The Application Value Of Transvaginal Ultrasound Detection Of Uterine Artery Blood Flow Parameters In The Diagnosis Of Missed Abortio

Objective:By comparing the ratio between the peak of systolic velocity and the end of diastolic velocity(S/D),resistant index(RI)and Pulse Index(PI)of uterine artery blood flow parameters between normal early pregnancy(EP)and missed abortion(MA)women,to analyze the correlation between uterine artery blood flow parameters and early missed abortion,and to explore the value of transvaginal ultrasound(TVS)in detecting uterine artery blood flow parameters(S/D,RI and PI)in the diagnosis of MA,to provide evidence for the early clinical diagnosis of MA.Methods:Collect pregnant women,aged between 20 and 40 years old,with regular menstrual cycle,natural pregnancy,diagnosed single pregnancy,who were examined by ultrasound in our hospital in October 2022 to January 2023,the gestational weeks were 6-10 weeks,100 cases of missed abortion and 100 cases of normal intrauterine early pregnancy served as control group.The ultrasonographic findings including gestational sac size,yolk sac,fetal bud and cardiac pulsation,serum HCG level and bilateral uterine artery blood flow parameters were analyzed.The Hemodynamics parameters were recorded,the ratio of peak systolic to end diastolic flow velocity(S/D),resistance index(RI)and pulsatility index(PI)were measured.According to the level of HCG,the patients were divided into three groups:Group A,which corresponded to the corresponding gestational age;Group B,which did not corresponded to the corresponding gestational age;and Group C,which did not undergo HCG detection,the spectrum of uterine artery was recorded and analyzed.The patients were divided into four groups according to two-dimensional ultrasound image: Group 1: the length of parietal-buttock ≥7 mm,the fetal heart beat was not detected;Group 2: the mean diameter of intrauterine pregnancy sac ≥25 mm,the fetal echo was not found;Group 3: the yolk sac echo was not found in intrauterine pregnancy,and the embryo and heart tube beat were not detected after 2 weeks;Group 4: the yolk sac echo could be detected in intrauterine pregnancy,but the fetal heart beat was not found after 11 days,the spectrum of uterine artery was recorded and analyzed.Results:(1)In the case group and the control group,the rate of showing intrauterine pregnancy sac was 100%,there were 18 cases in group A,48 cases in group B and 34 cases in Group C.Satisfactory uterine artery blood flow could be detected in all cases and controls.There were 46 cases in group 1,9 cases in group 2,12 cases in Group 3 and 33 cases in Group4.(2)The comparison of PI,RI and S/D value of uterine artery blood flow parameters between case group and control group: PI value contrast P<0.001,RI value contrast P<0.001,S/D value contrast P<0.001;There were significant differences in PI,RI and S/D between Case Group and control group.PI,RI and S/D in case group were significantly higher than those in control group.(3)The comparison of PI,RI and S/D of uterine artery blood flow parameters among group A,Group B and Group C: the comparison of PI among three groups P=0.136 >0.05,the comparison of RI among three groups P=0.0282>0.05;S/D values among the three groups P =0.075 >0.05.There were no significant differences in PI,RI and S/D among groups A,B and C.(4)Comparison of PI,RI and S/D of uterine artery blood flow parameters among groups 1,2,3 and 4 in case group: Comparison of PI between four groups P=0.315> 0.05;Comparison of RI between four groups P=0.964>0.05,Comparison of S/D between four groups P=0.075>0.05.among the four groups,there were no significant differences in PI,RI and S/D among groups 1,2,3 and 4 in case group.(5)ROC analysis of uterine artery blood flow parameters PI,RI and S/D: The results of ROC curve analysis showed that PI was the best parameter for diagnosis of MA.The optimal thresholds of PI,RI and S/D were 2.23,0.86 and 6.53 respectively.The area under the ROC curve of PI,RI and S/D were 0.87,0.77 and 0.78 respectively.Conclusion:(1)The value of PI,RI and S/D of uterine artery blood flow in patients with missed abortion is of diagnostic value.The value of PI,RI and S/D of uterine artery blood flow in patients with missed abortion is significantly higher than that in normal early pregnant women,when PI ≥2.23,RI ≥0.86,S/D≥6.53,it can provide effective information for early diagnosis of missed abortion.(2)PI,RI and S/D were the best indexes for diagnosis of missed abortion,RI and S/D were lower than PI.(3)In the patients with missed abortion,there was no significant correlation between the single HCG detection and the uterine artery Doppler parameters(PI,RI,S/D).(4)In the patients with missed abortion,there was no significant correlation between the results of two-dimensional ultrasound and the doppler parameters of uterine artery,such as PI,RI,S/D.