Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Centre, PO Box 9101, Nijmegen 6500 HB, The Netherlands.
Hum Reprod. 2012 Sep;27(9):2613-8. doi: 10.1093/humrep/des245. Epub 2012 Jul 3.
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.
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)).
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).
Women with URPL have lower venous reserves when compared with controls at comparable arterial demand. Interventions that increase venous reserve may improve pregnancy outcome.
超过一半的复发性妊娠丢失（RPL）仍然无法解释。我们假设有不明原因 RPL（URPL）病史的女性静脉储备不足。
在 12 名有 URPL 病史的女性、11 名健康未生育对照者和 12 名有简单妊娠史的初产妇对照者中进行病例对照研究。为了量化静脉储备，我们在月经周期的卵泡期测量了血浆容量（PV，ml/m(2)）和前臂及小腿的静脉顺应性（VC(arm)、VC(calf)，（ml/dl）/mmHg）。平均动脉血压（mmHg）通过振荡测量法测量。通过心指数（CI，（l/min）/m(2)）评估动脉需求。
各组间的基线特征无差异。所有组的 CI 相似。有 RPL 病史的女性与未生育和初产妇对照组相比，平均 PV 分别低 14%和 9%（P < 0.01 和 P = 0.04）。URPL 女性的 VC(arm)分别比未生育和初产妇对照组低 25%和 32%（P = 0.04 和 P < 0.01），而 VC(calf)分别比两个对照组低 29%和 22%（P < 0.01 和 P = 0.03）。
与对照组相比，URPL 女性在相当的动脉需求下静脉储备较低。增加静脉储备的干预措施可能改善妊娠结局。
