Outcome of pregnancy following low molecular weight heparin (LMWH) and aspirin therapy in mothers with recurrent miscarriages

Abstract

Recurrent miscarriages can be due to many aetiologies. Antiphospholipid syndrome (APS) is a well-recognized entity in which fetal loss, preterm delivery and thrombosis are seen. The diagnosis of APS is by demonstrating the presence of one or more antiphospholipid antibodies in 12 weeks apart together with one or more clinical criteria. The diagnosis requires high laboratory standards in confirming antiphospholipid antibodies and is not freely available in government sector laboratories in Sri Lanka. The treatment includes aspirin and LMWH during pregnancy. Objective of the study was to retrospectively analyze the pregnancy outcome of women who were either treated with Aspirin or LMWH or had not received any treatment Records were retrieved retrospectively from July 2016 to July 2019 in women with suspected APS and were followed up at the haematology and obstetric clinics in a teaching hospital. Overall 46 women who met the clinical criteria of APS had a total of 208 pregnancies during the study period. Out of this, 155 pregnancies (74.5%) were fetal losses; as three consecutive first trimester losses, miscarriages beyond tenth week and premature births before 34weeks amounting to 43.47%, 72% and 4% respectively. Total of 68 pregnancies had intervention with either aspirin, or LMWH or both. Out of those 68, the number of successful pregnancies was 35(51.5%). Out of this 35, 4 received aspirin alone, 5 had LMWH and the majority; 26 had both aspirin and LMWH. Thus the preliminary results showed that fetal losses occur in considerable number of pregnancies and combination of aspirin and LMWH show better outcome. Studies are ongoing to strengthen this conclusion with more evidence, to suggest combination therapy as a measure to improve pregnancy outcome in Sri Lanka.