الفهرس | Only 14 pages are availabe for public view |
Abstract Recurrent pregnancy loss (RPL) is defined as the loss of two or more consecutive miscarriages before 20 weeks gestation. Polycystic ovary syndrome (PCOS) is a common endocrine disorder in females, especially in those of reproductive age. PCOS diagnosed according to Rotterdam criteria the sho if two out of three criteria are met: the presence of: Clinical or biochemical features of hyperandrogenism. Oligo-ovulation or anovulation (i.e. menstrual cycle disturbance). Polycystic ovaries on ultrasound. Elevated homocysteine may occur in cases of dietary or genetic vitamin deficiency, or diminished enzyme activities. Hyperhomocysteinemia is a common finding in women with PCOS and was found to be associated with both RPL. Recent evidence suggests a causal association between HHcy and RPL and mild-to-moderate degree of HHcy leads to a 3-fold increase in the risk of early pregnancy loss. On the other hand, obesity and IR have been implicated as individual risk factors for RPL, while HHcy, IR, and obesity are very common associates of PCOS. Hyperhomocysteinemia has been suggested to augment hypercoagulable state of pregnancy, and thrombosis in maternal and fetal circulations, it lead to abnormality of placental vasculature and disturbances in homeostasis and inadequate fetal circulation and linked with adverse pregnancy outcome. It was shown that combined treatment with aspirin and low molecular weight heparin (LMWH) in women with hyperhomocysteinemia improved successful pregnancy rates. This study was designed to evaluate prophylactic measures against early recurrent pregnancy loss in women with polycystic ovary syndrome and hyperhomocysteinemia by administration of folic acid 5 milligram/day, low dose asprin 81mg/day, LMWH 40mg/day as a single agent or in combination. This study included 60 women diagnosed as RPL and PCO, selected from the outpatient Obstetrics & Gynecology clinics of Menoufia University hospitals and Basion central hospital. Patients divided into 3 groups including: group 1: Includes 20 patients with PCOS, hyperhomocysteinemia and a history of early recurrent abortion, treated with folic acid 5mg /day and low dose asprin 81mg/day until 20 weeks of pregnancy, group 2: Includes 20 patients with PCOS, hyperhomocysteinemia and a history of early recurrent abortion, treated with folic acid 5mg/day and LMWH 40mg/day until 20 weeks of pregnancy and group 3: Includes 20 patients with PCOS, hyperhomocysteinemia and a history of early recurrent abortion treated with LDA 81mg/day, LMWH 40mg/day and folic acid 5mg/day until 20 weeks of pregnancy. All patients included in this study were subjected to full history taking about personal history, present history, Husband history, Past history including medical diseases, abdominal surgeries, drug therapy or allergy, Menstrual history, General & local clinical examination, measurement of serum homocysteine by ELISA– FSH- LH- testosterone. Finally, using folic acid 5 mg/ day, LDA 81mg/ day and LMWH 40mg/day to evaluate the effect in prophylaxis against early recurrent pregnancy loss in women with polycystic ovary syndrome and hyperhomocysteinemia and Follow up by ANC every 2 week. |