Accuracy of Pre- Intrauterine Contraceptive Device Insertion Doppler Ultrasound in Prediction of IUCD Induced Heavy Menstrual Bleeding

Abstract

Previous studies reported changes in the local vasoactive substances production within the endometrium with subsequent increase in vascularity as a possible mechanism of Intrauterine contraceptive device (IUCD) induced heavy menstrual bleeding. This research was held a larger sample size to assess the role of Power Doppler velocimetries of the uterine arteries, endometrium and subendometrium vascularization as a predictor of IUCD induced heavy menstrual bleeding. Objective: To assess uterine artery, endometrial and subendometrial microvascularization indices in relation to heavy menstrual bleeding as a predictor the risk of bleeding before IUCD insertion. Null hypothesis of this study: There is no difference between uterine artery Doppler indices, endomertrial and subendometrial microvascularization before and after insertion IUCD. Question of this study: Can Doppler ultrasound predict the risk of bleeding before IUCD insertion? Patients and Methods: We conducted this Prospective cohort study to assess uterine artery, endometrial and subendometrial microvascularization indices in relation to heavy menstrual bleeding as a predictor the risk of bleeding before IUCD insertion. Patients dived to group A corresponded to women with IUCD- induced heavy menstrual bleeding and Group B included patients who not present heavy menstrual bleeding. Results: Endometrium FI &VFI signifciantly increased with time in heavy and non-heavy menstrual bleeding cases. Endometrium FI & VFI (basal and month-3) and their elevation was signifciantly higher in heavy menstrual bleeding cases. Endometriaium VFI had highest significant diagnostic performance in the prediction of heavy menstrual bleeding, followed by Subendometrium VI. Endometriaium VFI ≥0.18 had highest significant diagnostic characteristics in the prediction of heavy menstrual bleeding, followed by Subendometrium VI ≥3.75. Conclusion: The IUD modified subendometrial mcirovascularization of those patients who presented with IUD-induced menorrhagia, through changes in the production of prostaglandins leading to increase in subendometrial, endometrial and uterine artery blood flow.