Predictive uterine hemodynamic parameters in the first trimester of pregnancy following treatment for chronic endometritis

Objective: To evaluate the usefulness of the uterine arterial perfusion index (API) and uterine artery Doppler parameters for assessing uterine blood supply in the first trimester of pregnancy in women with a history of chronic endometritis and to determine their prognostic value for adverse outcomes in the first half of pregnancy.

Material and methods. Pregnant women (401) in the first trimester were enrolled and divided into a main group (with a history of chronic endometritis) and a comparison group (without evidence of chronic endometritis). Uterine artery Doppler parameters were assessed, and the uterine arterial perfusion index was calculated as an integral measure of uterine arterial blood supply. Analyses were performed separately for gestational windows of 5–7⁺⁶, 8–10⁺⁶, and 11–13⁺⁶ weeks. Nonparametric statistical methods with median differences and 95% confidence intervals were used. Prognostic performance was evaluated using ROC analysis.

Results. Across all first-trimester gestational windows, women in the main group demonstrated lower uterine arterial perfusion index values compared with the comparison group. The most pronounced differences were observed at 11–13⁺⁶ weeks of gestation, when API demonstrated the greatest magnitude of effect (AUC 0.92), exceeding that for velocity indicators and vascular resistance indices and high prognostic significance in relation to adverse outcomes in the first half of pregnancy. Resistance indices (PI, RI) were less consistent and more operator-dependent than the integral perfusion index.

Conclusion. The uterine arterial perfusion index is an informative integral parameter of uterine blood supply in the first trimester of pregnancy. A history of chronic endometritis is associated with reduced API and an unfavorable uterine hemodynamic profile. These findings support the potential use of API as a marker of early placentation conditions and for risk stratification of adverse pregnancy outcomes.

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