Thromboprophylaxis throughout pregnancy in women with previous history of recurrent miscarriages of unknown aetiology.

The purpose of this prospective preliminary clinical study was to assess the efficacy of thromboprophylaxis throughout pregnancy in women with a history of unexplained first trimester recurrent miscarriages. From the 53 patients originally assigned to the study 15 were excluded. The remaining 38 were treated with low molecular weight heparin (LMWH-natroparine calcium 0.3 ml twice daily) and low dose aspirin from the day the fetal heart motion was detected until the 37th week or earlier at the onset of premature labor. Among the patients treated (n = 38) thrombophilia screening was positive in 16 patients and in the remaining 22 no causative factor was detected. The overall success rate (viable pregnancy > or = 24 weeks) was 92.2% with no significant difference between patients with positive or negative thrombophilia screening. The most significant complications were: preeclampsia (21%), IUGR (26%), placenta abruptio (5.2%), injection site haematoma (44%) and skin reaction (15.7%). No abnormal bleeding was observed during vaginal or caesarean section. The results of this study suggest that thromboprophylaxis during pregnancy, which has already been successfully tried in patients with recurrent miscarriages with a causative factor, may be similarly effective in patients with such a pregnancy complication but of unknown aetiology.

Chlamydia trachomatis in infertile Greek women. A serologic and laparoscopic study.

This study investigates the prevalence of antichlamydial antibodies in infertile women, who underwent diagnostic laparoscopy. The patients were divided into two groups based on the presence or absence of damage of the fallopian tubes. Antichlamydial IgG antibodies were found in 22 of 27 (81.5%) infertile women with damaged fallopian tubes and 10 of 23 (43.5%) women with normal tubes. Mean geometric IgG titres for C. trachomatis were significantly higher in the patients with damaged tubes (187.4 vs. 39.39). C. trachomatis was not isolated from the peritoneal fluids. Only two chlamydial cultures of cervical specimens were positive, one in each group. These findings confirm that C. trachomatis may be a major cause of tubal damage with resultant infertility.

Chemotherapy for acute leukemia during pregnancy. Five case reports.

We summarize the cases of four women with acute myeloid leukemia (AML) and of one with acute lymphoid leukemia (ALL) presenting in the first, second and third trimester of pregnancy. Remission of AML was induced by doxorubicin, vincristine, and cytosine arabinoside. The ALL case was treated with vincristine and prednisone initially, and subsequently with vindesine for maintenance. Four patients entered a complete (3 AML and the ALL case), and one (AML) a partial remission. This patient was delivered of a normal, 3140 g, male infant by Caesarian section in the 38th gestational week and 1 month later she died of her disease. One patient (AML, promyelocytic type) who presented in the 10th week of pregnancy underwent elective abortion while in remission after induction treatment. The patient with ALL gave birth to a normal, full-term, male infant by Caesarian section. The two other patients (AML) had spontaneous deliveries of normal male infants in the 37th and 38th weeks of pregnancy. Growth and development of three of the children are normal at 12, 36, and 37 months of life while the fourth child was lost to follow-up evaluation. The disease relapsed in all mothers but they are still alive at 15 (ALL), 37, and 42 months after diagnosis. We feel that current chemotherapy could improve the high post-partum maternal mortality rate and the chance of producing live babies without excessive risk to the fetus or the mother, even if administered relatively early in the course of pregnancy.