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Research Article
*Corresponding Author: Nareman Elhamamy, Assistant Professor of Obstetrics and Gynecology, Faculty of Medicine, Tanta University. Egypt
Citation: Nareman Elhamamy, Ahmed M. Hagras (2021) Evaluation the Role Uterine Artery Doppler Indices in Prediction of Abnormal Uterine Bleeding in Intrauterine Contraceptive Device Users. J.Women Health Care and Issues 4(4); DOI: 10.31579/2642-9756/067
Copyright: © 2021 Nareman Elhamamy, this is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 24 May 2021 | Accepted: 31 May 2021 | Published: 08 June 2021
Keywords: intrauterine device ; pulsitility index ; resistant index
Contraceptive intrauterine device (IUD) is a successful method of contraception which has been used for more than 30 years.
The objectives of our study were to evaluate the correlation between abnormal uterine bleeding in IUD users and uterine artery Doppler [pulsitility index (PI); Resistant index (RI)] using transvaginal ultrasound and Doppler.
The study included 120 women from obstetrics and gynecology department Hospital. ,divided into three groups:
All fullfil the inclusion and exclusion criteria
The Results Of This Work Were:-
As regard to Doppler findings, it was noted that RI was significantly lower in group I in comparison to group II and group III and Pulsitility index (PI) followed the same pattern as RI.
We can conclude that detection of PI and RI in the uterine artery could be used to identify patients at risk of developing excessive bleeding after copper IUD insertion.
The Intrauterine Device (IUD) is the most widely used reversible form of contraception in the world [1].
AUB may be defined as any variation from the normal menstrual cycle, and includes changes in regularity and frequency of menses, in duration of flow, or in amount of blood loss [2].
Ultrasound is the imaging modality+ of choice for the female pelvis. It is widely available, has broad acceptance by patients and is relatively inexpensive. High-resolution imaging of transvaginal ultrasound provides high diagnostic accuracy for pelvic pathology [3].
Color Doppler ultrasonography to confirm the hypothesis that CIUD-induced bleeding is secondary to an increase in the uterine blood flow (as indicated by decreased PI and RI in uterine artery). Transvaginal color Doppler can be used to identify women at risk of developing abnormal uterine bleeding after CIUD insertion [4].
Aim of the Work
The present study aimed at using color Doppler ultrasonography in prediction of abnormal uterine bleeding in women after IUD insertion.
Patients And Methods
This study was a prospective clinical study including women who have been wearing an CIUCD, presenting to Obstetrics and Gynecology Department, from may 2018 to may 2019.
Study populations:
The study included 120 women. Sample size was calculated using Epi-Info® version 6.0 software, assuming a power of 80% and an -error of 0.5%.
Included women were divided into 3 groups:
Inclusion criteria:
Exclusion Criteria:
Methods:
History taking:
Clinical examination:
C- investigations:
-CBC.
-Random blood sugar.
Ultrasound examination:
All included women had a transvaginal ultrasound performed after instructing the patient to evacuate the bladder.
Measurements of dimension of the uterus (sagittal, transverse) sections were performed in addition to comment
on:
(a) Position.
(b) Endometrial thickness measured in sagittal section.
(c) Myometrial fibroids or adenomyosis.
(d) Endometrial polyps, thickness and irregularities.
(e) Adenexa and any abnormalities as ovarian cysts.
(f) Comment on IUCD: including site, displacement, partial expulsion, partial perforation, embedding:
I) the IUCD was detected by its echogenicity compared to the normal endometrium.
Blood flow indices of the uterine artery:
Transvaginal probe is placed in the anterior fornix , moved laterally to visualize the paracervical vascular plexus, -Color Doppler is turned on and the uterine artery is marked as it bends cranially into the uterine body.
Measurements are made at this point, before the uterine artery divides into the arcuate arteries. The same procedure is repeated on the contralateral side.
Note should be taken not to insulate the cervicovaginal artery (which passes from the cephalad to the cauda) or the arcuate arteries. Speeds of more than 50 cm / s are characteristic of the uterine arteries that may be affected.
Data were entered using Epi-Info version 6 and SPP for Windows version 8 [5].
Results
This prospective clinical study included 120 women who have been wearing anIUD for at least 6 months, presenting to Outpatient Gynecologic Clinic.
