| Recurrent spontaneous abortion(RSA)refers to three or more consecutive spontaneous abortions with an identical partner.The etiology of RSA is complex,and common causes include chromosomal abnormalities,immune dysfunction,endocrine abnormalities,luteal dysfunction,autoimmune diseases,etc.Causes of about 30-40%patients with RSA are unknown.In recent years,the application of endometrial receptivity(ER)evaluation in RSA has become a hot topic.A large number of studies believe that ultrasound can be used to evaluate ER by monitoring intimal thickness,morphology,movement,volume,intimal and subintimal blood flow distribution,etc.Which has clinical practicability,but the individual application of each indicator has limitations.At present,there are few studies on the evaluation of ER in patients with RSA by multimode ultrasound score,and there is no recognized guideline for clinicians.To this end,this study is to explore the clinical value of ER in patients with RSA caused by luteal insufficiency through multimodal ultrasound score.In the first step,subjects were divided into normal control group and case group of RSA caused by luteal insufficiency,100 in each group.ER evaluated by multimodal ultrasound was performed.In the second step,100 subjects who are in case group of RSA caused by luteal insufficiency were divided into two groups and treated with different schemes.After one cycle of treatment,evaluation of ER was performed again.In the third step,all the subjects in the second step were followed up for the pregnancy outcomes.In the fourth step,according to the results of the first three steps,another 100 RSA patients caused by luteal insufficiency were collected and treated with diquprogesterone tablets combined with compound xuanju capsule.They were divided into the guidance group and the non-guidance group,50 in each group,and the pregnancy outcomes were followed up.Part ? Evaluation of endometrial receptivity in patients with recurrent spontaneous abortion caused by luteal insufficiency and normal volunteers by multimodal ultrasoundObjective:To investigate the feasibility of multimodal ultrasound in evaluating endometrial receptivity in patients with RSA caused by luteal insufficiency and normal volunteers.Methods:Patients with RSA caused by luteal insufficiency and normal volunteers were studied.100 patients with RSA caused by luteal insufficiency were enrolled as the case group,which met the diagnostic criteria of RSA and luteal insufficiency.100 normal volunteers were enrolled as the normal control group,who had given birth and had no history of miscarriage.Age and BMI of all the subjects in these two groups were collected.Serum progesterone was examined in both groups.The endometrial thickness,type,movement,blood flow,endometrial volume(EV),vasculared-flow index(VFI)were examined.ER was evaluated by multimode ultrasonic scoring according to the scoring criteria.The optimal cutoff value and Jordan index of endometrial thickness,EV,VFI and scores for judging RSA caused by luteal insufficiency were further analyzed by ROC curve.Results:There was no significant difference in age and BMI between these two groups(P>0.05).The level of progesterone in the case group was lower than that in the normal control group(P<0.05).Endometrial thickness,EV and VFI in the case group were all lower than those in the normal control group(P<0.05).Endometrial morphology,movement and blood flow in the case group were worse than those in the normal control group(P<0.05).The endometrial multimodal ultrasound score of the case group was lower than that of the normal control group(P<0.05).ROC curve analysis showed that endometrial thickness,EV,VFI and multi-mode ultrasound scores have statistical significance,and the optimal cut-off value and yoden index were(8.71mm,0.49),(4.00cm3,0.59),(0.27mm,0.58)and(14.5,0.67)respectively.In the diagnosis of RSA caused by luteal insufficiency,the jorden index of multi-mode ultrasound scores was higher than that of endometrial thickness,EV and VFI.Conclusion:The endometrial multimodal ultrasound score of RSA patients with luteal insufficiency was lower than that of normal volunteers.The multimodal ultrasound score could reflect the endometrial condition comprehensively and objectively,and effectively evaluate ER in RSA patients caused by luteal insufficiency.The accuracy of endometrial multimodal ultrasonography in the diagnosis of RSA caused by luteal insufficiency was higher than that of endometrial thickness,EV and VFI.Part ? Evaluating the effects of drug therapy on endometrial receptivity in patients with recurrent spontaneous abortion caused by luteal insufficiencyObjective:To evaluate the effects of multimodal ultrasound on endometrial receptivity in RSA patients caused