Doppler assessment of uterine artery blood flow in women with spontaneous unexplained recurrent early pregnancy loss

Abstract

Purpose Recurrent pregnancy loss is an important reproductive health care issue. It may be due to various aetiological causes. Recurrent pregnancy loss can be frustrating and difficult to treat for both the couple and the doctor. Few evidence based treatments and diagnostic tests are available. Research into the subject is lacking both due to ethical issues and difficulty in understanding the pathology. Unfortunately almost half of the cases of recurrent pregnancy loss are unexplained. It is this group of women who in spite of empirical treatment still continue to have a pregnancy loss.

Objectives Uterine artery Doppler has been suggested as a mode of investigating endometrial receptivity and implantation failure. Its use in unexplained Recurrent pregnancy loss has been debated over the past 30 years. Currently uterine artery measurements are not a routine investigation in recurrent pregnancy loss clinics. It has been suggested by many researchers that uterine artery measurements should be incorporated into routine testing. Research into its implication and treatment in recurrent pregnancy loss is lacking.

Methodology This research study is a novel approach in investigating unexplained recurrent pregnancy loss in the Maltese population. Women with unexplained recurrent pregnancy loss and controls had their uterine artery Doppler measured in the mid-luteal phase of the cycle. The results were compared and analyzed.

Results This research study has shown that women with unexplained recurrent pregnancy loss have increased resistance to flow at implantation time compared to controls. The study group showed a left uterine artery pulsatility index of 2.65 (SD +/- 0.839) and right PI of 2.65 (SD+/- 0.483) was obtained in the study group. This value can be compared to the PI obtained from the control group that showed a left uterine artery PI of 1.63 (SD+/- 0.257) whilst the right uterine artery had a PI of 1.78 (SD+/- 0.684). Both the left and right uterine artery PI were statistically significant left p<0.001; right p<0.001.

Conclusion The findings of this research study are similar to those obtained from other studies. Through this research uterine artery measurements may be an applicable tool to further investigate recurrent pregnancy loss, and provide a better understanding and strategy for future management and treatment.