Frequency of Uterine Anomalies Associated with Persistent Miscarriages in Pregnancy on Ultrasound PAKISTAN JOURNAL OF Health Sciences

Miscarriages is when an embryo/foetus expires before the tenth week of gestation. It occurs most commonly early during pregnancy. Women who had a miscarriage looked to be more likely to die before the age of 70 than those who had any other pregnancy outcomes. Objective: To determine the frequency of uterine abnormalities related with persistent miscarriages in pregnancy on ultrasound. Methods: It was a cross-sectional study conducted over a period of 4 months from February 2022 to May 2022. A sample size of 70 patients was collected using purposive sampling technique. Data was collected from Memorial Christian Hospital Sialkot. Patients with multiple miscarriages due to uterine abnormalities were included in the current study. Patients with less than two miscarriages, self-induced miscarriages and miscarriages due to foetal anomalies were excluded. Data was analysed using SPSS version 20.0. Results: The study showed that the mean age of affected women experiencing miscarriage is 28.72. The highest rate of miscarriage was found in 38 (54.3%) of females and least in 4 (5.7%). The common cause of miscarriage was broids. Out of 70 females, 34 (48.6%) had broids, 14 (20%) had cervical incompetence, 9 (12.9%) had uterine adhesions, 6 (8.6%) had abnormal uterine size, 4 (5.7%) had uterine polyp and remaining 3 (4.3%) had congenital anomalies. Conclusion: The study concluded that miscarriages and uterine factors are closely linked. Uterine broids have shown the highest percentage of patients that had undergone miscarriage.

ultrasonography, hysteroscopy, and laparoscopy [23]. The i n t r o d u c t i o n o f h i g h -r e s o l u t i o n Tr a n s -Va g i n a l Ultrasonography (TVS) has completely changed our knowledge of the pathogenesis and management of early pregnancy failure [24]. For the diagnosis and management of early pregnancy failure, recognizing the ultrasonography appearances of normal early pregnancy development and their hazards is critical. The study highlighted the signi cance of ultrasound in diagnosing the uterine abnormalities that lead to miscarriages. Moreover, the study will also help to determine the frequency of uterine abnormalities that affect women's mental health leading to anxiety, depression, and grief associated with habitual miscarriages.
of 70 than those who had any other pregnancy outcomes [9]. The uterus is a muscular, hollow, pear-shaped organ located in the lower part of the pelvis. It lies posterior to the bladder and in front of the rectum, with its base positioned cranially [10]. The size of the uterus varies with age, the pro le of hormones, and history of obstetrics. In parous and nulliparous women, the length, width, and anteriorposterior diameter of uterus are 9. 07x5.19x4.14 and 7.10x4.52x3.27, respectively [11]. Anatomic abnormalities like mullerian duct and Diethylstilbestrol (DES)-related anomalies can be inherited or acquired. Attained abnormalities include Intrauterine Adhesions (IA) and leiomyoma [12]. Mullerian duct anomalies are found in 8 to 10% of women who have had three or more spontaneous miscarriages in a row and have been evaluated by hysterosalpingography or hysteroscopic examination, whereas hyperprolactinemia has been identi ed in 30% to 40% of infertile and 15% to 20% of women having menstrual complications [13]. Many pregnancies are genetically defective, resulting in miscarriage, the most common pregnancy problem. Inherited abnormalities (unicornuate, bicornuate, septate, and double uterus), adhesions, cervical incompetence, broids/polyps, intrauterine, and endometriosis lead to recurrent second trimester loss [14]. Anatomic abnormalities, which make up 10% to 15% of the incidences of repeated miscarriage by blocking the endometrium's vasculature, resulting in aberrant and inadequate placentation, are the nal cause and most widely accepted aetiology [15]. A lower incidence of recurrent pregnancy loss has been linked to malformations such as unicornuate, didelphis, and bicornuate uteruses [16]. Surgical correction of a uterine septum, bicornuate uterus, intrauterine adhesions, broids, and cervical incompetence may also result in recurrent pregnancy losses. A preventative cervical cerclage can be bene cial for women who have a Mullerian abnormality and a history of second-trimester pregnancy losses [17]. However, most miscarriages are caused by defects in the viable ovum [18]. Studies have shown that uterine hypoplasia can also cause miscarriage [19]. For three decades, researchers have looked into the cause of recurrent miscarriages, which is linked to polycystic ovarian syndrome [20]. Women with polycystic ovaries are more likely to have numerous miscarriages than women with normal reproductive histories [21]. Uterine broids affect up to 40% of women, but their impact on reproductive success is debatable. Incompetence of the cervix is frequently reported as a reason for mid-trimester recurrent losses based on a history of late losses proceeded by spontaneous rupture of membranes and painless cervical dilatation [22]. An accurate diagnosis can be made using a combination of radiologic imaging modalities, ultrasound, trans-vaginal R E S U L T S It was a cross-sectional study conducted over a period of four months. A sample size of 70 patients was taken using a purposive sampling technique. Data were collected from Memorial Christian Hospital, Sialkot. A consent form was signed by the patients. The gynaecological examination of the patients was performed in a supine position using a Toshiba Famio 5 ultrasound machine. Patients with multiple miscarriages due to uterine abnormalities were included in the current study. Patients with less than two m i s c a r r i a g e s , s e l f-i n d u c e d m i s c a r r i a g e s , a n d miscarriages due to foetal anomalies were excluded. Data was analysed using SPSS 20.

