The Application Research Of Aspirin/low Molecular Heparin Improving Uterine Blood Flow Perfusion In The Treatment Of Pregnant Women With Recurrent Pregnancy Loss

Objective 1.To compare uterine blood flow perfusion parameters(uterine artery resistance index(RI))between normal women and women with recurrent pregnancy loss(RPL),in middle luteal phase and early pregnancy.2.To compare the clinical effect of low-dose aspirin(LDA),low molecular weight heparin(LMWH),LDA combinating LMWH on the pregnancy outcomes of pregnant women with RPL and abnormal uterine blood flow perfusion.Methods 2.From January 2014 to June 2017,the female patients of childbearing age who admitted to the Second Affiliated Hospital of Soochow University were selected,including 242 cases of women with RPL group and 135 cases of normal women group.The parameters of uterine blood flow perfusion(uterine arterial RI)were measured by transvaginal ultrasound in the middle luteal phase,the differences of uterine artery RI between normal women and women with RPL in the middle stage of luteal was compared and a scatter plot is drawn.2.Drug intervention is carried out for pregnant women with RPL and abnormal uterine artery RI(n=133).According to the drug regimen,it was divided into aspirin group(n=14),low molecular heparin group(n=37)and combined treatment group(n = 82).The drug regimen of aspirin group was 1 pill/day for aspirin 100 mg.The drug regimen of LMWH group was subcutaneous injection of LMWH 4100 U 1 time/day.The drug regimen of combined treatment group was aspirin 100 mg orally 1 pill/day,at the same time combined LMWH 4100 U subcutaneously 1 time/day.There are another group of 54 cases of normal pregnancy,compare the uterine blood flow perfusion parameters(uterine artery RI)of treatment groups and normal group in early pregnancy,follow-up pregnancy outcomes,including miscarriage,live birth,preterm birth,full term-living birth,pregnancy complications,neonatal birth situation,etc.Results 1.In the middle luteal phase,It was found that the mean±standard deviation of the right side,left side,average of uterine arterial RI in women with RPL was 0.82 ±0.08,while it was 0.80±0.07,0.80±0.06 and 0.80±0.06 in normal women,respectively,and the differences between the two groups were statistically significant(P < 0.05).2.The abortion rates of aspirin group,LMWH group,combination therapy group,and normal pregnancy group were 21.4%,32.4%,22.0%,16.7% respectively,and the differences were not statistically significant(P>0.05).3.The risk of pregnancy complications(such as abortion,preeclampsia and fetal growth restriction,etc)in aspirin group,LMWH group,combination therapy group,and normal pregnancy group were 50.0%,37.8%,35.4%,31.5% respectively,and the differences were not statistically significant(P>0.05).Conclusions 1.The uterine arterial RI of women with RPL was higher than that of normal women in middle luteal phase.It is suggested that uterine blood flow perfusion should be used as a routine examination for the etiology screening and evaluation of women with RPL.2.In the group of pregnant women with RPL and abnormal uterine artery RI,it can effectively reduce the RI of uterine artery through the treatment of aspirin,LMWH and combination therapy in early pregnancy,and the incidence of adverse pregnancy outcomes(such as abortion,preeclampsia and fetal growth restriction)were not different from that of the normal pregnant women.3.There was no difference in the treatment effect of aspirin,LMWH and combined medication in early pregnancy women with RPL and abnormal uterine arterial RI.It was recommended that a single drug treatment of aspirin or LMWH should be used for clinical treatment.