Abstract
It is very common to offer low molecular weight heparin (LMWH) medications to women with unexplained habitual abortion, to increase the livebirth rate. Although no benefit from LMWH has been clearly demonstrated, examination of the effects of enoxaparin on placental structure is lacking. To assess placental structural changes in pregnancies treated with enoxaparin, compared with controls. Case-control study in an obstetrics and gynecology unit of a tertiary-level university hospital in Turkey. Forty patients who had had term pregnancies and live births but also histories of habitual abortion were recruited for this study. Placentas were sampled using a systematic random sampling method. Tissue samples were obtained, embedded and sectioned for routine histological analyses. Hematoxylin and eosin staining was used. Surface area and length estimates from placental components were evaluated by using Image J. Cell proliferation and apoptosis were also assessed via immunohistochemistry. There were no significant differences between the groups regarding maternal age, abortion rate, birth weight or gestational age. Comparison of the enoxaparin and control groups showed that there were no significant differences in terms of surface area and ratios of placental components. We found that Bcl-2 was generally expressed at high levels in the enoxaparin group, while there was no difference in terms of Ki-67 between the groups. This study demonstrates that enoxaparin did not show any significant effect on the placental structure of cases that had histories of habitual abortion.
Highlights
Habitual abortion is defined as the loss of three or more consecutive pregnancies prior to 20 weeks of gestation or a fetus weighing less than 500 g.1 Approximately 1%-2% of all women are affected.[2]
There is no established therapy for treatment of this patient group, it has been reported in several studies that use of progesterone and low-dose aspirin may be effective.[4,5,6]
Even though most published reports in the literature have failed to show any beneficial effect from low molecular weight heparin (LMWH) in enhancing the livebirth rates among women with unexplained habitual abortion,[7,8,9] some other studies have suggested that the use of LMWH is beneficial.[10]
Summary
Habitual abortion is defined as the loss of three or more consecutive pregnancies prior to 20 weeks of gestation or a fetus weighing less than 500 g.1 Approximately 1%-2% of all women are affected.[2]. Even though most published reports in the literature have failed to show any beneficial effect from low molecular weight heparin (LMWH) in enhancing the livebirth rates among women with unexplained habitual abortion,[7,8,9] some other studies have suggested that the use of LMWH is beneficial.[10] The mechanisms through which enoxaparin might have an effect during pregnancy are unclear. METHODS: Forty patients who had had term pregnancies and live births and histories of habitual abortion were recruited for this study. Comparison of the enoxaparin and control groups showed that there were no significant differences in terms of surface area and ratios of placental components. CONCLUSIONS: This study demonstrates that enoxaparin did not show any significant effect on the placental structure of cases that had histories of habitual abortion
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