Abstract
Objective:To explore the correlation between endometrial receptivity(ER)and pregnancy outcome by multi-modal ultrasound in patients with recurrent spontaneous abortion(RSA).Methods:A prospective,double-blind cohort study was conducted,in which 2458 cases who were evaluated by transvaginal ultrasound in the middle luteal phase(7～9 days after ovu-lation)in Weifang People's Hospital were selected.After screening,98 cases with RSA were randomly selected as the study group,and 96 normal people(no history of spontaneous abortion)were randomly selected as the normal control group.The en-dometrial morphological parameters(endometrial thickness,endometrial volume,endometrial type and endometrial peristalsis fre-quency)and uterine hemodynamic parameters(endometrial and subendothelial blood flow types,vascular blood flow index(VFI),vascularization index(VI),flow index(FI),the ratio of uterine artery systolic peak blood flow velocity to end diastolic blood flow velocity(S/D),uterine artery pulse index(PI),resistance index(RI))were recorded in the two groups respectively.The pregnancy outcomes of RSA group and control group were tracked and divided into RSA pregnancy success group(46 cases),RSA non-pregnancy group(52 cases),normal pregnancy success group(80 cases)and normal non-pregnancy group(16 cases).The ultra-sonic parameters of endometrial receptivity of patients with different pregnancy outcomes were analyzed by statistical method,and the predictive value of each parameter and its parallel diagnosis were analyzed by receiver operating characteristic(ROC)curve.Results:The endometrial thickness,endometrial volume,VI,FI and VFI in RSA group were all lower than those in the control group,while the RI,PI and S/D of uterine artery were higher than those in the control group.Tracking the preg-nancy outcome:the VI,FI and VFI in RSA pregnant patients were significantly higher than those in RSA non-pregnant group,with statistical significance(P<0.05).The pregnancy success rate of type Ⅰ,Ⅱ and Ⅲ intima blood flow was 63.8%,77.6%and 92.5%respectively,and the pregnancy success rate of type A,B and C intima was 89.8%,66.6%and 65.5%re-spectively,with statistical differences.Through ROC curve analysis,the best cutoff value,AUC,specificity and sensitivity of each ultrasound parameter were:endometrial thickness(6.2 mm,0.664,0.365,0.894),endometrial volume(2.13 cm3,0.776,0.500,0.831)and uterine artery RI(0.84,0.639,0.472,0.788),PI(2.27,0.591,0.493,0.692),S/D(6.295,0.622,0.788,0.507),VI(6.09,0.846,0.923,0.655),FI(12.61,0.736,0.769,0.704),VFI(0.775,0.841,0.904,0.676).The AUC,sensitivity and speci-ficity of parallel diagnosis of each parameter in predicting pregnancy outcome were 0.867,82.4%and 84.6%.Conclusion:Ul-trasound examination of RSA patients in the middle luteal phase reveals significant differences in endometrial morphology and hemodynamics compared to normal individuals,ER can predict pregnancy outcomes in RSA patients through ultrasound tech-nology,and the value of diagnosing endometrial receptivity in parallel with each ultrasound parameter is greater than that of a single parameter.关键词
子宫内膜/流产/超声检查,多普勒,彩色Key words
Endometrium/Abortion/Ultrasonography,Doppler,Color分类
医药卫生
