Evaluation of the efficacy of aspirin and low molecular weight heparin in patients with unexplained recurrent spontaneous abortions

The roles of inflammatory cytokines and local placental thrombosis in patients with unexplained recurrent spontaneous abortion [URSA] have been shown. Since low molecular weight heparin [LMWH] and acetyl salicylic acid [ASA] have both anti-inflammatory and anti-coagulant effect, we evaluated their efficacy in patients with URSA. One hundred patients with a history of URSA referring to Obstetrics Clinic affiliated to Shiraz University of Medical Sciences between 2004 and 2009 were randomly divided into two groups. Fifty patients in thromboprophylaxis group were treated with LMWH [5000 unit; twice a day], ASA [80 mg daily] and calcium supplement [500 mg daily] after detection of fetal heart beat. Another 50 patients received no thromboprophylaxis. Live birth rate, obstetrical complications, prenatal and neonatal complications and hemorrhagic side effects were recorded. Both groups were matched for mean age and mean number of pervious abortions. Thromboprophylaxis group had a higher rate of live birth [83.7%] in comparison to the control group [54%]. No maternal or neonatal side effects were seen. There were no differences in obstetrical complications, prenatal and neonatal complications between the two groups. Thromboprophylaxis with ASA and LMWH seems to be safe and effective in patients with URSA

[ value of determining antipaternal leukocyte antibodies in the diagnosis of alloimmune factors in recurrent abortion]

Background: Habitual abortion is defined as the occurrence of three or more consecutive pregnancy losses before the twentieth week of gestation. This is a challengeable clinical issue, as no cause can be found for abortion in over 50% of patients. There is increasing evidence to support an alloimmune mechanism in the unexplained group. It has been stated that the absence of maternal antibodies against the paternal leukocyte antigen [APLA] presented by the fetus causes abortion in this group. The objective of this study was to determine the value of APLA in the diagnosis of immunological causes of unexplained habitual abortion

Patients and Methods: One-hundred-thirty women with primary habitual abortion who had referred to Motahari Clinic, Shiraz, were enrolled in the study. In patients with nonspecific causes for abortion [unexplained abortion] white blood cell cross match was done for determination of APLA. Also, in the control group [women with at least one term pregnancy who had referred for kidney donation], APLA was determined. Immunization with paternal leukocytes was done for patients with negative APLA in several steps

Results: In fifty [38.5%] women out of 130 cases with habitual abortion, no recognized cause was found. APLA was positive in 8% and 20% in the case and control groups, respectively. There was no statistical difference between the two groups. Overall, 88% of the patients with negative APLA were immunized with paternal leukocytes

Conclusion: A negative APLA test does not correlate with the immunological basis of unexplained habitual abortion

Successful pregnancy outcome with IUI in patients with unexplained recurrent miscarriage, whose male partners have low score hypo-osmotic swelling test

In order to determine outcome of pregnancy with IUI in patients with unexplained recurrent miscarriage whose husbands have low hypo-osmotic swelling test scores, a prospective clinical intervention was performed at a university referral clinic of recurrent abortion. Out of 56 patients whose husbands had abnormal hypo-osmotic swelling tests, 43 patients underwent IUI, from which only 14 patients became pregnant [treatment group] and 13 patients became spontaneously pregnant without IUI as control group. Our main outcome measure was successful pregnancy [continuation of pregnancy after 20 weeks]. Among the 14 patients who became pregnant, 3 patients aborted below 20 weeks [21.4%], and 11 patients continued pregnancy after 20 weeks of gestation [78.6%]. In the control group among the 13 patients with spontaneous pregnancy, 8 patients aborted below 20 weeks [61.5%] and 5 patients continued pregnancy over 20 weeks [36.4%], success rate ratio was 2.04% and the difference was statistically significant [c[2]=4.49, p<0.05]. Treating the unexplained recurrent aborter whose male partner has a low hypo-osmotic swelling test score with IUI could be effective. This is the first study to present an ideal way for selection of recurrent aborters who benefit from IUI. The probable mechanism for this effect may be selection of the best quality sperms which will be discussed in detail

Congenital adrenal hyperplasia in north-east of Iran: a review of 47 patients and the role parental consanguinity in the occurrence of disease.

In this study the clinical and epidemiological characteristics of congenital adrenal hyperplasia were evaluated prospectively in 47 patients admitted in Imam Reza Hospital in Mashhad during a 4 year period. 21-hydroxylase deficiency was present in 42 patients [89.3%], the simple virilizing form in 6 and the salt-losing form in 36 of them. 11b-hydroxylase deficiency was present in 5 patients [10.7%]. The median chronological age at diagnosis in the salt-losing form was 68 and 47 days in boys and girls respectively. 7 girls were considered to be male before the diagnosis was established. Parental consanguinity rate among families of patients was higher than the general population in Mashhad [82% vs. 35%]. In 16.2% of patients the history of disease was positive in siblings. This study showed that the incidence of congenital adrenal hyperplasia is expected to be high due to a high rate of consanguinity in our population, hence genetic counseling before marriage would definitely be beneficial in our population

value of dipstick analysis of urinary protein in pregnancy induced hypertension

In order to determine the value of dipstick analysis of urinary protein in pregnancy induced hypertension, a prospective study analyzing pregnant patients with a diagnosis of hypertensive disorder was conducted to compare the result of urinary protein dipstick analysis with 24hr. urine protein collection in obstetrical clinics affiliated to Shiraz University of Medical Sciences. All patients fulfilling the criteria of the American College of Obstetricians and Gynecologists' definitions for establishing a diagnosis of hypertensive disorder on the basis of urinary dipstick measurements were included in the study. During the study, 102 hypertensive pregnant patients aged from 16-42 years were included in the study. Obtained results showed that the presence of negative value on urinary dipstick with a sensitivity of 100% is a useful method for ruling out significant proteinuria [> 300 mg/24hr]. But values of >2+ are not adequate to confirm a diagnosis of severe hypertensive disorder because its positive predictive value is only 22% and values of > trace-although highly suggestive of significant proteinuria [positive predictive value: 78%]-have a false positive rate of 23%; a timed collection of urine for determination of 24-hr protein excretion becomes mandatory in such cases. The urinary dipstick determination of protein excretion therefore has significant limitations for determination of the presence or severity of proteinuria