Prevention, management and extent of adverse pregnancy outcomes in women with hereditary antithrombin deficiency.

Antithrombin (AT) deficiency is a rare hereditary thrombophilia with a mean prevalence of 0.02 % in the general population, associated with a more than ten-fold increased risk of venous thromboembolism (VTE). Within this multicenter retrospective clinical analysis, female patients with inherited AT deficiency were evaluated concerning the type of inheritance and extent of AT deficiency, medical treatment during pregnancy and postpartally, VTE risk as well as maternal and neonatal outcome. Statistical analysis was performed with SPPS for Windows (19.0). A total of 18 pregnancies in 7 patients were evaluated, including 11 healthy newborns ≥37th gestational weeks (gw), one small for gestational age premature infant (25th gw), two late-pregnancy losses (21st and 28th gw) and four early miscarriages. Despite low molecular weight heparin (LMWH) administration, three VTE occurred during pregnancy and one postpartally. Several adverse pregnancy outcomes occurred including fetal and neonatal death, as well as severe maternal neurologic disorders occurred. Patients with substitution of AT during pregnancy in addition to LMWH showed the best maternal and neonatal outcome. Close monitoring with appropriate anticoagulant treatment including surveillance of AT levels might help to optimize maternal and fetal outcome in patients with hereditary AT deficiency.

Maternal factor V Leiden and prothrombin mutations do not seem to contribute to the occurrence of two or more than two consecutive miscarriages in Caucasian patients.

BACKGROUND: We analysed the prevalence of the most common hereditary thrombophilia (hTP) - factor V Leiden (FVL) mutation, prothrombin 20210 G>A substitution (PT) - and the 677 C>T replacement in the 5,10-methylenetetrahydrofolate reductase (MTHFR) gene in Caucasian patients with a history of two and more consecutive recurrent miscarriages (RMs) as compared to healthy controls with an identical ethnic background and at least one live birth. METHODS: A multicenter analysis of three hTP was performed in 641 RM patients identically screened at specialized university centres. RESULTS: The study groups consisted of 240 patients with 2 (1) and 401 patients with >2 miscarriages (2) and were compared with 157 controls. There was no significant difference in the prevalence of the hTP between RM patients and controls nor within the two study groups. Subgroup analysis showed that the homozygous MTHFR polymorphism was significantly more prevalent in the study group 2 as compared to study group 1 (13.9 versus 7.9%, P = 0.02). CONCLUSION: In Caucasians, maternal FVL or PT mutations do not seem to contribute to the pathophysiology of RM, irrespective of the number of miscarriages. However, the role of the homozygous MTHFR polymorphism merits further investigation.

In vitro maturation: a five-year experience.

OBJECTIVE: Although some patients may benefit from reduced follicle-stimulating hormone (FSH) application, in-vitro maturation (IVM) belongs to the rare treatment options in assisted reproduction. We summarize our five-year IVM experience. DESIGN: Retrospective, observational study. SETTING: Reproductive Medicine, University Hospital. SAMPLE: 115 patients with polycystic ovary syndrome (PCOS) as well as patients after ovarian hyperstimulation syndrome (OHSS) from February 2005 to December 2009. MATERIAL AND METHODS: Stimulation started between day 3-10 of the menstrual cycle and FSH dosage was 125IU/day over three days. Ovulation was induced on the third day of FSH injection or one day afterwards and oocyte retrieval was performed 33-38 hours later. Oocytes were cultivated for 24 hours in IVM medium. Fertilization was carried out one day after oocyte retrieval and embryo transfer two days afterwards. MAIN OUTCOME MEASURES: Pregnancy rates. RESULTS: 115 patients were included and 215 oocyte retrievals (intracytoplasmic sperm injection: n=125, 59%; in vitro fertilization: n=73, 34.4%) with 177 embryo transfers performed. The main reasons for IVM were: PCOS (71.7%) and OHSS (15.0%). Mean number of oocytes was 8.9/oocyte retrieval with 5.9 (64%) becoming mature, 2.8 (45.1%) being fertilized and 2.1 transferred. Pregnancy rate per transfer was 15.3% (n=27) with 13 live births (7.3%), one intrauterine death (0.6%), four miscarriages (2.3%) and nine biochemical pregnancies (5.1%). In 61 cases, fertilized oocytes were frozen and 32 cryotransfers were performed, resulting in three pregnancies. CONCLUSIONS: Although the pregnancy rate was low, IVM is very convenient for patients due to low FSH dosages and few appointments at low cost.

Hysteroscopic findings in women with two and with more than two first-trimester miscarriages are not significantly different.

The purpose of this study was to analyse hysteroscopic results in patients with recurrent miscarriages and to compare the frequency of uterine anomalies in women with a history of exactly two and with more than two consecutive miscarriages. A retrospective analysis of 206 patients undergoing hysteroscopy for repeated early pregnancy losses was performed at two university centres. Late miscarriages were excluded, terminations of pregnancy were not counted. Eighty-seven patients had suffered from exactly two early miscarriages and 119 from more than two. Both groups were comparable with respect to age at admission (32.95+/-4.46 versus 34.06+/-5.02 years) and at first miscarriage (30.43+/-4.24 versus 29.08+/-5.38 years). The prevalence of acquired (adhesions, polyps, fibroids) and congenital uterine anomalies (septate or bicornuate uterus, etc.) did not differ significantly (acquired: 28.7 versus 27.7%; congenital: 9.2 versus 16.8%). The rates of uterine anomalies did not differ significantly overall (36.8 versus 42.9%). In conclusion, uterine anomalies are frequently found in patients with two and with more than two early miscarriages. Due to the high rate of anomalies, their risk for adverse pregnancy outcome and a possible therapeutic approach, hysteroscopy might be a diagnostic option even after two early miscarriages.