Uterine arterial blood flow was studied at defined times during the ovarian or menstrual cycles. Transvaginal colour pulsed ultrasound was used to identify the vessels in 23 healthy women. Blood flow impedance as reflected by the pulsatility index (PI) was determined for both arteries on 132 occasions. There was no significant difference in the PI values between the right and left arteries. The average PI value was used for subsequent analysis (range 0.5-5.6; mean 2.8). Peak mean PI values occurred on day 1 of menses (4.6), the day of the plasma oestradiol peak (3.7) and the day of the LH peak plus 3 (2.9). The lowest mean PI values (indicating the least impedance to blood flow) occurred on the day of the LH peak minus 6 (2.6), and the day of the LH peak plus 9 (1.9). There are complex temporal relationships between uterine blood flow, ovarian morphology, the concentrations of plasma oestradiol and progesterone and the thickness of the endometrium.

These results highlight the need for the development of in-house ESAs that are specific to the patient, treatment, and environment. These data suggest that currently available ESAs may not be clinically applicable and lose their diagnostic value when externally applied.

Objective To assess the role of a single maternal serum progesterone measurement in the immediate diagnosis of early pregnancy failure and in the long term prognosis of fetal viability.Design A prospective comparative study of women presenting with vaginal bleeding and abdominal pain in early pregnancy. The comparison group was defined retrospectively as women who presented with abdominal pain without history of, or the subsequent occurrence of, vaginal bleeding and whose pregnancies continued to viability. The study groups were defined retrospectively as threatened‐continuing, non‐continuing (including blighted ovum, missed abortion, incomplete and complete abortion) and tubal pregnancy groups, according to the outcome of the pregnancies.Setting The emergency room at the gynaecology department of a teaching hospital.Subjects Four hundred and eighty‐nine women presenting with singleton pregnancy, vaginal bleeding and/or abdominal pain in the first 18 weeks of pregnancy. The comparison group comprised 131 women without vaginal bleeding whose pregnancies continued to viability. The study group comprised 358 women with 148 threatened‐continuing pregnancies, 175 non‐continuing and 35 tubal pregnancies.Interventions A 10 ml blood sample was taken and pelvic ultrasonography was performed at presentation. Otherwise, conventional management was used.Main outcome measures Progesterone levels were interpreted in accordance with the outcome of the pregnancy: comparison, threatened‐continuing, non‐continuing or tubal. Viability was defined as 28 weeks or more weeks of gestation.Results Progesterone levels were significantly lower in the non‐continuing and tubal pregnancy groups than in the comparison and threatened‐continuing groups (P < 0.001 in all cases). A cut‐off level at 45 nmol/l was found to differentiate between the viable (comparison and threatened‐continuing) pregnancies and the abnormal (non‐continuing and tubal) pregnancies with 87.6% sensitivity and 87.5% specificity.Conclusions A single serum progesterone measurement taken in early pregnancy is valuable in the immediate diagnosis of early pregnancy failure and the long term prognosis of viability.

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