by luteal insufficiency.Methods:100 RSA patients caused by luteal insufficiency were enrolled as the study objects,and they met the diagnostic criteria of RSA and luteal insufficiency.According to the different treatment schemes,they were divided into two groups:diquprogesterone tablet group and diquprogesterone tablet combined with compound xuanju capsule group,50 in each group.Age and BMI were collected in all subjects.Progesterone was tested in both groups before treatment.Endometrial thickness,shape type,movement,blood flow,EV and VFI were examined by ultrasound,and ER was evaluated according to the scoring criteria before treatment.After one cycle of treatment,the above examinations were performed again.Inter-group and intra-group comparative analysis was conducted before and after treatment.Results:There was no significant difference in age and BMI between these two groups(P>0.05).Before treatment,there were no significant differences in progesterone,endometrial thickness,EV and VFI between these two groups(P>0.05).There was no significant difference in endometrium morphology,movement and blood flow between these two groups(P>0.05).There was no significant difference in endometrial multimodal ultrasound scores between these two groups(P>05).After treatment,the progesterone in these two groups were higher than those before treatment(P<0.05),and the difference between these two groups has no statistically significant(P>0.05).The endometrial thickness,EV and VFI of these two groups after treatment were higher than those before treatment(P<0.05),and the diquprogesterone tablet combined with compound xuanju capsule group was higher than diquprogesterone tablet group(P<0.05).The endometrial morphology,movement and blood flow of these two groups after treatment were better than before treatment,and the combination of diquprogesterone tablet and compound xuanju capsule group was better than diquprogesterone tablet group(P<0.05).The endometrial multimodal ultrasound scores of these two groups after treatment were higher than before(P<0.05),and the endometrial multimodal ultrasound scores of the diquprogesterone tablet combined with compound xuanju capsule group was higher than that of the diquprogesterone tablet group(P<0.05)..Conclusion:Multimodal ultrasound score can evaluate the difference of endometrial receptivity in patients with recurrent spontaneous abortion caused by luteal dysfunction before and after treatment.Part ? Effect of drug therapy on pregnancy outcome of recurrent spontaneous abortion caused by luteal insufficiencyObjective:To investigate the effect of drug therapy on pregnancy outcome of recurrent spontaneous abortion caused by luteal insufficiency.Methods:The patients with RSA caused by luteal insufficiency were studied,and the patients met the diagnostic criteria of RSA and luteal insufficiency.They were divided into two groups according to different treatment schemes:diquprogesterone tablet group and diquprogesterone tablet combined with compound xuanju capsule group,50 in each group.These two groups continued treatment for six cycles according to the treatment schemes in the part ?,and the pregnancy outcome was followed up.For the pregnant patients,the drug was applied until 20 weeks after gestation.According to pregnancy outcome these patients were divided into two groups:68 for normal pregnancy and childbirth group and 32 for the abnormal pregnancy and childbirth group.Age and BMI of all these subjects were collected.Comparison of the parameters between the normal pregnancy and childbirth group and the abnormal pregnancy and childbirth group were carried after the first cycle treatment in the part ?,which include the endometrial thickness,types,movement,blood flow,EV,VFI and multimodal ultrasonic score.The ROC curve analysis were carried out.Results:There were 50 cases of diquprogesterone tablets,31 cases of pregnancy after treatment,19 cases of non-pregnancy,4 cases of early pregnancy abortion,and 27 cases of normal pregnancy.There were 50 cases of diquprogesterone tablets combined with compound xuanju capsule group,40 cases of pregnancy after treatment,10 cases of non-pregnancy,2 cases of early pregnancy abortion,and 38 cases of normal pregnancy.The percentage of pregnancy to normal delivery in the diquprogesterone tablet group was 54%,and the percentage of pregnancy to normal delivery in the diquprogesterone tablet group combined with compound xuanju capsule group was 76%.The percentage of pregnancy to normal delivery in diquprogesterone tablet combined with compound xuanju capsule group was significantly higher than that in diquprogesterone tablet group(P<0.05).There was no significant difference in age and BMI between the gestation to normal delivery group