To operate or to wait? Doppler indices as predictors for medical termination for first trimester missed abortion

Abstract

To operate or to wait? Doppler indices as predictors for medical termination for first trimester missed abortion Wassan Nori1 , Muna Abdulghani2 , Ali B Roomi3,4, *, Wisam Akram5 1Department of Obstetrics and Gynecology, College of Medicine, Al-Mustansiriyah University, 10052 Iraq 2Department of Radiology, College of Medicine, Al-Mustansiriyah University, 10052 Iraq 3Ministry 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 *Correspondence: alibadr205@gmail.com; dr.ali_bader@alayen.edu.iq (Ali B Roomi) DOI:10.31083/j.ceog.2021.01.2215 This is an open access article under the CC BY 4.0 license (https://creativecommons.org/licenses/by/4.0/). Submitted: July 08, 2020 Revised: September 11, 2020 Accepted: September 17, 2020 Published: February 15, 2021 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 diȞferences (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 coeȞficient of correlation proves that RI is the primary predictor of successful termination of a first trimester missed abortion with a cut-oȞf 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