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