Recurrent Pregnancy Loss. Obstetrics and Gynecology Clinics of North America, 42(1), pp.117-134.
  5. Le, T., Nguyen, D., Ta, T. and Hoang, V., 2017. Analysis of the cause of recurrent pregnancy loss in Vietnam: A cross-sectional study. Health Care for Women International, 39(4), pp.463-471.
  6. El Hachem, H., Crepaux, V., May-Panloup, P., Descamps, P., Legendre, G. and Bouet, P., 2017. Recurrent pregnancy loss: current perspectives. International Journal of Women's Health, Volume 9, pp.331345.
  7. Pillai, R., Konje, J., Richardson, M., Tincello, D. and Potdar, N., 2018. Prediction of miscarriage in women with viable intrauterine pregnancy—A systematic review and diagnostic accuracy meta-analysis. European Journal of Obstetrics & Gynecology and Reproductive Biology, 220, pp.122-131.
  8. San Lazaro Campillo, I., Meaney, S., Corcoran, P., Spillane, N. and O’Donoghue, K., 2019. Risk factors for miscarriage among women attending an early pregnancy assessment unit (EPAU): a prospective cohort study. Irish Journal of Medical Science (1971 -), 188(3), pp.903-912.
  9. Thomsen, L., Kesmodel, U., Andersen, C. and Humaidan, P., 2018. Daytime Variation in Serum Progesterone During the Mid-Luteal Phase in Women Undergoing In Vitro Fertilization Treatment. Frontiers in Endocrinology, 9.
  10. Yang, W., Wu, Z., Yu, M., Peng, X., Lu, W., Feng, W. and Kang, X., 2019. Characteristics of midluteal phase uterine artery hemodynamics in patients with recurrent pregnancy loss. Journal of Obstetrics and Gynaecology Research, 45(7), pp.1230-1235.
  11. Neykova, K., Tosto, V., Giardina, I., Tsibizova, V. and Vakrilov, G., 2020. Endometrial receptivity and pregnancy outcome. The Journal of MaternalFetal & Neonatal Medicine, pp.1-15.
  12. Chen, L., Quan, S., Ou, X. and Kong, L., 2012. Decreased endometrial vascularity in patients with antiphospholipid antibodies–associated recurrent miscarriage during midluteal phase. Fertility and Sterility, 98(6), pp.14951502.e1.
  13. Garhy, I. T. E., Mohamed, A. H., & Sultan, A. S. (2018). Uterine and Subendometrial Arteries Doppler in Patients with Recurrent First Trimestric Abortion. The Egyptian Journal of Hospital Medicine, 73(5), 6683-6690.
  14. ELSWAH, H. A., MOHAMED, E., YASSMIN, T., & DALIA, A. (2018). Endometrial and Subendometrial Vessels in Cases of Unexplained Infertility (Case Control Study). The Medical Journal of Cairo University, 86(September), 3245-3251.
  15. Abdel Wahab H, Salah El-Din D, Zain E, Abdelgany M and Youssef M (2011): Uterine artery Doppler and subendometrial blood flowin patients with unexplained recurrent miscarriage Middle East Fertility Society Journal; 16: 209–214.
  16. Sugiura-Ogasawara, M., 2015. Recurrent pregnancy loss and obesity. Best Practice & Research Clinical Obstetrics & Gynaecology, 29(4), pp.489-497.
  17. King J and Casanueva E (2007): Obesity in Pregnancy: Maternal and neonatal effects. Perinatol Reprod Hum; 21: 210-217.
  18. Lashen H, Fear k, Sturdee DW (2004): Obesity is associated with increased risk of first trimester and recurrent miscarriage: matched case–control study. Human Reproduction; 19(7):1644-1646.
  19. Yan, J., Liu, F., Yuan, X., Saravelos, S., Cocksedge, K. and Li, T., 2013. Midluteal serum progesterone concentration does not predict the outcome of pregnancy in women with unexplained recurrent miscarriage. Reproductive BioMedicine Online, 26(2), pp.138-141.
  20. Ogasawara, M., Kajiura, S., Katano, K., Aoyama, T. and Aoki, K., 1997. Are serum progesterone levels predictive of recurrent miscarriage in future pregnancies?. Fertility and Sterility, 68(5), pp.806-809.
  21. Ferreira AM, Pires CR, Moron AF, Araujo JE, Traina E, Mattar R (2007): Dopplerassessment of uterine blood flow in recurrent pregnancy loss. Int J Gynaecol Obstet; 98:115–119.
  22. Taher A, Shara M, Hefny S (2014): Uterine artery and subendometrial blood flow assessment in recurrent unexplained first trimesteric abortion. Evidence Based Women's Health Journal; (4): 189–193.
  23. Ghazi Rifat, A., 2019. Doppler Ultrasound Screening of the Uterine Arteries as a Predictor for Early Miscarriage. International Journal of Women's Health and Reproduction Sciences, 8(1), pp.79-84.
  24. Ertuğrul, Funda & Özakşit, Gülnur & Ozdemir, Ozhan & Sarı, Mustafa Erkan & Yorgancı, Aycag & Öztopcu, Cihan. (2015). Mid-luteal phase Doppler assessment of uterine artery blood flow in patients with a history of recurrent pregnancy loss. Mitteilungen Klosterneuburg. 65. 412-21.
Egyptian Journal of Medical Research
Volume 4, Issue 3
July 2023
Pages 129-142

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