Doppler Study of Uterine Arteries Blood Flow in Patients with Unexplained Recurrent Pregnancy Loss and the Effects of Nitric Oxide Donors

Objectives: To study the uterine artery resistance and pulsation indices during the mid luteal phase in patients with history of unexplained recurrent pregnancy loss and the effects of the nitric oxide donor isosorbid mononitrite on these indices. Study Design: A cross-section, controlled observational study. Setting: Benha University Hospital, Egypt. July 2009 to July 2010. Subjects and Methods: Two groups of women each 30 cases were studied. The control group included women with no history of abortion who delivered at least one living child. The study group included nulliparous women with history of unexplained recurrent pregnancy loss. Vaginal color Doppler ultrasound was done in the mid luteal phase of the menstrual cycle to measure uterine arteries resistance and pulsation indices, then 20 mg isosorbid mononitrate tablet was applied vaginally in the study group and the Doppler indices were measured again after two hours. Outcome Measures: Comparison between uterine artery resistance and pulsation indices in both groups and the effects of isosorbid mononitrate on these indices in the study group. Results: Women with recurrent pregnancy loss had significant higher uterine artery resistance and pulsation indices. Isosorbid mononitrate applied vaginally causes significant decrease in these indices. Conclusions: Patients with history of unexplained recurrent pregnancy loss had decreased uterine arteries perfusion during the mid luteal phase. Nitric oxide donors increases uterine arteries blood flow and may have a role in the treatment of these patients.