M E T H O D S
The study highlighted signi cance of ultrasound in evaluating the uterine abnormalities that leads to miscarriages. In the present study 70 patients were selected.  Table 2 shows number of pregnancies in females related with miscarriage. The highest pregnancy number was 3 which was found in 23 (32.9%) females and the least number was 6 found in 5 (7.1%) of females.   Table 3 shows the frequency of miscarriages in females. The highest rate of miscarriage was found in 38 (54.3%) of females and least in 4 (5.7%).  Table 4 shows the frequency of uterine abnormaliti

C O N C L U S I O N
A miscarriage occurs when an embryo or foetus expires before the tenth week of gestation. It is most prevalent early in pregnancy. Uterine causes account for 8 out of 10 miscarriages. However anatomic abnormalities make up 10% to 15% of the incidences of repeated miscarriage. The current study was conducted on 70 female patients with a history of uterine abnormalities leading to miscarriage. The most frequent neoplasm in the reproductive tract of females is broids. The number of women who have or will have broids is alarming. It is estimated that 30% of women by the age of 30 will have a broid or broids, with this percentage rising over time to a total of 50% of females of reproductive age, with racial differences. Subfertility, late conception complications, for example, preterm birth, complications during labour, malpresentation, obstructed labour, dysfunction in contractions of the uterus, and postpartum complications (haemorrhage, sepsis, and uterine involution failure) are all caused by broids. The current study found that in 34 (48.6%) patients, broids were the leading cause of miscarriages followed by cervical incompetence which contributes 14% to miscarriage. Similarly, according to Hartmann et al, (2017)

D I S C U S S I O N
women miscarried as a result of this issue. Among 23.8 percent of females who had repeated miscarriage, congenital uterine abnormalities were discovered. The arcuate uterus, on the other hand, was the most prevalent aberration, with serious malformations seen in 6.9% of women. Congenital uterine defects were found to be prevalent in women with a history of recurrent early pregnancy loss in previous research. Based on another study, it was also reported that the increased risk of second trimester miscarriage was mostly found in women with arcuate uterus [27]. According to the ndings of certain research, the prevalence of signi cant congenital uterine defects is three times higher in patients with a past of repeated miscarriage than in the general population. This shows that in a tiny percentage of women who have recurrent miscarriages, congenital uterine defects may be the cause of pregnancy loss.  Table 3: Number of miscarriages es that leads to miscarriage. The most common among them is broids. Out of 70 patients, 34 (48.6%) had broids, 14 (20%) had cervical incompetence, 9 (12.9%) had uterine adhesions, 6 (8.6%) had abnormal uterine size, 4 (5.7%) had uterine polyp and remaining 3 (4.3%) had congenital anomalies.  The study concluded that miscarriages and uterine factors are closely linked. Uterine broids have shown the highest percentage of patients that have undergone miscarriage. Such studies that identify the major factor responsible for recurrent miscarriages can aid in raising awareness and combating the causes in a timely and effective manner.