and the non-gestation to normal delivery group(P>,0.05).In the part II of research there was no statistically significant difference in both progesterone and endometrial thickness after the first period of treatment(P>0.05).The normal pregnancy and childbirth group are better than the abnormal pregnancy and childbirth group in the endometrial types,movement and blood flow(P<0.05).The normal pregnancy and childbirth group are higher than the abnormal pregnancy and childbirth group in EV,VFI and multimodal ultrasound score(P<0.05).ROC curve analysis showed that EV and multi-mode ultrasound scores have statistical significance,and the optimal cut-off value and yoden index were(4.333,0.393),(12.5,0.687).Conclusion:The normal pregnancy childbirth percentage in RSA patients caused by luteal insufficiency treated with progesterone tablets combined with compound XuanJu capsule is higher than that in RSA patients caused by luteal insufficiency only treated with progesterone tablets.There are significant differences between the normal pregnancy and childbirth group and the abnormal pregnancy and childbirth group after the first cycle treatment in EV,VFI and multimodal ultrasonic score,diagnosis accuracy of multimodal ultrasound score is higher than that of progesterone.Part ? Evaluation of the guiding value of endometrial receptivity in drug treatment of recurrent spontaneous abortion caused by luteal insufficiency with multimodal ultrasonographyObjective:To explore the guiding value of multimodal ultrasound in evaluating endometrial receptivity in drug treatment of RSA caused by luteal insufficiency.Methods:Another 100 RSA patients caused by luteal insufficiency were enrolled in this study,and the patients met the diagnostic criteria of RSA and luteal insufficiency.Who were treated with progesterone tablets combined with compound XuanJu capsule.According to whether guided by a multimodal ultrasound score all the subjects were divided into the guidance group and the non-guidance group,50 in each group.In the guidance group the drug dosage was adjusted according to the best cutoff value of the endometrial multimodal ultrasonic score in part ? study.While in the non-guidance group the dose of drugs was not adjusted.The progesterone and endometrium multimodal ultrasound scores of these two groups were detected before continuous treatment.The treatment scheme of the guidance group was adjusted based on the multimode ultrasound score.For those who exceeded the optimal cut-off value,the dosage was maintained to guide conception.While for those who were below the optimal cut-off value,the drug dose was adjusted for next cycle of treatment.Then the reexamination was conducted.The duration of treatment is six cycles.If pregnancy is confirmed during this process the examination is stopped.The drug is applied until 20 weeks of pregnancy,and the pregnancy outcome is followed up.Results:There was no significant difference in age and BMI between these two groups(P>.05).Before the first treatment cycle,there was no significant difference in progesterone and multimodal ultrasound scores between these two groups(P>0.05).After the first treatment cycle,there were no statistically significant differences in progesterone and multimodal ultrasound scores between these two groups(P>0.05).The difference of progesterone and multimode ultrasound scores between these two groups before and after the first treatment cycle was statistically significant respectively,which was greater after treatment than before treatment(P<0.05).The progesterone and the modal ultrasonic score of the patients who was in the guidance group and the multimode ultrasound core were below 12.5 after the second treatment cycle were greater than those after the first cycle treatment(P<0.05).There were 50 cases of guidance group,46 cases of pregnancy after treatment,4 cases of non-pregnancy,1 case of early pregnancy abortion,and 45 cases of pregnancy to normal childbirth.There were 50 cases of non-guidance group,40 cases of pregnancy after treatment,10 cases of non-pregnancy,2 cases of early pregnancy abortion,and 38 cases of normal pregnancy.The percentage of pregnancy to normal birth in the guidance group was 90%,and that in the non-guidance group was 76%.The percentage of pregnancy to normal birth in the guidance group was significantly higher than that in the non-steering group.Conclusion:In the treatment of RSA caused by luteal insufficiency with progesterone tablets combined with compound xuanju capsule.The percentage of pregnancy to normal birth can be increased by guiding conception according to the optimal cut-off value of multi-mode ultrasound score compared with the non-guidance condition. |
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