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IMR Press / CEOG / Volume 48 / Issue 1 / DOI: 10.31083/j.ceog.2021.01.2215
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Open Access Original Research
To operate or to wait? Doppler indices as predictors for medical termination for first trimester missed abortion
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1 Department of Obstetrics and Gynecology, College of Medicine, Al-Mustansiriyah University, 10052 Iraq
2 Department of Radiology, College of Medicine, Al-Mustansiriyah University, 10052 Iraq
3 Ministry of Education, Directorate of Education Thi-Qar, Thi-Qar, 64001 Iraq
4 College of Health and Medical Technology, Al-Ayen University, Thi-Qar, 64001 Iraq
5 Consultant Obstetrician and Gynecologist, AL-Yarmook Teaching Hospital, 10015 Iraq
Clin. Exp. Obstet. Gynecol. 2021, 48(1), 168–174; https://doi.org/10.31083/j.ceog.2021.01.2215
Submitted: 8 July 2020 | Revised: 11 September 2020 | Accepted: 17 September 2020 | Published: 15 February 2021
Abstract

Purpose: Missed abortion is a common obstetrical problem with a high incidence. Evidence supports a change in approach from the traditional dilatation and curettage to medical; however, few studies have investigated the prediction success of the medical approach. This study investigates whether first trimester missed abortion can be successfully terminated using Doppler indices, such as resistance index (RI) and pulsatility index (PI), as predictors. Material and Method: In this prospective study, the sample is made up of 78 patients, with a first trimester missed abortion range of 6-13 weeks of pregnancy who meets the maternal parameters as well as transvaginal Doppler indices, RI and PI. The participants were subdivided into 3 groups based on their response to sublingual misoprostol and weeks needed to terminate as Groups I (43/78), II (26/78), and III (9/78) aborted in the first, second, and third weeks, respectively. Results: Age, BMI, and gestational age of dead fetus were not significant for Groups I, II, and III with P = 0.13, P = 0.13, and P = 0.35, respectively. Parity and delivery mode showed significant differences (P $<$ 0.0001) between group means of PI and RI. PI for Group I plus II and Group III are 1.53 (0.75-2.70) and 1.58 (1.10-2.10), respectively. RI for Group I plus II and Group III are 0.71 (0.50-1.00) and 0.80 (0.69-0.92), respectively. The coefficient of correlation proves that RI is the primary predictor of successful termination of a first trimester missed abortion with a cut-off value of 0.74 with associated sensitivity and specificity of 68.7% and 56.7%, respectively. Conclusions: Increased parity and a history of vaginal delivery, in addition to measured RI, were predictors of successful termination of a first trimester missed abortion. These results may be used in counseling patients to decide safest and most suitable option to terminate a first trimester missed abortion, depending on their demographic criteria and ultrasound scores.

Keywords
Missed abortion
First trimester
Misoprostol
Doppler
Resistance index
Pulsatility index
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