J. Infertil. Reprod. Biol.

Volume 5, Issue 4, 2017

Anti-Coagulant Therapy in Unexplained Recurrent Pregnancy Loss – Is It Indispensible?

Bishista Bagchi, Sukanta Misra*, Ashish Seal

Department of Obstetrics and Gynecology, Vivekananda Institute of Medical Sciences(VIMS), Ramakrishna Mission Seva Pratishthan (RKMSP), 99 Sarat Bose Road, Kolkata – 700026, India

Journal of Infertility and reproductive Biology, 2017, Volume 5, Issue 4, Pages 15-19, | Full Text in PDF | Full Text in HTML

Abstract

Recurrent pregnancy loss (RPL) is a heterogeneous reproductive problem with multiple aetiologies and contributing factors. It becomes quite challenging to form a work-up to detect the cause of RPL in the early months as a continuation of pregnancy involves many factors. In more than half of all recurrent miscarriage the cause still remains uncertain. Thrombophilia has been identified in about 50% of women with recurrent miscarriage and thromboprophylaxis has been suggested as an option of treatment.. In obstetric APLA Syndrome (Antiphospholipid antibody) the combination of aspirin and heparin has improved outcomes. The use of low molecular weight heparin (LMWH) has become a common practise in women with inherited thrombophilia and also those with unexplained miscarriage to help safeguard the ongoing pregnancy. To evaluate if there is any effectiveness of low molecular weight heparin (enoxaparin)   in women with a history of at least two miscarriages without any apparent aetiology for recurrent pregnancy loss. A prospective randomised controlled study held at Vivekananda Institute of Medical Sciences, Kolkata from August 2015- July 2018. The study assessed the effect of anticoagulant treatment on the live-birth rate (primary outcome) in 80 antenatal women with a history of at least two miscarriages without any apparent causes. Interventions included low molecular weight heparin administration in one group and the other one was not given any anti-coagulant therapy. Similar live birth rates were observed with enoxaparin and the patients who did not receive any anti-coagulant, respectively 84% and 82% (RR 0.97, 95% CI 0.81 to 1.16). There were no significant differences in live birth weight and other pregnancy outcomes between the two groups. Therefore, there is no evidence to support any incremental benefit of adding LMWH to the treatment as a routine in unexplained cases of recurrent pregnancy loss.

Keywords: Abortion, Anti-coagulant, Enoxaparin, Live birth, Aspirin

Maternal, Fetal and Placental Responses in the Early and Late Onset Preeclampsia

Mona Sharma^1*, Renu Dhingra², Neerja Bhatla³

¹ Assistant Professor, Department of Reproductive Biology, All India Institute of Medical Sciences, New Delhi, India

² Professor, Department of Anatomy, All India Institute of Medical Sciences, New Delhi, India

³ Professor, Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India

Journal of Infertility and reproductive Biology, 2017, Volume 5, Issue 4, Pages 20-25, | Full Text in PDF | Full Text in HTML

Abstract

Preeclampsia is the pregnancy induced disorder of hypertension and proteinuria manifesting after midgestation. Depending upon the onset of symptoms, it can be classified as early onset (≤34 wks) or late onset (≥34wks). The objectives of the present study were to compare the maternal responses (maternal age, gestational age, mode of delivery, blood pressure, proteinuria), the fetal responses (birth weight, APGAR score) and placental responses (placental weight, placental morphology, trophoblastic and syncytial knot apoptotic rates) between the early and late onset preeclamptic women. The study group included early onset (20 placentas), late onset (20 placentas) cases of preeclampsia and control group included 20 placentas from normotensive nonproteinuric pregnant women. For the placental pathological changes, hematoxylin and eosin staining and M30 immunostaining were used. The maternal, fetal and placental responses were compared between study and control groups. As compared to the control group, the maternal age, blood pressure and proteinuria were higher in both early and late onset preeclamptic groups. The early onset preeclamptic group was associated with low placental weight along with premature delivery of low birth weight babies with low APGAR scores as compared to control and late onset preeclamptic group. The mode of delivery in most of the cases of early onset preeclamptic group was caesarean section. The fetal and placental responses in late preeclamptic group were comparable to that of control group. The placental villous and vascular morphology along with apoptotic indices were severely altered in early onset preeclamptic group. Between the two types of preeclampsia, the early onset preeclamptic group showed poor maternal, fetal and placental responses suggesting its severity and bad prognosis.

 Keywords: Preeclampsia, Maternal age, Placentas, Premature delivery, APGAR Score

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