Study On The Charateristics Of Endometrial Thickness And Uterine Hemodynamics On Recurrent Spontaneous Abortion

Objective: The characteristics of endometrial thickness and uterine hemodynamic parameters were observed and compared between recurrent spontaneous abortion(RSA) group and the control group,and the potential influencing factors were analyzed.The effects of aspirin o n the parameters mentioned above were also observed.This study was aimed to investigate the correlation between endometrial thickness,uterine hemodynamics and RSA.Besides,to provide theoretical basis for aspirin treatment in the field of RSA.Method: A total of 1155 reproductive age women presenting to outpatient clinic during January 2014 to January 2017 were recruited,inc luding 917 patients with a history of RSA(RSA group),188 patients without a history of RSA(control group)and 50 normal pregnant women(control group).The color Doppler ultrasonography was used to measure the endometrial thickness and endometrial hemodynamic parameters(inc luding pulsatility index(PI),resistance index(RI) and systolic/ diastolic ratio(S/D)) during the midluteal phase,and uterine artery hemodynamic parameters during the midluteal phase and different gestational weeks.Meanwhile,to observe the changes of parameters mentioned above after administration of aspirin at a dose of 50mg/d for two months.Results: During the midluteal phase,the res istance to uterine artery blood flow was significantly higher in RSA group than in the control group(P<0.001),and was not correlated with age and the number of abortions.RSA patients with autoimmune diseases,uterine anomalies,thrombophilia,or unexplained RSA patients showed higher resistance to uterine artery blood flow than those in the control group during the midluteal phase(P<0.05).RSA patients with autoimmune antibodies positive,such as ANA,anti-ds DNA antibody,anti-β2-GP1 antibody,anticardiolipin antibody(ACA)and lupus anticoagulant(LAC),showed high resistance to uterine artery blood flow during the midluteal phase.The endometrial thickness of RSA patients was thinner than those in the control group and one time spontaneous abortion group.Besides,the endometrial thickness was associated with the number of abortions,while it had no correlation with age.Patients with a history of spontaneous abortion,inc luding only one time spontaneous abortion and RSA,had significantly higher impedance to uterine artery blood flow than those in the control group during the midluteal phase(P<0.05).Moreover,the resistance to endometrial blood flow in RSA patietns were increased with the growth of age,whilst it had no association with the number of abortions.RSA patients with autoimmune diseases,uterine anomalies,thrombophilia,endocrinological abnormalities,or unexplained RSA patients showed higher res istance to endometrial hemodynamics than those in the control group during the midluteal phase(P<0.05).RSA patients with autoimmune antibodies positive,such as ANA,anti-ds DNA antibody,showed higher impedence to endometrial blood flow than those in the control group during the midluteal phase(P<0.05).The endometrial hemodynamic parameters(PI,RI,S/D)had a certain predictive value for early spontaneous abortion,and the RI of endometrial blood flow had the highest predictive value.Low-dose aspirin could significantly reduce the resistance to uterine artery and endometrial blood flow,and improved uterine perfus ion,especially for patients with endometrial thickness <7mm,it could significantly increase endometrial thickness(P<0.001).During pregnancy,there was no significant difference of hemodynamic parameters between the left and right uterine artery(P>0.05).After 12 th weeks of gestation,the resistance to uterine artery blood flow of both normal women and RSA patients was significantly decreased with the increase of gestational weeks,which declined fastest during 12 to 16 weeks of gestation.During pregnancy,the changes of uterine artery hemodynamic parameters in RSA patients with successful treatment after individualized therap ies were consistent with those in normal pregnant women.Conclusions: Endometrial thickness and high resistance state of uterine hemodynamics(inc luding uterine artery and endometrial blood flow)were closely associated with RSA.Autoimmune diseases,thrombophilia and other diseases would affect uterine hemodynamics and endometrial thickness.Some autoantibodies were risk factors for high res istance state of uterine hemodynamics.The PI,RI and S/D of endometrial blood flow had a certain predictive value for early spontaneous abortion.During pregnancy,there was no significant difference of hemodynamic parameters between left and right uterine artery,and after 12 th weeks of gestation,the resistance to uterine artery blood flow decreased significantly with the increase of gestational weeks.Aspirin could significantly reduce res istance to uterine artery and endometrial blood flow,and improve uterine perfusion.