الفهرس 
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Abstract
Early pregnancy loss is defined as the termination of pregnancy before 20 weeks’ gestation or with a fetal weight of < 500 g.
Recurrent miscarriage (RM) is a distressing condition affecting around 1% of couples trying to conceive.
The UK Royal College of Obstetricians and Gynecologists (RCOG) define RM as the loss of three or more consecutive pregnancies, while the American Society for Reproductive Medicine (ASRM) defines RM as two or more failed clinical pregnancies (pregnancy in this case requiring ultrasound or histological confirmation).
Both ultrasound and biochemical markers such as serum progesterone level either alone or in combination have been described in the literature for the prediction of miscarriage which is important especially for cases with RM.
The aim of this study was to assess the impedance of uterine artery blood flow and serum progesterone levels during the midluteal phase in women with unexplained RPL compared to normal control group.
This case-control study was conducted in obstetrics and gynecology department in Beni-Suef University Hospital in the period from October 2020 to April 2021 and was applied on 110 non pregnant women after obtaining consents from them to participate in this study.
The patients were divided into two groups:
group I (Study Group): Included 55 women with recurrent pregnancy loss.
group II (Control Group): Included 55 healthy fertile non-pregnant women with no history of previous miscarriage and had at least one child born at term.
All patients were (20-35) years old, non-pregnant and have no diabetes mellitus, thyroid disorders, hyperprolactinemia, no documented uterine anomalies and negative markers of antiphospholipid syndrome. They did not receive any hormonal contraception or use IUCD at the time of study.
Detailed history was taken from all women that included personal, menstrual, obstetric history with special stress on parity, time at which previous abortions had occurred, time of the last delivery or abortion, any complications happened after deliveries or abortions, medical history to exclude medical conditions included in the exclusion criteria, family history to exclude diabetes mellitus, hypertension, autoimmune disorders and history of chromosomal abnormalities in the family.
Clinical examination had been done including general, abdominal and pelvic examinations to exclude obesity, hirsutism, hypertension, cardiac or renal diseases, thyroid disorders and vaginal infection.
Transvaginal ultrasound examination was done to exclude any uterine or adnexal abnormalities. Transvaginal bilateral uterine artery Color Doppler assessment of Pulsatility index (PI) and Resistance index (RI) was done.
The average pulsatility index (PI) and resistance index (RI) of the bilateral uterine arteries were calculated.
In this study, the mean age of women of group 1 (study group) was 27.8±4.7 years. On other hand, the mean age of women of group 2 (control group) was 28.1±4.3 years.
The mean BMI of women of the study group was 25.1±3.2. While the mean BMI of women of the control group was 24.6±2.8.
It was found that there was no statistically significant difference between both groups as regards age and BMI with P-value > 0.05.
78.2% had 3previous miscarriages, 12.7% had 4 previous miscarriages, while 5.5 % had 5 previous miscarriages, and 3.6% had more than 5 previous miscarriages.
There was no significant difference in midluteal serum progesterone level in women with unexplained RPL and normal fertile women (11.1±3 and 10.9±3.5, respectively) with p value 0.855.
The uterine artery RI was significantly higher in the study group (0.91±0.11) compared to the control group (0.81±0.09) with P-value < 0.001 and the uterine artery PI was significantly higher in the study group (2.59±0.53) compared to control group (1.85±0.33) with P-value< 0.001.
At a cut off 2.3 or more of uterine artery PI, it can significantly predict the unexplained recurrent abortion with 72.73% sensitivity, 94.55% specificity, 93.0% PPV and 77.6% NPV.
At a cut off 0.85 or more of uterine artery RI, it can significantly predict the unexplained recurrent abortion with 80.0% sensitivity, 70.91% specificity, 73.3% PPV and 78.0% NPV.
Uterine artery PI is better than RI in the prediction of unexplained RPL with 72.73 % sensitivity and 94. 55% specificity for PI compared to 80% sensitivity and 70.91% specificity for RI.
There was no statistically significant linear correlation between the uterine arteries’ PI and RI and patient’s age, BMI and progesterone level (P-value >0.05).