Early antiplatelet and antithrombotic therapy in patients with a history of recurrent miscarriages of known and unknown aetiology.

OBJECTIVES: To assess the efficacy of early thromboprophylaxis throughout pregnancy in women with previous history of first trimester recurrent miscarriages of unknown aetiology. METHODS: Low dose aspirin and low molecular weight heparin (LMWH) were administered from the day of detection of the fetal heart up to the 37th week, in two groups of patients of known (Group A, n = 24) and unknown aetiology recurrent miscarriages (Group B, n = 27). RESULTS: The success rate (viable pregnancy >24 weeks) was high and equally effective in both Groups A and B (83.3% and 85.1%, respectively). The complications recorded (pre-eclampsia, IUGR, placenta abruptio, injection site heamatomas and skin reactions) were more prevalent in Group A but of no significant difference. No abnormal bleeding was observed during vaginal delivery or caesarean section. CONCLUSIONS: Our results reaffirm previous reports that the use of LMWH in combination with low dose aspirin throughout pregnancy is safe and effective. It was also shown that the treatment is equally effective against recurrent miscarriages in both groups of patients, of known and unknown aetiology.

Asynchronous delivery of twins and triplets with an interval period ranging from 48 hours to 19 weeks.

OBJECTIVE: To improve perinatal survival rates by prolonging the rest of the pregnancy after an abortion or extremely premature birth of one fetus in multiple pregnancies, especially in women with low fertility potential. METHODS: Following the expulsion of one fetus a cervical cerclage was applied to all patients. The placenta of the expelled fetus including a small portion of its cord after it was ligated close to the external os, was left in situ. The patients were invariably kept on bed rest until the pregnancy was completed under close observation, tocolysis and preventive antibiosis. After the 24th week of gestation corticosteroids were administered. RESULTS: The delivery interval achieved ranged between two and 135 days, the longest reported. Although the survival rate was relatively low (40%) all but one of the women (83%) managed eventually to have a live child, one with twins. CONCLUSIONS: In selected multiple pregnancies the attempt to prolong the rest or the pregnancy, following the abortion or the extremely premature birth of one fetus, seems efficacious and justified especially in women with a history of long-term infertility.