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 40 pregnant women with a history of unexplained recurrent early pregnancy loss, with specific inclusion and exclusion criteria. Control group: comprised 44 normal pregnant women at the same age and period of pregnancy, with history of non recurrent pregnancy loss, and no thrombophilic disorders. Results: This study included 84 pregnant women, their age ranged from 18 to 38 years. Forty women with gestational age: 12-18 weeks, had a history of unexplained recurrent early fetal loss (cases), and 44 women without history of recurrent early fetal loss (control group). The screening of coagulation tests (Prothrombin Time (PT), Prothrombin Concentration (PC), In-ternational Normalization Ratio (INR), and Activated partial thromboplastin time (aPTT) were done for both the control and the cases. The aPTT in the control group ranged from 29 sec. to 36 sec. with mean ±SD (32.2±3.2) sec., while its 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 prolonged in the cases compared with the control group, (p<0.05). There is mild decrease in the cases compared with the control group in the level of protein C antigen, in the control group it ranged from 70% to 175% with mean ±SD (124.9±29.9)%, while its range in the cases was from 30% to 160% with mean ±SD (116.9±30)%. The incidence of deficiency was 7.5% in the cases versus 2.3% in the controls but without statistical significance (p>0.05). In the control group 6 women out of 44 (14%) were positive with anticardiolipin IgG, in the other hand, 13 women out of 40 (32%) were positive with IgG in the cases. The incidence of IgG in the cases was markedly statistically significant than the control group ( p<0.05). In the con-trol group 7 women out of 44 (16%) were positive for Lupus Anticoagulants (LA), while 18 women out of 40 (45%) were positive for LA in the cases. Conclusion: There is a strong association between deficiency of both antithrombin III & protein S levels and early recurrent pregnancy loss. There is a high incidence of antiphospholipid antibodies (ACL & LA) in the majority of the cases that could be a common cause of unexplained recurrent early pregnancy loss after ruling out the other causes of abortion.