ABSTRACT
The purpose of this study is to investigate the correlation between the changes in duration of the absent diastolic flow during first trimester and fetal survival during first trimester pregnancy with and without anti-coagulant treatment. A second objective is to determine the duration and dose of anticoagulant treatment needed to have best outcome in these conditions. A prospective observational study. Al Nahda hospital in cooperation with the maternity hospital in Prince Sultan militaty Hospital, Al Taief, KSA. The study was approved by the committee of study and research in Al Nahdah Hospital. All patients have consented for the plan of care of pregnant women with history of more than previous two consecutive first trimester pregnancy losses with all possible consequences. The study patients are pregnant women with a history of two or more consecutive first trimester pregnancy losses in the form of blighted ovum or sudden first trimester fetal demise. They were studied starting from 6 weeks up to 16 weeks gestaion. The patients were divided into two groups. Group A [n = 12] were managed conservatively with the routine antenatal care without additional anticoagulant treatment and group B [n = 14] were given enoxaparinl 20mg subcutaneously daily starting from the time of positive pregnancy test to end of the study at 16 weeks gestation. A third group of 100 patients with good obstetric history were examined to build up the reference values for the normal progress of the fetal circulation during this period and this group was considered as the control group [group C]. All patients were studied from the time of 6 weeks gestation and up to 16 weeks gestation by Doppler flowmetry to test for the duration of the late diastolic flow in the umbilical arteries. All patients were followed-up starting from 6 weeks gestation till 16 weeks gestations in the period between October 2007 and June 2008. Doppler flowmetry using pulsed. wave color Doppler. In each patient the duration of absent diastolic flow was measured. In group [A], there was persistent longer periods of absent diastolic flow compared to group B and C. In this group four losses happened [2 fetuses were lost at time of 8-10 weeks gestation and 2 patients had blighted ovum]. Patients who were given acetylsalicylic acid and enoxaparine had shorter periods of absent diastolic flow and got a continuous diastolic flow at 13-14 weeks gestation without any losses. The rate of change of the duration of diastolic flow showed that in the B and C groups there is a progressive persistent shortening of the duration of absent diastolic flow by an average rate of 0.0255 seconds per week till 14 weeks when a continous diastolic flow becomes established. On the other hand in group A, the rate of change is very slow [on the average 0.015 seconds per week] up to 16 weeks without a continuous diastolic blood flow. Absent diastolic flow is a normal finding during early pregnancy. Adequate flow without diastolic arrest should be reached by 13-14 weeks gestation. However, patients with history of recurrent first trimester pregnancy loss have longer periods of arrest of diastolic flow. This may be related to imbalance between the coagulation and fibrinolysis in the fetus. This needs further studies to correlate ultrasound findings with coagulation studies during first trimester