IDIOPATHIC RECURRENT MISCARRIAGES

USE OF ASPIRIN ALONE OR HEPARIN AND ASPIRIN: EMPERICAL OR EVIDENCE BASED MANAGEMENT.

Abstract

Objectives: The rationale of our study is to investigate whether aspirin alone,
or aspirin combined with low molecular weight heparin as compared to placebo (intensive
pregnancy surveillance), would improve the live birth rate (primary outcome) among with
idiopathic recurrent miscarriages. Secondary outcomes included rate of serious adverse events
during pregnancy among pharmacological intervention group and intensive surveillance group:
rates of miscarriage, intrauterine fetal death (fetal death after 24 weeks of gestation), small for
gestational age, premature delivery, APH and PPH. Study Design: A prospective, randomized,
single-blinded, placebo- controlled trial was conducted at Tertiary Referral Obstetric Hospital.
Setting: Fatima Memorial Hospital, Lahore Period: 2007 to 2013. Method: The participants
were 172 women with a diagnosis of idiopathic recurrent miscarriage.12 patients dropped out
of the study. Women with 2 or more recurrent fetal losses and after exclusion of all known
causes of recurrent miscarriage were randomly allocated to receive aspirin alone (n=54),
combination treatment aspirin and heparin (n=56) or placebo (n=50 intensive pregnancy
surveillance). The results were analyzed by SPSS (version 17) and they were tested by chisquare
test. Results: Out of 160 women who underwent randomization, live birth rate did not
differ significantly among the three groups. The live birth rate was 70.3% among aspirin only
group, 73.2% among aspirin and heparin group and 70% among intensive surveillance group
(placebo) with a p value equal to 0.11. No significant differences in secondary outcome were
observed among three groups. Conclusion: In conclusion, our findings do not support the
hypotheses that use of aspirin alone or in combination with enoxapirin improves the live birth
rate in women with idiopathic recurrent miscarriages.