Idiopathic Recurrent Miscarriages; Use of Aspirin Alone or Heparin and Aspirin: Emperical or Evidence Based Management

.. 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, placebocontrolled 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.