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A comparison of the uterine and intraovarian arterial flows in nonpregnant women having a history of recurrent spontaneous miscarriage associated with antiphospholipid syndrome

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Abstract

Objective

The objective was to study the relationship between values of Doppler indices characterizing the uterine and intraovarian arterial flows and presence or absence of antiphospholipid syndrome in women with history of recurrent spontaneous miscarriage in the midluteal phase of unstimulated menstrual cycle.

Methods

Sixty two non pregnant women attending our recurrent spontaneous miscarriage clinic were recruited for this prospective study and subsequently divided to group A (n=35) involving recurrent spontaneous miscarriage women with normal anticardiolipin antibodies values and group B (n=27) for those with abnormal anticardiolipin antibodies values. Anticardiolipin antibodies were measured in the blood using the standardized enzyme linked immunosorbent assay. B-mode, pulsed, color and power Doppler transvaginal ultrasonography was used to estimate the uterine artery pulsatility index, spiral artery resistance index, intraovarian arterial resistance index and endometrial thickness on the 21st day of a regular 28-day unstimulated menstrual cycle. The data were analyzed using the statistical software SPSS 9.0 Windows. Statistical significance was defined as p≤0.05.

Results

There was no statistically significant difference in values of Doppler indices characterizing uterine and intraovarian arterial flows in women having a history of recurrent spontaneous miscarriage (RSM) with presence or absence of antiphospholipid syndrome. There were a significantly higher number of women with normal anticardiolipin antibodies above 30 years having a history of six or more RSM [7 (31.8)] compared to RSM women with abnormal anticardiolipin antibodies [0 (0)] (p<0.028). Significantly higher incidence of the primary RSM was found in group A [16 (64.0)] compared to group B [9 (36.0)] (p≤0.02). A consistently similar difference pattern was observed between the mean intraovarian arterial resistance index value in group A primary RSM [0.54 (0.40–0.63)] compared to a more favorable mean intraovarian arterial resistance index value in group B secondary RSM [0.46 (0.43–0.58)] (p≤0.02).

Conclusions

Our prospective study did not confirm any statistically significant difference in values of Doppler indices characterizing uterine and intraovarian arterial flows of RSM women with presence or absence of antiphospholipid syndrome in the midluteal phase of unstimulated menstrual cycle. This finding suggests that a mild form of APS will not result in any significant impairment of angiogenesis occurring at time of implantation of fertilized ovum.

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Abbreviations

APS:

Antiphospholipid syndrome

RSM:

Recurrent spontaneous miscarriage

ACL IgM antibodies:

Anticardiolipin antibodies immunoglobulin M

ACL IgG antibodies:

Anticardiolipin antibodies immunoglobulin G

LA antibodies:

Lupus anticoagulant antibodies

ELISA:

Enzyme linked immunosorbent assay

UTAPI:

Uterine artery pulsatility index

SARI:

Spiral artery resistance index

IOARI:

Intraovarian arterial resistance index

ALARA:

As low as reasonably achievable

ETH:

Endometrial thickness

LH:

Luteinizing hormone

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Acknowledgement

The authors are grateful to Mrs Asiya T. Mohammed for her assistance with the final arrangement of the manuscript.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Maternity Hospital, Kuwait

    Jiri Jirous, Michael E. Diejomaoh & Fahed Al-Abdulhadi

  2. Department of Obstetrics and Gynecology, Faculty of Medicine, Kuwait University, P.O. Box 24923, 13110, Safat, Kuwait

    Michael E. Diejomaoh

  3. Department of Biochemistry, Maternity Hospital, Kuwait

    Masooma H. Boland

  4. Department of Community Medicine, Faculty of Medicine, Kuwait University, P.O. Box 24923 , 13110, Safat, Kuwait

    Maqsood Nazar

Authors
  1. Jiri Jirous
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  2. Michael E. Diejomaoh
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  3. Fahed Al-Abdulhadi
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  4. Masooma H. Boland
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  5. Maqsood Nazar
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Correspondence to Michael E. Diejomaoh.

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Jirous, J., Diejomaoh, M.E., Al-Abdulhadi, F. et al. A comparison of the uterine and intraovarian arterial flows in nonpregnant women having a history of recurrent spontaneous miscarriage associated with antiphospholipid syndrome. Arch Gynecol Obstet 270, 74–78 (2004). https://doi.org/10.1007/s00404-003-0510-0

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  • DOI: https://doi.org/10.1007/s00404-003-0510-0

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