Uterine artery Doppler in the management of early pregnancy loss: a prospective, longitudinal study.

Luís Guedes-Martins,Ana Reynolds,Joaquim P Saraiva,Ana R Gaio,Filipe Macedo,Henrique Almeida

doi:10.1186/s12884-015-0464-9

Abstract

BackgroundThe pharmacological management of early pregnancy loss reduced substantially the need for dilation and curettage. However, prognostic markers of successful outcome were not established. Thus the major purpose of this study was to determine the sensitivity and specificity of the uterine artery pulsatility (PI) and resistance (RI) indices to detect early pregnancy loss patients requiring dilation and curettage after unsuccessful management.MethodsA cohort prospective observational study was undertaken to include women with early pregnancy loss, ≤ 12 weeks of gestation, managed with mifepristone (200 mg) and misoprostol (1600 μg) followed by PI and RI evaluation of both uterine arteries 2 weeks after. At this time, in 173/315 patients, incomplete miscarriage was diagnosed. Among them, 32 underwent uterine dilatation and curettage at 8 weeks of follow-up.ResultsThe cut-off points for the uterine artery PI and RI, leading to the maximum values of sensitivity (69.5%, CI95%: 61.5%-76.5% and 75.0%, CI95%: 57.9%-86.8%, respectively) and specificity (75.0%, CI95%: 57.9%-86.8% and 65.6%, CI95%: 48.3%-79.6%, respectively), for the discrimination between the women who needed curettage from those who resolved spontaneously were 2.8 and 1, respectively.ConclusionsThe potential usefulness of uterine artery Doppler evaluation to predict the need for uterine curettage in patients submitted to medical treatment for early pregnancy loss was demonstrated.

Highlights

The pharmacological management of early pregnancy loss reduced substantially the need for dilation and curettage
Medical management with misoprostol, as an alternative to uterine dilation and curettage (D&C), has been associated with very high success rates of up to 99% in cases of early pregnancy loss [3,4,5,6], expectant management has been indicated as a safe option for women with a first-trimester miscarriage [7,8,9]
The lack of consensus on the criteria for the success or failure of medical management in early miscarriage [4,7,8,9,10] precludes comprehensive conclusions regarding the obtained results. This lack of comparative data hinders a timely decision regarding whether to proceed with a uterine D&C, which, it is a simple procedure, could result in serious complications

Summary

Introduction

The pharmacological management of early pregnancy loss reduced substantially the need for dilation and curettage. Medical management with misoprostol, as an alternative to uterine dilation and curettage (D&C), has been associated with very high success rates of up to 99% in cases of early pregnancy loss [3,4,5,6], expectant management has been indicated as a safe option for women with a first-trimester miscarriage [7,8,9]. This lack of comparative data hinders a timely decision regarding whether to proceed with a uterine D&C, which, it is a simple procedure, could result in serious complications. Uterine sonographic assessment in incomplete miscarriages might estimate the amount of ovular tissue remaining in the uterine cavity and the decidua thickness, the data fail to accurately predict the outcome when conservative management is an option [7].

Objectives

Methods

Results

Discussion

Conclusion