الفهرس 
Aim of the WorkOnly 14 pages are availabe for public view
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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.