الفهرس 
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Abstract
Loss of pregnancy is a distressing problem for both the patient and physician. Not all conceptions result in live birth of the infant and most of pregnancy losses are not diagnosed, approximately 70% of human conceptions fail to achieve viability and an estimated 50% are lost before the first missed period.
Threatened miscarriage is a common complication in the first trimester of pregnancy and is often associated with anxiety regarding pregnancy outcome. Approximately 20% of pregnant women have symptoms of threatened abortion in the first trimester of pregnancy. Of these women who bleed in early pregnancy; approximately half will abort.
It is useful to predict the likelihood of success in human reproduction for many reasons. First, prediction is necessary to understand what factors contribute to success. This is true if optimal strategies are to be devised for pregnancy prevention. Second, it is imperative to understand the natural limits of successful human reproduction in order to devise strategies for improving the likelihood of a live-borne infant. Third, it is essential to comprehend the likelihood of the reproductive failure at each junction of the reproductive process to understand the causes of pregnancy failure. For these purposes, estimates have been developed of the likelihood of pregnancy success and failure under optimal conditions.
In first trimester bleeding, neither statistical prediction models based on signs and symptoms, nor clinical judgment, are valid replacements for ultrasonographic assessment in establishing a diagnosis. The introduction of transvaginal ultrasonography (TVS)has greatly improved the evaluation of early pregnancy in these cases.The use of this technique allows the assessment of embryo vitality by visualizing cardiac activity on real time sonography. It has been shown that the rate of fetal loss after ultrasound-proved embryo vitality in normally developing early pregnancies is low, approximately 3.2%. However, in patients with first trimester threatened abortion and a living embryo, the rate of fetal loss is much higher, approximately 15%.Because of high prevalence of spontaneous abortion in this group of patients, a technique that could predict pregnancy outcome would be extremely useful.
The introduction of transvaginal color-Doppler sonography has allowed assessment of uteroplacental circulation in early pregnancy.Sufficient uteroplacental blood flow is essential for normalpregnancy outcome.
Transvaginal color-Doppler sonography is an appropriate, non-invasive diagnostic method to evaluate the integrity of the uteroplacental circulation during early pregnancy and may be used to predict pregnancy outcome.
Abnormal blood flow patterns of the early uteroplacental circulation are associated with an increased prevalence of pregnancy complications. Abnormal color Doppler signals can be used to predict the outcome of first trimester gestations in women with threatened abortion.
The human corpus luteum is a temporary endocrine gland that develops after ovulation from the ruptured follicle during the luteal phase.Corpus luteum of pregnancy can be routinely identified within the ovary during the first trimester, using transvaginal sonography (TVS). This physiologic structure is considered essential for the maintenance of the early pregnancy. Its primary function is the production of progesterone, which sustains the pregnancy until the placenta is formed.In a historical study, surgical removal of the corpus luteum during the first trimesterof pregnancy resulted in a 100% loss rate in pregnancies of less than 7 weeks gestation.
It has a wide range of sonographic morphologies.With color Doppler sonography, blood flow around the corpus luteum can be assessed, color Doppler imaging most often reveals a circumferential rim surrounding part or all of the corpus luteum, with an occasional intraovarian vessel seen flowing toward the corpus luteum.
Measuring serum progesterone may be a useful adjunct for evaluating abnormal early pregnancy. Serum progesterone is a reflection of progesterone production by the corpus luteum, which is stimulated by a viable pregnancy. Measurement of serum progesterone is inexpensive and can reliably predict pregnancy prognosis.
This prospective study was conducted on 160 women in their first trimester of pregnancyattending the outpatient clinic or the casuality department of Obstetrics & Gynaecology, Beni-suef University hospital.
All the Patients aged between 20 to 35 years were in their 1st trimester of a viablesingleton spontaneouspregnancy i.e no history of induction of ovulation or ART, presenting with vaginal bleeding or spotting. Gestational age ranged (8-12) weeks calculated from the 1st day of the last normal menstrual period, preceded by 3 regular menstrual cycles, and correlating with ultrasound measurements, together with positive urinary pregnancy test.
The study group consisted of eighty (80) women with clinical diagnosis of threatened abortion, which was further subdivided during follow up into: group of patients who aborted (twenty (20) patients) and another group who continued their pregnancy and proceeded into the second trimester (sixty (60) patients) and 80 women having normal uncomplicated pregnancy.
The study aimed to evaluate the prognostic value of correlating the color Doppler blood flow changes in the corpus luteum and the uterine arteries together with the results of serum progesterone at the time of initial presentation with pregnancy outcome in patients with first trimesteric threatened abortion.
Transvaginal color Doppler studies of the corpus luteum pulsitility index and peak systolic velocity showed no significant results between the threatened abortion groups; both who aborted and who continued their pregnancies, and the controls.
In the study, corpus luteum volume showed a significant differences between the three study groups, threatened abortion(aborted), threatened abortion(continued), and control groups and athe cut-off limit of 4.185 cm3 was suggested in predicting termination of pregnancy in threatened abortion cases which achieved sensitivity of 82.4 % and specificity of 80.7%.
Also, the Corpus luteum was absent in 4 out of 20 cases (20.0 %)of threatened abortion who aborted afterwards and was present in the remaining 16 cases (80.0%), while the Corpus luteum was present in 96.7 % of the threatened abortion cases who continued their pregnancy into the second trimester indicating the importance of corpus luteum, in the prognosis of first trimesteric threatened abortion pregnancies.
Maternal serum progesterone showed significant results regarding the prediction of pregnancy outcome in early pregnancies complicated by vaginal bleeding.
There were statistically significant differences between threatened abortion, aborted and continued groups and the control group. The study suggested a cut-off limitof 18.6 IU/ml of progesterone level which achieved sensitivity of 90.0% and specificity of 75.0% which that may help in predicting termination of pregnancy in threatened abortion cases.