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DOI: 10.1177/107602969500100408 Fetal Wastage Syndrome due to Blood Protein/Platelet Defects: Results of Prevalence Studies and Treatment Outcome with Low-Dose Heparin and Low-Dose AspirinDepartments of Medicine (Hematology & Oncology), Presbyterian Hospital of Dallas and University of Texas Southwestern Medical Center
Department of Hematopathology, Presbyterian Hospital of Dallas and University of Texas Southwestern Medical Center
Department of Reproductive Endocrinology, Medical City Hospital, Dallas, Texas, U.S.A.
Department of Obstetrics/Gynecology, Presbyterian Hospital of Dallas and University of Texas Southwestern Medical Center
Department of Obstetrics/Gynecology, Presbyterian Hospital of Dallas and University of Texas Southwestern Medical Center
Department of Obstetrics/Gynecology, Presbyterian Hospital of Dallas and University of Texas Southwestern Medical Center
Fetal wastage syndrome is characterized by recurrent spontaneous abortion. Many syndromes are associated with recurrent fetal loss, including anatomical anomalies, endocrine/hormonal abnormalities, and coagulation defects, with coagulation defects accounting for
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30% of cases. Most procoagulant factor defects are due to inadequate fibrin-mediated implantation of the fertilized ovum into the decidua. However, blood protein/ platelet defects leading to hypercoagulability and thrombosis are associated with thrombosis of placental vessels, precluding viability of the implanted ovum or later fetus. During the past 2 years, we have seen 46 patients with fetal wastage syndrome due to thrombosis-associated hemostasis defects. In this group, there have been three patients with sticky platelet syndrome, one patient with dysfibrinogenemia, four patients with congenital protein S deficiency, 35 patients with anticardiolipin antibodies, and one patient with a lupus anticoagulant. Patients were started on one low-dose aspirin (ASA), 81 mg per day preconception, at time of diagnosis, and low-dose s.c. porcine heparin at 5,000 units every 12 h was added immediately postconception. The combination of low-dose ASA plus low-dose s.c. porcine heparin was used throughout pregnancy. All patients achieving pregnancy have had uneventful, normal deliveries. It appears that blood protein/platelet defects leading to thrombosis and associated with recurrent fetal loss can be successfully managed with the use of preconception low-dose ASA, followed by immediate postconception addition of fixed low-dose porcine heparin, both used throughout pregnancy. Using this regimen, our success rate has been 100%. Ideal heparin doses, which might be much lower than our empirically chosen and currently used doses, remain to be defined in this particular indication. Key Words: Fetal wastage syndrome—Heparin—Aspirin. 
