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العنوان
Uterine Artery and Subendometrial blood
flow assessment in recurrent unexplained first
trimesteric abortion /
المؤلف
El Ashmawy,Ahmed Abd El Salam.
هيئة الاعداد
باحث / Ahmed Abd El Salam El Ashmawy
مشرف / Sheriff Mohamed Abd El Hamid
مشرف / Mohamed Osama Taha
تاريخ النشر
2015
عدد الصفحات
178p.:
اللغة
الإنجليزية
الدرجة
ماجستير
التخصص
أمراض النساء والتوليد
تاريخ الإجازة
1/1/2015
مكان الإجازة
جامعة عين شمس - كلية الطب - امراض النساء و التوليد
الفهرس
Only 14 pages are availabe for public view

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from 178

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.