Evaluation of Haemostatic Changes Associated with Unexplained Recurrent Early Pregnancy Loss

Objective: To study the changes in the haemostatic variables in pregnant women with unex-plained recurrent early pregnancy loss and to compare them with the corresponding variables in a control group of normal pregnant women. Design: A retrospective descriptive study. Material and Methods: This study carried out in the period between March 2006 and February 2008 in the Departments of Clinical Pathology and Obstetrics and Gynecology, Assiut University Hospital, Assiut, Egypt. This study included 84 women divided into two groups: Cases group: comprised 40pregnant women with a history of unexplained recurrent earlypregnancy loss, with specific inclusion and exclusion criteria.Control group: comprised 44 normal pregnant women at thesame age and period of pregnancy, with history of non recurrentpregnancy loss, and no thrombophilic disorders.Results: This study included 84 pregnant women, theirage ranged from 18 to 38 years. Forty women with gestationalage: 12-18 weeks, had a history of unexplained recurrent earlyfetal loss (cases), and 44 women without history of recurrentearly fetal loss (control group). The screening of coagulationtests (Prothrombin Time (PT), Prothrombin Concentration(PC), In-ternational Normalization Ratio (INR), and Activatedpartial thromboplastin time (aPTT) were done for both thecontrol and the cases. The aPTT in the control group rangedfrom 29 sec. to 36 sec. with mean±SD (32.2±3.2) sec., whileits range in the cases was from 32 sec. to 48 sec. with mean±SD(37.9±9.9) sec. The mean of aPTT was significantly prolongedin the cases COIJlpared with the control group, (p 0.05). Thereis mild decrease in the cases compared with the control groupin the level of protein C antigen, in the control group it rangedfrom 70% to 175% with mean±SD (124.9±29.9)%, while itsrange in the cases was from 30% to 160% with mean±SD(! 16.9±30)%. The incidence of deficiency was 7.5% in thecases versus 2.3% in the controls but without statisticalsignificance (p 0.05). In the control group 6 women out of44 (14%) were positive with anticardiolipin lgG, in the otherhand, 13 women out of 40 (32%) were positive with lgG inthe cases. The incidence of IgG in the cases was markedlystatistically significant than the control group (p 0.05). Inthe con-trol group 7 women out of 44 (16%) were positivefor Lupus Anticoagulants (LA), while 18 women out of 40(45%) were positive for LA in the cases.Conclusion: There is a strong association between deficiencyof both antithrombin III protein S levels and earlyrecun·ent pregnancy loss. There is a high incidence of anti phospholipidantibodies (ACL LA) in the majority of the casesthat could be a common cause of unexplained recurrent earlypregnancy loss after ruling out the other causes of abortion.