Colour Doppler Study of ovarian blood vessel in threatened abortion and comparison with asymptomaic normal pregnancy

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Int.J.Curr.Res.Aca.Rev.2016; 4(2): 160-163
160
Introduction
The advent of sonography has changed the
practice of obstetrics by providing a window
to the womb through which anatomic
structure of the fetus can be evaluated (1, 2).
The addition of Doppler flow studies of
maternal & fetal vessels has provided a tool
where the physiology of maternal-fetal unit
can be assessed (3, 4). The utilization of real
time scanning and improvement in image
resolution following the introduction of high
frequency probes have enabled accurate
diagnosis and revolutionized the diagnostic
Colour Doppler Study of ovarian blood vessel in threatened abortion and
comparison with asymptomaic normal pregnancy
Ruchika Garg*, Rachna Agarwal, Mukul Chandra, Meenal Jain and Sadhana Singh
Department of Obstetrics and Gynaecology, S.N.Medical, College, Agra, U.P, India
*Corresponding author
A B S T R A C T
The aim of this study was to test velocimetric pattern of ovarian blood vessels
in threatened abortion by Transvagimal colour Doppler ultrasound and to
compare it with normal asymptomatic pregnancy, with gestational age
ranging from 5 week to 16 weeks of pregnancy. We enrolled 120 patient from
August 2011 to Sep 2013. Patient were divided in two groups according to
the symptoms. One was study group (patients who presented here with
features of threatened abortion) and other was control group with normal
asymptomatic pregnancy. Ovarian velocimetric pattern was found abnormal
in 37% of untreated patient who fail to continue pregnancy while 63% patient
were able to continue pregnancy with abnormal ovarian velocimetric pattern
after taking treatment, 21% of asymptomatic pregnancy shows abnormal
wave forms with resistivity Index of 0.77 to 0.98, Which were treated timely
before the appearance of symptoms and continue pregnancy till term. So
higher the resistivity index of ovarian vessels higher the chances of
miscarriage. Colour Doppler ultrasound is a safe, painless, non invasive
diagnostic test, which seems to be very helpful in prevention of future fetal
losses in asymptomatic symptomatic as well as in patient, at very early
gestational age.
KEYWORDS
Colour Doppler,
Ovarian blood vessel,
Asymptomaic normal
pregnancy
International Journal of Current Research
and Academic Review
ISSN: 2347-3215 Volume 4 Number 2 (February-2016) pp. 160-163
Journal home page: http://www.ijcrar.com
doi: http://dx.doi.org/10.20546/ijcrar.2016.402.019

Int.J.Curr.Res.Aca.Rev.2016; 4(2): 160-163
161
as well as therapeutic management of
different clinical conditions (5).
The first twelve weeks of intra uterine life
are the most crucial period which needs a
careful eye on the growing fetus inside and
if bleeding occurs at this stage history and
clinical examination may frequently be
inconclusive (6).
Colour Doppler ultrasound plays a role of
utmost importance in confirming the
pregnancy, site of pregnancy, viability and
also in predicting whether a pregnancy has a
good chance of continuing or it is destined
to fail. Colour Doppler study of ovarian
blood vessels performed in early pregnancy
can be helpful in predicting the risk of
miscarriage and also helpful in choosing the
management modality in patient with
threatened abortion.
Materials and Methods
The present study was carried out on 120
married women with gestational age of 5-16
week of pregnancy from Agra or nearby
area, who attended Antenatal clinic or
admitted in the labour room during
emergency in the department of Obstetrics
and Gynaecology S.N. Medical College
Agra. The study was carried out during the
period of August 2011 to Sep 2013.
Approval of ethical committee of hospital
was obtained. The patient were divided in to
two groups. One was study group which
include those patients who visited hospital
after having signs and symptoms threatened
abortion another group was control group
which include those female who were
having normal pregnancy without any
symptom.
Detail history was taken and through
examination was done in all the patients,
while per-speculum examination was done
in patient who presented with bleeding
pervaginum.
Transvaginal Doppler ultrasound was done
in all the patients, to see the velocimetric
pattern of ovarian blood vessels. Patients
with abnormal velocimetric pattern were
called for follow up every weekly till next 8
weeks or till normal pattern achieved.
Results and Discussion
During this study total 120 patients
underwent Doppler ultrasound of ovarian
blood vessels along with obstetrical
ultrasound examination at our institution.
Maternal age at the time of first visit was
(27.27±2.7) in study group while (26±2.6) in
control group. There were no significant
differences between study and control group
regarding maternal age, parity, Gestational
age.2 From study group mean of duration of
bleeding per-vaginum was 17 hrs. The
symptoms of threatened abortion such as
vaginal bleeding, brownish discharge with
or without cramping were detected in 17%
while 29% did not have any symtoms. The
“silent hematoma” in these cases was
diagnosed only by ultrasound.2,3
Table 2 Present Gestational Sacpattern
which includes Turgidity, Regularity of Sac,
Yolk Sac. In study group 67% patients had
good turgidity while in control group 83.3%
patients had good turgidity. In control group
80% had regular pattern of gestational
Sacwhile in study group 66.7% patient had
regular pattern, Yolk sacwas found normal
in 87% control group and 70% in study
group.4
Table 3 Shows that 22 cases from study
group aborted with mean resistivity index of
(0.91± 0.01) while 38 cases continue their
pregnancy with mean resistivity index of
(0.78± 0.01). These are statistically
significant that higher the resistivity index,
higher the chances of miscarriage. All

