| Objective: To study the diagnostic value of uterine spiral artery RI on incompleteabortion and complete abortion by Transvaginal sonography.Materials and methods:182abortion patients of pregnancy were collected, theyunderwent the first time routine TVS examination in6~8days after abortion, observationuterine endometrial clear or not, whether have pregnancy villus tissue residues, theresidues echo of two-dimensional ultrasonographic,and measured accurately theendometrial thickness,and/or the A-P diameter of uterine cavity in vertical axis,and the sizeof the residues. Color Doppler technology was used to detect the blood flow signal ofintrauterine residues; Pulse doppler technology was used to trace the blood flow signal, andgain the resistance index(RI to shorten) of uterine artery and uterine spiral artery. Patientswas suspected incomplete abortion by TVS examination,which who pathological tissuebiopsy was taken all. The patients with no eidence of incomplete abortion when the firstTVS examination,13~15days after miscarriage reviewed TVS again, endometrialthickness were recorded,and then follow-up until the first menstruation coming.If there aresuspected incomplete abortion by review TVS,then pathological biopsy is also done.Using independent sample t test to compare the bilateral uterine artery RI value anduterine spiral artery RI value of incomplete abortion and complete abortion group; Paired ttest was used to compare the endometrial thickness of complete abortion after6~8daysand13~15days. The pathology results as the gold standard, calculate the diagnosisefficiency of two-dimensional ultrasound and of a CDFI in182cases of abortion patientsafter; The ROC (Receiver operating characteristic) curves uterine spiral artery RI valueswas build to calculate the best diagnostic cutoff value of incomplete abortion and completeabortion, and analyzes its sensitivity, specificity, accuracy, positive predictive value andnegative predictive value.About the93patients whom complete the two-dimensionalultrasound and CDFI and PW at the same time, the2test was used to compare the diagnostic performance between the two-dimensional ultrasound and CDFI and PW.Results:（1）The left side of uterine artery RI of incomplete abortion and completeabortion group are0.804±0.089and0.796±0.095, the difference between the two groupshas no statistical significance (t=0.367,P>0.001). The right side of uterine artery RI ofincomplete abortion and complete abortion group are:0.798±0.050and0.804±0.089,andthe difference between the two groups has no statistical significance (t=0.295,P>0.001).（2）The uterine spiral artery RI of incomplete abortion group and complete abortionare:0.540±0.037and0.618±0.096, there was a statistically significance between the twogroups (t=3.558,P<0.001).（3）The endometrial thickness of6~8days and13~15days after miscarriage incomplete abortion group are:0.470±0.175cm and0.664±0.305cm, the differences betweenthem has a statistically significance (t=4.514,P<0.001).（4）Two-dimensional ultrasound and CDFI diagnose182patients after miscarriage(A-P value is1.0cm or more as the standard of diagnosis of incomplete abortion), itssensitivity, specificity,accuracy,positive predictive value and negative predictive value arerespectively:95.56%(43/45),77.37%(106/137),81.87%(132/182),58.11%(43/74) and98.15%(106/108).（5）According to the ROC curve of the uterine spiral artery RI, the area under thecurve is0.883, the cutoff of uterine spiral artery RI on diagnosing incomplete abortion is0.58, when RI is0.58or less could diagnose incomplete abortion, if more than0.58couldmean complete abortion, and the sensitivity, specificity, accuracy, positive predictive valueand negative predictive value are:86.36%(39/45),73.91%(35/48),79.57%(74/93),75.00%(39/52) and85.37%(35/41) respectively.（6）The camparison of diagnosis effectiveness of93patients who both finshed thetwo-dimensional ultrasound and CDFI and PW check: the sensitivity of PW check is lessthan two-dimensional ultrasound and CDFI (95.56%vs.86.36%),but there was nostatictical difference between them(2=2.195,P=0.138). The specificity and accuracy ofPW check are significantly higher than that of two-dimensional ultrasound and CDFI（35.42%vs.72.92%;64.52%vs.79.57%）,and there are both statictical significancebetween them(2=13.594,P＜0.001;2=19.619,P＜0.001).Conclusion: The endometrial thickness of6~8days after complete abortion is less than the13~15days. Uterine artery RI has a limited value on diagosing incompleteabortion; the sensitivity of diagnosing incomplete abortion of PW is lower thantwo-dimensional ultrasound and CDFI, however the specificity and accuracy aresignificantly higher than that of two-dimensional ultrasound and CDFI. Uterine spiralartery RI can identify betterly incomplete abortion and complete abortion, with a higherclinical practicability. |
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