The study included 120 women, divided into three groups:
There was no substantial variation between the groups studied in terms of demographic evidence in our sample, there were no significant statistical variations between the groups studied in terms of age, parity and length of IUD usage Table 1.2.
There were no statistically meaningful variations between groups related to uterine proportions and endometrial thickness measurements by TVS. In women of group I, RI was slightly smaller than in women of groups II and III (p<0>
-PI was slightly smaller in Group I women than in Group II and Group III women (p<0>
Discussion
The objectives of our study were to evaluate the prediction between abnormal uterine bleeding in IUD users and uterine artery Doppler [pulsitility index (PI); Resistant index (RI)] using transvaginal ultrasound and Doppler.
In our study, there were no significant statistical differences between the studied groups concerning age, parity and duration of IUD use.
Our results are in agreement with study that During his work on levonorgestrel IUD, he reported that there is no connexion in both groups between endometrial thickness and days of bleeding or spotting [4, 6].
In our research, on the other hand, RI and PI were slightly lower in Group I women (women who use CIUD and complain about irregular uterine bleeding) than in Group II women and group III (control group) (p < 0>
Our results are correlated with Momtaz et al. (2014). -The PI and RI of the uterine arteries were measured in 68 women, including 44 who used intrauterine contraceptive devices and 24 control women who did not use a form of contraception. In women with CIUD-induced bleeding, both PI and RI were significantly lower than those who had used CIUD and did not think about irregular vaginal bleeding. Furthermore, there were no statistically relevant differences in PI and RI between women who used CIUD and women in c who did not complain of vaginal irregularity. [7].
Frajndlich et al. (2013) -Measured resistance and pulsatility in 101 women, 74 of whom used an intrauterine contraceptive device, and 27 of whom did not use a contraceptive process. Users of intrauterine contraceptives have been divided into three groups: those with frequent bleeding (n = 34); those with irregular uterine bleeding (n = 16); and those with excessive bleeding with a prostaglandin inhibitor (n = 24). Major Low resistance and pulsatility indices were recorded (8).
Hurskainen et al. -The PI of uterine arteries, arcuate arteries, and radial arteries is tested in 60 spontaneously menstruating women who complained of menorrhagia. The alkaline hematin mechanism has measured menstrual blood loss. A strong inverse correlation was observed between the uterine artery PI and the amount of menstrual blood loss, suggesting bleeding in individuals with lower uterine impedance. [9, 10].
Jamenez et al. (2018) reported that PI and RI variations were not statistically important between women with IUD-induced bleeding and women with regular menstrual IUD [11, 12, 17].
A foreign body reaction is caused in the adjacent endometrium by the insertion of an intrauterine implant into the uterine cavity. NO is present in the inflammatory response of the foreign body surrounding loosened implants for joint replacement. Thus, in the underlying tissue, it is likely that IUD still causes NO synthesis. A correlation between NO synthesis and prostaglandin synthesis is also present. NO interacts specifically with cyclo-oxygenase, which is responsible for the synthesis of prostaglandin and activates an injection. [13, 14 15].
Other potential pathways that clarify the relationship of uterine artery PI with menstrual blood loss are also accessible. A large rise in endothelial cell proliferation is seen by women with menorrhagia, suggesting disturbed angiogenesis. Such artery defects that occur from disrupted angiogenesis can also arise. In irregular vessels, weak haemostatic system contractibility and instability can cause menorrhagia and reduced impedance. [16, 18, 19].
In other study that. Three months later, on the corresponding period days, patients were checked again. Patients with dysmenorrhea consistent with IUD have improved pulsatility index. No major improvements in the blood supply of the uterine artery were found after the IUD was implanted during menstruation or in the midluteal process. There was, however, a drop in PI after IUD injection in patients with elevated IUD-related pain during menstruation. In all 5 patients, the decline in mean PI was present. They concluded that the copper IUD does not cause any significant improvements in uterine artery blood flow resistance, even in patients with increases during menstruation [20, 21].
Conclusion: -
The findings of our research support the theory that there is an improvement in uterine blood flow (indicated by diminished PI and RI in the uterine artery) in patients with CIUD-induced excessive uterine bleeding. The uterine artery Doppler can be used to classify patients at risk of experiencing severe bleeding following copper IUD.
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