Role of low molecular weight heparin and low dose aspirin in recurrent pregnancy loss with APLA /pre APLA syndrome and hyperhomocysteinemia: our experience
Madhuri R Dabade, Rajiv T Dabade, Avdhut Kashid, Sadhana P Deshmukh, Pradeep M Patil, Suman P Sardesai
Objective: The purpose of the study was to see the effect of low molecular weight heparin (LMWH) and low dose aspirin (LDA) in recurrent pregnancy losses (RPL) due to antiphospholipid antibody (APLA) / Pre APLA syndrome and hyperhomocysteinemia. Method: A total number of 138 women presenting in pregnancy with previous two or more consecutive pregnancy losses with APLA / Pre APLA syndrome or with hyperhomocysteinemia (HHCY) were included in the study. APLA tests and serum homocysteine levels were done in all cases. Patients were put on LMWH 40mg sc/day and tab aspirin 150mg/day after the cardiac activity was noted and continued till twelve hours before planned delivery. In cases of hyperhomocysteinemia vitamin B12 and folic acid supplementation was given along with thromboprophylaxis. Results: Out of 138 women with RPL, 105 (76.07%) had recurrent abortions while 52 (37.68%) had history of intrauterine deaths in past pregnancy along with obstetric complications like preeclampsia, IUGR etc. APLA test was positive in 42 women (30.43%) while it was negative in 86 (67.18%) women. Hyperhomocysteinemia was present in 10 (7.24%) women. Women who received thromboprophylaxis the outcome in index pregnancy was, 94.20% i.e. 130 women had successful pregnancy outcome (live births) while 8 women (6%) had pregnancy loss in spite of thromboprophylaxis and vitamin B12 supplementation. Conclusion: Combination treatment with LDA and LMWH in women with APLA / Pre APLA syndrome and additional vitamin B12 and folic acid supplementation in hyperhomocysteinemia significantly improves the pregnancy outcome in patients with recurrent pregnancy loss with success rate of 94%.