Uterine artery Doppler in the management of early pregnancy loss: a prospective, longitudinal study

BACKGROUND: The pharmacological management of early pregnancy loss reduced substantially the need for dilation and curettage. However, prognostic markers of successful outcome were not established. Thus the major purpose of this study was to determine the sensitivity and specificity of the uterine artery pulsatility (PI) and resistance (RI) indices to detect early pregnancy loss patients requiring dilation and curettage after unsuccessful management. METHODS: A cohort prospective observational study was undertaken to include women with early pregnancy loss, ≤ 12 weeks of gestation, managed with mifepristone (200 mg) and misoprostol (1600 μg) followed by PI and RI evaluation of both uterine arteries 2 weeks after. At this time, in 173/315 patients, incomplete miscarriage was diagnosed. Among them, 32 underwent uterine dilatation and curettage at 8 weeks of follow-up. RESULTS: The cut-off points for the uterine artery PI and RI, leading to the maximum values of sensitivity (69.5%, CI(95%): 61.5%-76.5% and 75.0%, CI(95%): 57.9%-86.8%, respectively) and specificity (75.0%, CI(95%): 57.9%-86.8% and 65.6%, CI(95%): 48.3%-79.6%, respectively), for the discrimination between the women who needed curettage from those who resolved spontaneously were 2.8 and 1, respectively. CONCLUSIONS: The potential usefulness of uterine artery Doppler evaluation to predict the need for uterine curettage in patients submitted to medical treatment for early pregnancy loss was demonstrated.