Int.J.Curr.Res.Aca.Rev.2016; 4(2): 160-163
162
patients of abnormal velocimetric pattern
were kept on progesterone support after 12
weeks of pregnancy and before this injection
human chorionic gonadotropin (HCG) was
given, with advice to take rest.5,6,7
Table.1 Distribution of Cases According to Sociodemographic Variables
Variables
Study group
Control group
Maternal age
27.27±2.7
25.92±2.6
Parity
2.6
2.7
Gestational age
9.77
10.62
Duration of bp/v
17 HRS
-
Income
54,69.8
3700
Pelvic pain
16 CASES
-
Table.2 Distribution of Cases According to Gestational Pattern
G e s t a t i o n a l s a c p a t t e r n
S t u dy G r o u p
Total
C ont ro l G r o u p
Total
N o
%
N o
%
T u r g i d i t y
G o o d
4 0
66. 67
6 0
5 0
8 3. 3 3
6 0
poor
2 0
33. 33
1 0
1 6. 6 7
Re gu lar ity of s ac
R e g u l a r
4 0
66. 67
6 0
4 8
8 0. 0 0
6 0
I r r e g u l a r
2 0
33. 33
1 2
2 0. 0 0
Y o l k s a c
N o r m a l
4 2
70. 00
6 0
5 2
8 6. 6 7
6 0
C on de ns e d or ill d ef in e d
1 0
16. 67
4
6 . 6 7
V . l a r g e
8
13. 33
4
6 . 6 7
Table.3 Distribution of Cases in Study Group According to Ri of Ovarian Artery
Category
No. of cases
Mean of RI
SD
t-value
p-value
Cases who
continue
pregnancy
normally
38
0.75
0.01
-48.5256
<0.0001*
Cases who
aborted
22
0.91
0.01
Table.4 Comparion of Ri of Ovarian Artery in Study Group and Control Group
C a t e g o r y
No. of case s
Me an of RI
S D
t - v a l u e
p - va l u e
S t u d y g r o u p
6 0
0 . 8 3
0.06
6.3671
<0.0001*
C o n t r o l g r o u p
6 0
0 . 7 8
0.01
In control group resistivity index mean was
found (0.78± 0.01), which is in favour of
good outcome of pregnancy. Due to
introduction of non-invasive technology of
Doppler ultrasound, it is now possible to
study the flow of blood in vessels, along
with other fetal parameters, In study group
mean resistivity index of ovarian vessels

Int.J.Curr.Res.Aca.Rev.2016; 4(2): 160-163
163
was at higher side (0.83± 0.06). Out of 60
patients, 38 patients continue their
pregnancy, while 22 cases aborted due to
lack of follow up and inadequate treatment
taken by the patients, In control group few
cases found of having higher resistivity
index of ovarian blood vessels, with
abnormal velocimetric pattern and irregular
fetal parameters, they were treated and
prevented from future miscarriage and
continue their pregnancy till term.
Conclusion
It is concluded that colour doppler study of
ovarian blood vessels during normal
asymptomatic early pregnancy seems to be
useful and non invasive method of
diagnosing impending abortion. It seems to
be useful in the assessment of prognosis and
management of threatened abortion.
Resistivity index of ovarian blood vessels
are utmost clinical implication to screen
impending abortion and this may help us in
establishing the basis to study the
abnormalities in early pregnancy. But we
must acknowledge the limitations of our
sample size and suggest a larger study to
refuse and reaffirm usefulness of colour
doppler in ovarian blood vessels as a
monitor in early pregnancy.
References
1. Burn PN. The physics of Doppler. In
Chervenak FA, Isaacsar GC, Campbell
S (Eds) : Ultrasound in Obstetrics and
Gynaecology, Boston, Little, Brown &
Co. 1993.
2. Sander Nagy, Melissa Bush, Joanne
Stone, Robert H, Lipinski and Sandor
Gardo. Clinical significance of
subchorionic and retroplacental
haematoma detected in the first
trimester of pregnancy. Obst. Gynecol
2003; 102: 94-100.
3. Jouppila P. clinical consequences after
ultrasonic diagnosis of intrauterine
hematoma in threatened abortion. J.
Clin Ultrasound, 1985; 13: 107-11.
4. Dongol A, Mool S, Timaeir P.
Outcome of pregnancy complicated by
threatened abortion. Kathmandu Univ
Med J 2011; 33(1): 41-44.
5. Beu-Haroush A, Yogev Y, Mashiach
R, Meizner I. Pregnancy outcome of
threatened abortion with subchorionic
hematoma possible benefit of bed rest?
Isec Med Assoc. J. 2003; 5: 422-4.
6. Giobbe M, Fazzio M, Boui T. Current
role of bed rest in threatened abortion.
Minerva Gynecol 2001; 53: 337-40.
7. Igor Hudic, Zlatar Fatusic.
Progesterone induced blocking factor
(PIBF) and Th1/Th2 cytokine in
women with threatened abortion. J
Perinat Med 2009; 37: 338-42.
How to cite this article:
Ruchika Garg, Rachna Agarwal, Mukul Chandra, Meenal Jain and Sadhana Singh. 2016.
Colour Doppler Study of ovarian blood vessel in threatened abortion and comparison with
asymptomaic normal pregnancy. Int.J.Curr.Res.Aca.Rev. 4(2): 160-163.
doi: http://dx.doi.org/10.20546/ijcrar.2016.402.019