Hi Venkata,

Low-molecular-weight heparins (LMWH) therapy may be linked with osteopenia. Calcium vitamin D supplementation during pregnancy may reduce the risk of LMWH-induced osteoporosis. As LMWH do not cross the placenta, No fetal or neonatal complication has been reported (see Deruellea P and Coulon C. The use of low-molecular-weight heparins in pregnancy – how safe are they? Curr Opin Obstet Gynecol 19:573–577). So, that should allay your anxiety.

Also a good study on this topic was recently written in the journal “blood” written by JM Connors (JM Connors. Preventing pregnancy loss. Blood Jan 2014, vol. 123, No. 3 pp 308 – 310). To access the study on line see http://www.bloodjournal.org/content/123/3/308?sso-checked=true

Regards

Dear Dr Vekata,

I had very good expiriance with Aspirin a 100 mg until 4-6 weeks before delivery and Pregnyl a 1500 i.e. every second day until 12 week of gestation. All pregnant had a succesful pregnancies.

This topic is very interesting but few doctors go through the evidences. 

Now, come to the evidences. Pregnancy miscarriage rate is 15% (15-25). 5% will have second time miscarriage, and 1% will have third time miscarriage. 

If APA syndrome screening is negative, then there could be chances of Hyperhomocysteinemia. If homocysteine level is unknown, you can advise her Folic acid, Vit B12, and B6. Vit D3, Calcium can be added. Aspirin can be added considering other causes of thrombophilia.

When clinical history is suggestive of APS, but serological markers are negative, you can consider the case as seronegative APS, and heparin or LMWH can be added (evidenced).  

In your concern, it could not be ethical to add heparin following one episode of miscarriage. Aspirin is sufficient. You can add progesterone up to 16 weeks (few evidence). hCG is not required as it crossed 8 weeks. 

Dear colleagues,

Unfortunately, I disagree in one part with dr Mondal.

I repeat that my experience with Aspirin and HCG is with excellent results: healthy newborns, in expected period, with normal weight, without any perinatal or maternal complications. HCG is requried up 9-12 wewks of gestations.

I recommend some links as:

http://www.update-software.com/PDF-ES/CD008611.pdf

In other hand, we should be very careful with the kind of progesterone- especially with progesterone caproate which could be in relation with missed abortions. If you are decide to use Progesterone maybe it's better to use micronised progesterone e.g. Utrogestan or Crinone gel.

I'm reminding that some of patients with recurrent pregnancy losses, had negative serologic markers and absent antibodies regarding immunological disorders and syndromes. But our aims are healthy babies in women's arms.

Best regards to all of you

Dear Emilija Jasovic-Siveska,

  I know the review. You are concerned about Luteal phase defect. The review clearly saying that the effect of hCG is equivocal. Evidences are again lacking. But I am not sure in which cases you are using your regime. If APS positive cases, it is always better to use combined heparin and aspirin. In unexplained RM, I follow the article published in 'Obs Gyne Clinic of north Am' published in 2014.  

The issue is very vital especially for medical practitioners. Good to learn from experienced practitioners. However, it seems that there are lots of issues which need to be clarified, hence I like to recommend a multi-center research.