Evaluation of perinatal outcomes in patients with recurrent pregnancy losses

OBJECTIVES: This study aimed to evaluate the incidence of thrombophilia in women with recurrent miscarriage (RM) and assess its impact on pregnancy outcomes. MATERIAL AND METHODS: A prospective study was conducted from 2021 to 2023 at the Fryderyk Chopin University Clinical Hospital in Rzeszow, Poland. Forty women with at least two pregnancy losses were enrolled. Laboratory tests assessed genetic and acquired thrombophilias, including Factor V Leiden, prothrombin G20210A, protein C/S, antithrombin III, MTHFR mutations, homocysteine, and antiphospholipid antibodies. Pregnancy outcomes were compared in patients receiving LMWH versus those without anticoagulant therapy. Statistical analysis employed Mann-Whitney U and McNemar chi-square tests, with significance set at p < 0.05. RESULTS: Congenital thrombophilia was found in 17.5% and acquired thrombophilia in 10% of participants, with Factor V Leiden present in 12.5% and antiphospholipid syndrome in 10%. No significant differences were observed in miscarriage or birth rates between women with and without thrombophilia. However, anticoagulation strongly influenced outcomes: 95% of miscarriages occurred without LMWH, while 52.5% of women receiving LMWH achieved live births (χ² = 14.09; p < 0.001). The combined use of LMWH and low-dose aspirin (ASA) showed the highest success rate, with 47.2% of treated pregnancies resulting in full-term deliveries. CONCLUSIONS: Thrombophilia alone did not significantly increase miscarriage risk, but LMWH therapy markedly improved perinatal outcomes in women with RM, regardless of thrombophilia status. These findings support the potential role of anticoagulant therapy in selected patients to enhance live birth rates.