Comparison of Transvaginal Colour Doppler Ultrasound and Progesterone Level Estimation in Outcome of Threatened Abortion in Early Pregnancy

Introduction: Threatened abortion is a clinical puzzle in obstetrics on which depends the fate of pregnancy. It is one of the most common complications in the 1st trimester and early 2nd trimester and these women are more prone to abort in comparison of healthy pregnancy. During luteo-placental shift, sometimes adequate progesterone is not produced by placenta and its falling level may start onset of vaginal bleeding and put a brake on successful continuation of pregnancy. Abnormal Colour Doppler findings can be used to anticipate satisfactory or poor outcomes in women with first trimester threatened abortion. Aim: This study was done to compare efficacy of transvaginal Colour Doppler ultrasound of uterine arteries with serum progesterone levels in outcome of threatened abortion in early pregnancy. Materials and Methods: This prospective study was conducted at the Department of Obstetrics and Gynaecology, Acharya VinobaBhave Rural Hospital, JNMC, Sawangi (Meghe) Wardha, Maharashtra. The duration of the study was two years (September 2017 to August 2019 and sample size for the study was 101 cases. Subjects included in this study were viable pregnancies with 6-12 weeks Gestational age presenting with pain in abdomen or with bleeding per vagina. All 101 subjects were admitted and underwent serum progesterone estimation and Transvaginal ultrasound Colour Doppler. Statistical analysis was done by using descriptive and inferential statistics using student's unpaired t-test, sensitivity, specificity, Positive Predictive Value (PPV),Negative Predictive Value (NPV), Receiver Operating Characteristic analysis (ROC). Results: In this study, it was found that serum progesterone and uterine artery blood flow studies by transvaginal colour doppler Ultrasonography (USG) both were useful for predicting the outcome of threatened abortion in early pregnancy. Serum progesterone, uterine artery Resistance Index, Pulsatility Index and Systolic/Diastolic ratio were compared with ROC curves and AUC (Area Under Curve) were measured. It was found that the resistance index of uterine arteries had a higher AUC than serum progesterone (0.855 vs 0.773). Conclusion: Doppler study of uterine artery in early pregnancy was found to be a better tool for evaluating women with threatened abortion.