The Value of Three-Dimensional Doppler Indices in the Prediction of Successful Medical Treatment for Missed Miscarriage

Introduction: The purpose of this study was to examine the accuracy of three-dimensional (3D) Doppler ultrasound imaging to predict successful medical treatment for missed miscarriages. Methods: The 129 women included underwent transvaginal ultrasound 24 h after misoprostol administration for missed miscarriage. Endometrial thickness and uterine cavity volume were measured using three-dimensional (3D) ultrasound and virtual organ computer-aided analysis software. The following 3D Doppler indices were calculated: vascularity index, flow index, and vascularity flow index. Treatment failure was defined as the need for surgical evacuation of the uterus. Treatment was considered successful when no surgical intervention was necessary. Results: Twenty-nine women underwent curettage (treatment failure); all had histologic evidence of conception. One hundred women required no surgical intervention (treatment success). All 3D Doppler indices were significantly higher in the treatment failure than success group: median vascularity index 3.2% vs. 1.02% (p = 0.027), mean flow index 32.2 vs. 27.04 (p = 0.008), and median vascularity flow index 2.04 vs. 0.27 (p = 0.007). Uterine volume and endometrial thickness were significantly greater among women who underwent curettage vs. those who did not. Conclusions: 3D Doppler indices can predict the success or failure of medical treatment for missed miscarriage, as can endometrial thickness and uterine cavity volume.