Unexplained recurrent pregnancy loss and markers of arterial vascular health: An experimental case-control study.

OBJECTIVE: To investigate whether women with unexplained recurrent pregnancy loss have impaired arterial vascular health compared with controls, and to evaluate whether this is modifiable by exercise. DESIGN: Experimental case-control pilot study. SETTING: University medical centre in the Netherlands. POPULATION: Twelve women with unexplained recurrent pregnancy loss, 11 nulliparous women and 19 primiparous women with a history of uncomplicated pregnancies. METHODS: In all three groups we measured baseline characteristics, metabolic components and arterial vascular health, and repeated this in women with unexplained recurrent pregnancy loss after 1 month of protocolled and supervised cycle training. MAIN OUTCOME MEASURES: Differences in arterial vascular health between women with unexplained recurrent pregnancy loss and controls, and the effect of exercise on arterial vascular health in women with unexplained recurrent pregnancy loss. RESULTS: Women with unexplained recurrent pregnancy loss have a significantly increased carotid intima media thickness in comparison with both controls (both P < 0.01), a significantly decreased brachial endothelial dependent flow-mediated vasodilation in comparison with both controls (nulliparous: P < 0.01; primiparous: P = 0.05) and a significantly decreased femoral endothelial dependent flow-mediated vasodilation in comparison with primiparous women (P = 0.01). The endothelium independent glyceryl trinitrate response was similar in all groups. With 1 month of exercise, the carotid intima media thickness decreased significantly by 7% (P = 0.05) and the femoral FMD increased significantly by 10% (P = 0.01) in women with unexplained recurrent pregnancy loss. CONCLUSIONS: Women with unexplained recurrent pregnancy loss have an impaired vascular health in comparison with controls. This impaired arterial vascular health can be improved by exercise.

Unexplained first trimester recurrent pregnancy loss and low venous reserves.

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.

The long-term outcome of 946 consecutive couples visiting a fertility clinic in 2001-2003.

OBJECTIVE: To describe the outcome of fertility work-up, treatment, and dropout in a cohort of subfertile couples in a well-defined area in Western Europe. DESIGN: Prospective cohort study. SETTING: Maastricht University Medical Center. PATIENT(S): Subfertile couples referred by their general physician between 2001 and 2003. INTERVENTION(S): Demographic data, findings of the fertility investigation, and outcome of treatment were entered prospectively into a database. Follow-up was performed until November 2008. MAIN OUTCOME MEASURE(S): Diagnosis, treatment, dropout rate, pregnancy rate, and live-birth rate. RESULT(S): During the study period, 946 couples were referred, of whom 17% dropped out. Follow-up was complete in 94% of couples. Spontaneous pregnancies occurred in 28% of all couples, and there were 32% treatment-dependent pregnancies. IVF (51% live births in couples treated) and no treatment/expectant management (50%) were the most effective treatments. CONCLUSION(S): After 5-8 years, 51% of couples referred for subfertility had at least one live birth.

[Compartment syndrome following laparoscopic procedures in the lithotomy position]. / Compartimentsyndroom na laparoscopische ingrepen in lithotomiepositie.

A laparoscopic tubectomy in the lithotomy position was performed on a healthy 31-year-old woman, as treatment following an extra-uterine pregnancy. The operation proceeded without complications and took 60 minutes. However, on the third day following surgery the woman was diagnosed with compartment syndrome, which was treated with three-compartment fasciotomy. Compartment syndrome is a rare but dangerous complication of an operation in the lithotomy position. Since pressure on leg compartments increases with time spent in the lithotomy position, regardless of the type of stirrups used, it is important to maintain the position only as long as is necessary for the procedure. The patient's legs should be taken out of the lithotomy position as soon as possible, and the position resumed if necessary at a later stage in the procedure. This can easily be achieved with pneumatic stirrups.