Ambreen Anwer, Nilofar Mustafa, Rubina Mushtaq
Naeem Akhtar

Lt Col. AmbreenAnwer, Classified Gynaecologist, Military Hospital, Rawalpindi.

Objective: To compare the perinatal outcome of low dose Aspirin (LDA) alone and low dose Aspirin with Heparin in pregnancies with recurrent pregnancy loss (RPL) with or without positive antiphospholipid antibodies (aPL).
Study Design: Randomized controlled trial.
Setting: Departments of Obstetrics and Gynaecology Combined Military Hospital (CMH) Quetta, Lahore and Rawalpindi.
Duration of Study:30 April 2009 to 30 April 2011.
Methodology:60 women with recurrent pregnancy losses (RPL) fulfilling clinical criteria of antiphospholipid syndrome (APS) with or without aPL antibodies positive reporting to the antenatal clinic at the three hospitals were included. Convenience sampling was done and subjects were randomly allocated into groups A and B using random numbers table.
GroupA received low dose Aspirin(LDA)  75 mg once daily starting from first trimester and GroupB received unfractioned Heparin (UH) 5000IU SC BD or low molecular weight Heparin (LMWH) 40mg subcutaneous along with LDA .
Results: In group A 26(86.7%) and in group B 25(83.3%) live births were attained. Significant side-effects were observed in groupB including bruising and injection site pain. Cost of drug for treatment over 28 weeks in groupA was Rs 300 and in groupB was Rs 6300.
Conclusion: LDA alone have comparable perinatal outcomes with Heparin in cases of RPL, with an added benefit of no pain and bruising, low cost and more convenience of administration. 
Key Words: Intrauterine death, Recurrent miscarriage,Antiphospholipid Syndrome,Bad Obstetric History,Low dose aspirin, Low molecular weight heparin.