Abstract: Objective To determine maternal and fetal outcomes in women with APS managed with aspirin or unfractionated heparin (UFH) plus aspirin during pregnancy. Design: prospective cohort study. Setting: high-risk pregnancy unit- Benha university hospital. Methods: Pregnant women with APS attending at high-risk pregnancy unit. Seventy seven selected patients with clinical and/or serological findings of antiphospholipid syndrome were divided into 2 groups: group A (n = 47) had received low-dose aspirin (81 mg once daily orally) plus heparin (5000 IU) every 12 h while group B (n = 30) had received aspirin (81mg once daily orally) with the first positive pregnancy test. Main outcome measures: Maternal outcomes included thromboembolic and haemorrhagic complications and pregnancy-induced hypertension .Prematurity, intrauterine growth restriction and neonatal death were considered as maternal and fetal complications. Results: There were significant differences in antenatal and maternal complications between the groups. Aspirin plus UFH was more efficacious than aspirin alone in women with antiphospholipid syndrome and recurrent miscarriage. There were significant differences between Groups A and B in the rate of miscarriages [3 miscarriages in Group A (6%) versus 8 miscarriage in Group B (27%); p = 0.03], the mean gestational age [38±1.73weeks versus 36 ±1.57; p ˂0.0001], the neonatal birth weight [3352.27 ± 368.2 versus 2620.45 ± 370.54 gm; p ˂0.0001] and pre-eclampsia [4/44 (9%) versus 8/22 (36%); p =0.03]. Although not statistically significant, women in Group A tended to have higher rates of number of live births [44/47(94%) versus 22/30(73%); p =0.49] but have lower rates of IUGR [5/44 (11%) versus 4/22 (18%); p =0.51] and preterm births [5/44 (11%) versus 6/22 (27%); p =0.18] than women in Group B. Conclusions: Use of low dose aspirin and heparin (5000 IU) every 12 h subcutaneously in patient with recurrent pregnancy loss due to antiphospholipid syndrome resulted in higher live birth rates compared to using low dose aspirin alone. |
