Comparison of two therapeutic protocols in patients with antiphospholipid antibodies and recurrent miscarriages.
OBJECTIVE
To compare the effects of two therapeutic protocols for the patients with recurrent miscarriages associated with the presence of antiphospholipid (anticardiolipin) antibodies.


METHODS
A prospective observational study included 20 patients with antiphospholipid antibodies in the first group who received low-molecular heparin and aspirin. The second group of 20 patients, in addition to this therapy, received immunotherapy (intravenous immunoglobulin). Aspirin was administered at the time of a positive pregnancy test, and low-molecular heparin not before the fetal heart activity registration by ultrasound. Intravenous immunoglobulin was given prior to the conception or at the beginning of the pregnancy. We compared these groups according to the pregnancy outcomes and the occurrence of complications during pregnancy, using standard statistical tests.


RESULTS
The rate of positive gestational outcome in the patients treated with aspirin and low-molecular heparin was 85% (17/20), and in the second group it was 90% (18/20). There was no significant difference in pregnancy outcomes between these groups (p > 0.05), except for the occurence of preeclampsia and thrombocytopenia, which were recorded only in the aspirin and low-molecular heparin group, but with no statistical significance (p > 0.05) compared to the second group, which received immunoglobulin additionally.


CONCLUSIONS
There was no significant difference (p > 0.05) in pregnancy outcomes between the two studied therapeutic protocols, but the therapy with aspirin and low-molecular heparin was cheaper and easier to apply than the therapy with immunoglobulins. The results of our study confirmed that the final pathogenic mechanisms in recurrent fetal miscarriages were inflammation and thrombosis of the uteroplacental blood vessels.
Jeremić
Katarina
K
Clinical Center of Serbia, Institute of Gynecology and Obstetrics, Belgrade. jeremicj@hotmail.com
Pervulov
Miroslava
M
Gojnić
Miroslava
M
Dukanac
Jelena
J
Ljubić
Aleksandar
A
Stojnić
Jelena
J
D000026:Abortion, Habitual / Q000209:etiology / Q000276:immunology / Q000517:prevention & control*; D000328:Adult; D017152:Antibodies, Antiphospholipid / Q000032:analysis*; D016736:Antiphospholipid Syndrome / Q000188:drug therapy* / Q000276:immunology; D001241:Aspirin / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage; D011247:Pregnancy; D011256:Pregnancy Outcome
D017152:Antibodies, Antiphospholipid; D005343:Fibrinolytic Agents; D016756:Immunoglobulins, Intravenous; D006493:Heparin; D001241:Aspirin