Objective:In this study the purpose is to
evaluate the effectiveness of daily bemiparin sodium injection in preventing
early pregnancy loss and in achieving live births in pregnant patients, not
ahead of 6th week, who are diagnosed with habitual abortion in a
case-controlled randomized prospective study. Study Design: In this prospective
study, 120 pregnant patients not ahead of 6th week and aged between 21 - 36 and
diagnosed with habitual abortion between April 2011 and April 2012 in our
clinic were included. Habitual abortion diagnosis criteria was based on patient
history of three or more miscarriages before the 20th week and a genetically
documented homozygote or heterozygote mutation of the methylenetetrahydrofolate
Reductase gene. Results: The rate and the number of live births in the study
group was 60 (93.75%) and statistically higher than the control group 32
(57.14%). The difference was found to be statistically significant (p = 0.001).
The rate and the number of abortions in the control group was 24 (42.85%) and
statistically higher than the study group 4 (6.25%). The difference was found
to be statistically significant (p = 0.001). Conclusion: In order to maintain a
healthy pregnancy an effective uteroplacental circulation is a must and any
defects in haemostasis mechanisms may have an adverse influence. A few
non-randomized studies comparing pregnancy results of low dose salycilic acid
and low molecular weight heparin usage in patients also show that prophylaxis
might be beneficial.
References
[1]
Alatas, E. (2004) Tekrarlayan gebelik kayiplarinda tani ve tedavinin yonlendirilmesi. TJD Uzmanlik Sonrasi Egitim Dergisi, 6, 19-25.
[2]
Tepeli, E., Müslümanoglu, H.M. and Uludag, A. (2007) Eskigehir ilinde idiyopatik tekrarlayan gebelik kayiplari ile metilentetrahidrofolat redüktaz (MTHFR) C677T ve A1298C polimorfizmleri arasindaki iligki. Osmangazi Tip Dergisi, 29, 1-11.
[3]
Oral, D., Alp, M.N. and Budak, T. (2006) Ailesel Resiprokal Translokasyon Olgusu ve Tekrarlayan Düsükler. Dicle Tip Dergisi, 33, 182-184.
[4]
Balci, A., Yirmibes, M. and Bal, F. (1996) Ailesel Resiprokal Translokasyon Olgusu ve Tekrarlayan Düsükler. Perinatoloji Dergisi, 4, 218-219.
[5]
Goyette, P., Sumner, J.S., Milos, R., Duncan, A.M., Rosenblatt, D.S., Matthews, R.G. and Rozen, R. (1994) Human Methylenetetrahydrofolate Reductase: Isolation of cDNA, Mapping and Mutation Identification. Nature Genetics, 7, 195-200. http://dx.doi.org/10.1038/ng0694-195
[6]
Ueland, P., Refsum, H., Stabler, S., et al. (1993) Total Homocysteine in Plasma or Serum: Methods and Clinical Applications. Clinical Chemistry, 39, 1764-1779.
[7]
Ray, J.G. and Laskin, C.A. (1999) Folic Acid and Homocyst(e)ine Metabolic Defects and the Risk of Placental Abruption, Pre-Eclampsia and Spontaneous Pregnancy Loss. Placenta, 20, 519-529.
http://dx.doi.org/10.1053/plac.1999.0417
[8]
Lissak, A., Sharon, A., Fruchter, O., et al. (1999) Polymorphism for Mutation of Cytosine to Thymine at Location 677 in the Methylenetetrahydrofolate Reductase Gene Is Associated with Recurrent Early Fetal Loss. American Journal of Obstetrics & Gynecology, 181, 126-130. http://dx.doi.org/10.1016/S0002-9378(99)70447-3
[9]
Garcia, D.A., Baglin, T.P., Weitz, J.I. and Samama, M.M. (2012) Parenteral Anticoagulants Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 141, e24S-e43S.
[10]
Sanson, B., Lensing, A., Prins, M., et al. (1999) Safety of Low-Molecularweight Heparin in 82 Pregnancy. Thrombosis and Haemostasis, 81, 668-672.
[11]
Gris, J., Neveu, S., Tailland, M., et al. (1995) Use of Low-Molecular Weight Heparin (Enoxaparin) or of a Phenformin-Like Substance (Moroxydine Chloride) in Primary Early Recurrent Aborters with an ?mpaired Fibrinolyitic Capacity. Thrombosis and Haemostasis, 73, 362-367.
[12]
Brenner, B., Hoffman, R., Blumenfeld, Z., et al. (2000) Gestational Outcome in Thrombophilic Women with Recurrent Pregnancy Loss Treated by Enoxaparin. Thrombosis and Haemostasis, 83, 693-697.
[13]
Preston, F.E., Rosendaal, F.R., Walker, I.D., Briet, E., Berntorp, E., Conrad, J., et al. (1996) Increased Fetal Loss in Women with Heritable Thrombophilia. The Lancet, 348, 913-916. http://dx.doi.org/10.1016/S0140-6736(96)04125-6
[14]
Brigden, M.L. (1997) The Hypercoagulable State, Who, How and When to Test and Treatment. Postgraduate Medicine, 101, 5249-5268. http://dx.doi.org/10.3810/pgm.1997.05.252
[15]
Dendrinos, S., Makrakis, E., Botsis, D., Chassiakos, D., Baka, S., Creatsas, G., et al. (2005) A Study of Pregnancy Loss in 352 Women with Recurrent Miscarriages. Archives of Gynecology and Obstetrics, 271, 253-259.
http://dx.doi.org/10.1007/s00404-004-0607-0
[16]
Li, T.-C., Iqbal, T., Anstie, B., et al. (2002) An Analysis of the Pattern of Pregnancy Loss in Women with Recurrent Miscarriage. Fertility and Sterility, 78, 1100-1106. http://dx.doi.org/10.1016/S0015-0282(02)04207-3
[17]
Paidas, M.J., Ku, D.H., Arkel, Y.S., et al. (2004) Screening and Management of Inherited Thrombophilias in the Setting of Adverse Pregnancy Outcome. Clinics in Perinatology, 31, 783-805.
http://dx.doi.org/10.1016/j.clp.2004.07.002
[18]
Gris, J.C., Mercier, E., Quere, I., Lavigne-Lissalde, G., Cochery-Nouvellon, E., Hoffet, M., et al. (2004) Low Molecular Weight Heparin versus Low-Dose Aspirin in Women with One Fetal Loss and a Constitutional Thrombophilic Disorder. Blood, 103, 3695-3699. http://dx.doi.org/10.1182/blood-2003-12-4250
[19]
Sharif, K.W. and Ghunaim, S. (2010) Management of 273 Cases of Recurrent ?mplantation Failure: Results of a Combined Evidence-Based Protocol. Reproductive BioMedicine Online, 21, 373-380.
http://dx.doi.org/10.1016/j.rbmo.2010.03.028
[20]
Alalaf, S. (2012) Bemiparin versus Low Dose Aspirin for Management of Early Pregnancy Loss Due to Antiphospholipid Antibody Syndrome. Archives of Gynecology and Obstetrics, 285, 641-647.
http://dx.doi.org/10.1007/s00404-011-2055-y
