Correlation Study Of Uterine Spiral Artery Three Dimensional Power Doppler In Predicting Recurrent Spontaneous Abortion

Objective: Analysis of Recurrent Spontaneous Abortions(RSA)patients with spectral doppler and three-dimensional power doppler Imaging(3D-PDI),To investigate the feasibility of spectral doppler and3D-PDI in evaluating the spiral arterial blood flow dynamics of uterus and the relevant parameters of 3D-PDI in patients with recurrent abortion and the optimal critical value in the diagnosis of recurrent abortion.Furthermore,to explore whether various ultrasound indicators of uterine spiral artery(SA)can improve the clinical diagnostic efficacy of recurrent abortion.Methods: Pregnant women who had RSA history in the Department of Obstetrics and Gynecology at Affiliated Hospital of Jining Medical University were recruited.Fifty pregnant women with RSA history and underwent early pregnancy NT examination(11～13+6 weeks gestation)were enrolled as the study group,and 100 pregnant women with no previous history of spontaneous abortion at the same gestational week were enrolled as the control group.Spectral doppler imaging and 3D-PDI were performed on spiral uterine arteries of all subjects.Vascularization index(VI),flow index(FI)and vascularization flow index(VFI)of the uterine spiral artery were measured and analyzed,the uterine spiral artery resistance index(RI),pulsatility index(PI)and peak systolic velocity/end diastolie veloeity(S/D),and other relevant data.Meanwhile,general clinical data such as gestational age,age,body mass index(BMI)and number of abortions were collected.To explore the feasibility of spectral doppler and 3D-PDI in predicting RSA.Receiver operating characteristic curve(ROC)was drawn for each individual ultrasonic index and the combined index of each ultrasonic index VI,FI and VFI in 3D-PDI.The area under curve(AUC)was calculated and the diagnostic efficiency of each index was compared.Results: There was no significant difference in gestational age,age,BMI and number of abortions between the study group and the control group.The values of spiral artery RI,PI and S/D in the experimental group were higher than those in the control group.The uterine spiral artery VI,FI and VFI of experimental group were higher than those of control group.The sensitivity and specificity of each ultrasonic index RI,PI and S/D in the diagnosis of RSA were 86.4%,25.3%,90.1%,29.5%,87.0% and 31.8%,respectively.The sensitivity and specificity of each ultrasonic index VI,FI and VFI in the diagnosis of RSA were 65.0%,58.9%,73.9%,89.0%,78.3%,75.6%,respectively.The sensitivity and specificity of VI,FI and VFI combined indexes in the diagnosis of RSA in 3D-PDI were 84.7% and 92.5%,respectively.The single application of the six ultrasonic indexes RI,PI,S/D,VI,FI and VFI values of the uterine spiral artery compared with the combined indexes VI,FI and VFI of 3D-PDI showed that the diagnostic efficiency of the combined indexes was higher than that of the single application of VI,FI,VFI,RI,PI and S/D values.The diagnostic efficiency of 3D-PDI ultrasound indexes VI,FI and VFI applied alone was higher than that of spectral doppler(RI,PI and S/D)applied alone.The area under the AUC curve of the combined indexes VI,FI and VFI of 3D-PDI ultrasound indexes was the highest 0.891.The optimal critical value was 0.58,and those difference was statistically significant(P<0.05).Conclusion: 1.The values of spiral artery RI,PI and S/D in pregnant women with RSA history were higher than those in pregnant women with no previous history of RSA at the same gestational week,while the values of spiral artery VI,FI and VFI in subendometrium were lower than those in pregnant women with no previous history of RSA at the same gestational week.2.Compared with the values of RI,PI and S/D of RI,FI and VFI of spectral doppler,the values of VI,FI and VFI of spiral uterine artery 3D-PDI have higher predictive value for recurrent abortion.