A new discovery into the cause of repeated miscarriages will help many women to become mothers at last.
by Judy Siegel-Itzkovich
There may be nothing more heartbreaking and frustrating to a woman yearning to be a mother than to get pregnant and then miscarry months or even weeks before the scheduled delivery. For some one to two percent of women who become pregnant, this happens more than once, and for two-thirds of these cases, doctors are unable to give an explanation - or a cure.
But now there is new hope. Professor Benjamin Brenner, head of the thrombosis unit at Rambam Hospital in Haifa, has found a way to help three-quarters of the women suffering from repeated miscarriage. During the past three years, he and his colleagues have undertaken pioneering work in this area, and have discovered that thrombophilia - too much clotting of the blood - in pregnant women causes most of the unexplained miscarriages.
Brenner explains that the tendency for the blood to coagulate too easily can deprive the fetus of adequate nutrition and oxygen, which normally passes from the mother via the placenta into the uterus. This condition can cause the death of the fetus in the first, second or even third trimester of pregnancy. Consequently, he advises that women suffering from recurrent miscarriages should undergo blood tests to see whether there is a blood-clotting problem. If so, all the woman must do is give herself a daily, low-dose injection of the anticoagulant drug, enoxaparin.
Professor Brenner's latest clinical study involved a group of women who suffered repeated miscarriages. Of 193 untreated women who became pregnant, only 38 (one in five) managed to deliver a live baby. However, after being diagnosed and undergoing the anticoagulant treatment, 46 out of 61 (75%) of the women who became pregnant delivered live babies.
Seventeen hospitals around the country are now conducting studies to find the optimal dose for the drug, but the low dose already given to the women has no side effects. There are anticoagulants in pill form, but these would allow the drugs to pass through the placenta and affect the baby; the injection of enoxaparin does not.
While injecting the drug at home may be difficult and uncomfortable for some women, Brenner says that in the many years of treating women who have undergone repeated miscarriages, he cannot recall anyone who refused the injections in order to save her baby. One woman he has treated successfully recently had a baby after enduring 14 miscarriages.
Brenner's latest study will be published in the May issue of the British medical journal Thrombosis Haemostasis. As a result of his findings, the preventive anticoagulant therapy has already become standard in Israeli hospitals, and is being adopted in Europe and other countries abroad.