الفهرس 
RECURRENT PREGNANCY LOSSOnly 14 pages are availabe for public view
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Abstract
R
ecurrent miscarriage (RM) is two or more consecutive miscarriages before the 20th week of gestation, which affects 0.5–5% of couples (PCARSM, 2013).
Treatment of RA is a real challenge and in most cases is unsuccessful as identifiable causes can be found only in 30-50% of women and the rest remain unexplained (Mofeed et al., 2018).
Scientists showed that uterine artery perfusion regulates uterine receptivity, influences the success of implantation, maintains early pregnancy and that impaired uterine perfusion plays a central role in the pathogenesis of unexplained recurrent miscarriage (Alexander et al., 2004).
Studies showed that low dose sildenafil improves uterine artery blood flow, improves endometrial and sub-endometrial vascularity (Sher et al., 2000).
This controlled clinical trial on 80 women diagnosed as recurrent miscarriage was held at recurrent pregnancy loss outpatient clinic at Ain shams university maternity hospital, transvaginal uterine doppler was done to all patients before treatment and after oral administration of sildenafil in study group or placebo in control group.
The results are:
After treatment, mean uterine arterial RI in sildenafil group was 0.72±0.08 while in placebo group was 0.88±0.06, mean subendometrial blood flow RI in sildenafil group was 0.64±0.08 while in placebo group was 0.75±0.05 thus showing a highly significant difference between the two groups (P<0.0001), mean uterine arterial PI in sildenafil group was 2.15±0.37 while in placebo group was 2.62±0.27, mean subendometrial blood flow PI in sildenafil group was 1.05±0.61 while in placebo group was 1.63±0.26 thus showing a highly significant difference between the two groups (P<0.0001), mean average uterine arterial S/D ratio in sildenafil group was 5.9±2.14 while in placebo group was 7.16±1.25, mean subendometrial blood flow S/D ratio in sildenafil group was 3.47±1.67 while in placebo group was 4.51±0.74 thus showing a highly significant difference between the two groups (P<0.0001), Mean pre-post treatment change uterine arterial RI in sildenafil group was -0.17±0.05 while in placebo group was -0.01±0.01, mean pre-post treatment change in subendometrial blood flow RI in sildenafil group was -0.13±0.05 while in placebo group was -0.01±0.01 thus showing a highly significant difference between the two groups (P<0.0001), Mean pre-post treatment change in uterine arterial PI in sildenafil group was -0.69±0.32 while in placebo group was -0.05±0.01, mean pre-post treatment change in subendometrial blood flow PI in sildenafil group was -0.65±0.29 while in placebo group was -0.01±0.01 thus showing a highly significant difference between the two groups (P<0.0001), Mean pre-post treatment change in uterine arterial S/D ratio in sildenafil group was -2.1±0.9 while in placebo group was -0.12±0.07, mean pre-post treatment change in subendometrial blood flow S/D ratio in sildenafil group was -1.28±0.72 while in placebo group was -0.08±0.07 thus showing a highly significant difference between the two groups (P<0.0001).