TITLE : Prednisolone and alternate-day Enoxaparin in unexplained recurrent pregnancy loss.

Authors: Dr. Sanghamitra Dash, M.D., O&G; Dr. Manoranjan Panda, M.D., O&G; and Dr Sasmita Das, M.D., O&G.

Affiliation: Life Institute of Gastroenterology and Gynaecology, Cuttack, Odisha, India

CORRESPONDING AUTHOR e-mAIL: thelifeclinicobg@gmail.com

INTRODUCTION:

Recurrent miscarriage (RM), defined as the loss of three or more consecutive pregnancies confirmed by ultrasonography or histopathological examination, affects 1% of couples trying to conceive. It has been estimated that 1–2% of second-trimester pregnancies miscarry before 24 weeks of gestation.Up until now, therapy has been empirical and not evidence based, resulting in a poor understanding of the precise aetiology of unexplained RM.Treatments includes Aspirin, Heparin, progesterone, steroids, leukocyte immunization, intralipids and IVIG. Heparin and aspirin have been recommended as a standard empiric treatment for cases of RM by the American College of Obstetrics and Gynecology and the Royal College of Obstetrics and Gynecology protocols. Prednisolone has been reported to improve in vitro fertilization treatment outcome and to reduce the rate of miscarriage due to various reproductive immunological problems by increasing the T-regulatory cells, which in turn regulate the peripheral NK cells and their homing into the decidua.

Aim and objectives: 

The aim of the study was to investigate whether the use of alternate day low molecular weight heparin (LMWH) and low dose prednisolone improve live birth rates in patients with unexplained recurrent miscarriages (URM)

MATERIAL AND METHODS:

This randomized double-blind placebo controlled clinical trial was conducted at LIGG hospital , maternity unit Odisha , India and involved patients who experienced unexplained recurrent miscarriage(which was defined as ≥3 previous miscarriages at <20 weeks, gestation) between January 2017 and May 2021.

CONCLUSION:

Low dose prednisolone (5mg) with alternate day enoxaparin 40 IU in addition to the empiric therapy resulted in improved live-birth rate in patient with 2 or more consecutive unexplained recurrent pregnancy loss which is more economical and convenient to the patient.