Now a days, the endometrium pattern is simply described as multilayered or nonmultilayered. Serafini(16) has shown that a multilayered pattern to be more predictive of implantation than any other parameter measured. Color flow Doppler of Endometrium and uterine arteries(17) have been extensively studied by Steer et al and they have found that no pregnancy occurred if the P.I. of uterine artery was >3 and there was no spiral artery blood flow in the endometrial zones. Color Doppler : Addition of color Doppler studies in evaluation of endometrial blood flow patterns and uterine artery flow pattern enabled us to evaluate the physiology of the endometrium. Various scoring systems have been proposed for prediction of implantation by color doppler. The most popular is Appelbaum’s USSR (18). Estrogen produces a vasodilatory effect on the uterine arteries. It has been seen that R.I., P.I. of uterine artery drops with increasing estradiol levels. (Fig. 23 : Uterine A)
(Fig. 23 : Uterine A) Depending on the vascularisation of the endometrial layers the late proliferative triple line endometrium is divided into four zones (19). (Fig. 24 : Uterine zones)
(Fig. 24 : Uterine Zones) Zones 1. 2 mm thick area surrounding zone 2. 2. Hyperechoic outer layer. 3. Hypoechoic inner layer. 4. Endometrial Cavity Applebaum’s USSR Scoring System (UBP) Ultrasound and the UBP(18) Ultrasound offers a simple, reliable, reproducible, quick and non-invasive method of assessing the female pelvic region, especially follicular and endometrial growth.
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