Unexplained first trimester recurrent pregnancy loss and low venous reserves.
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SourceHuman Reproduction, 27, 9, (2012), pp. 2613-8
01 september 2012
Article / Letter to editor
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SubjectNCEBP 14: Cardiovascular diseases IGMD 5: Health aging / healthy living; NCEBP 14: Cardiovascular diseases IGMD 6: Hormonal regulation; ONCOL 3: Translational research N4i 1: Pathogenesis and modulation of inflammation
BACKGROUND More than half of recurrent pregnancy loss (RPL) remains unexplained. We hypothesized that women with a history of unexplained RPL (URPL) have low venous reserve. METHODS Case-control study in 12 women with a history of URPL, 11 healthy nulliparous controls and 12 primiparous controls with a history of uncomplicated pregnancy. To quantify venous reserve, we measured plasma volume (PV, ml/m(2)) and venous compliance in forearm and calf (VC(arm), VC(calf), (ml/dl)/mmHg) during the follicular phase of the menstrual cycle. Mean arterial blood pressure (mmHg) was measured by oscillometry. Arterial demand was evaluated by cardiac index (CI, (l/min)/m(2)). RESULTS Baseline characteristics were comparable between groups. All groups had similar CI. Women with a history of RPL had 14% and 9% lower mean PV compared with nulliparous and primiparous controls (P < 0.01 and P = 0.04, respectively). In women with URPL, the mean VC(arm) was 25% and 32% lower compared with nulliparous and primiparous controls (P = 0.04 and P < 0.01, respectively), while the mean VC(calf) was 29 and 22% lower compared with the two control groups (P < 0.01 and P = 0.03, respectively). CONCLUSIONS Women with URPL have lower venous reserves when compared with controls at comparable arterial demand. Interventions that increase venous reserve may improve pregnancy outcome.
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