Recurrent miscarriage associated with antiphospholipid antibodies: assessment of endometrial and subendometrial characteristics by three-dimensional ultrasonography and power doppler angiography

Abstract

OBJECTIVE: The antiphospholipid antibodies (APA) are recognized being closely related to recurrent miscarriage (RM). The aim of this study was to evaluate endometrial and subendometrial parameters by three-dimensional ultrasonography and power Doppler angiography (3D-PDA) in primary RM patients with APA (aPL-RM). DESIGN: A prospective observational study of vaginal 3D-PDA assessment for endometrial-subendometrial area in mid-luteal phase. MATERIALS AND METHODS: Out of 1109 primary RM patients between August, 2007 and January, 2010, 107 non-pregnant patients with anticardiolipin antibodies and/or lupus anticoagulant (aPL-RM group) and 46 fertile Control women without APA who have had one or more live births and no history of spontaneous abortions were enrolled. All subjects underwent a screening protocol to exclude the common genetic, anatomical, endocrine, immunological, behavioral and infectious factors associated with RM. Uterine arteries flow indices and endometrial-subendometrial vascularity were measured on the 7th day after the ultrasonographically confirmed ovulation by GE Voluson i machine. Endometrial volume (EV), subendometrial volume (sEV), vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were calculated using the VOCAL (Virtual Organ Computer-aided AnaLysis) software. RESULTS: No significant differences were observed in EV,sEV, uterine arteries pulsatility index and resistive index between the two groups. aPL-RM patients had significantly lower subendometrial FI (P=.000), endometrial VI (P=.048) and FI (P=.000) as well as endometrial and subendometrial VFI (P=.000 and .011,respectively) than the Control group; but no significant difference in subendometrial VI (P=.260) could be detected between the two groups. CONCLUSION: A decrease in endometrial and subendometrial blood flows detected by 3D-PDA may demonstrate the impaired implantation environment in aPL-RM patients.