***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The prospect i ve evaluation of the effect of thromboprophylaxis in women with one unexplained pregnancy loss from the 10th week of amenorrhea was performed . A total of 160 patients with heterozygous factor V Leiden mutation , prothrombin G20210A mutation , or protein S deficiency were given 5 mg folic acid daily before conception , to be continued during pregnancy , and low-dose aspirin 100 mg daily or low-molecular-weight heparin enoxaparin 40 mg was taken from the 8th week . Twenty-three of the 80 patients treated with low-dose aspirin and 69 of the 80 patients treated with enoxaparin had a healthy live birth ( odds ratio [ OR ] , 15.5 ; 95 % confidence interval [ CI ] , 7 - 34 , P < .0001 ) . Enoxaparin was superior to low-dose aspirin in each subgroup defined according to the underlying constitutional thrombophilic disorder . An associated protein Z deficiency and /or positive antiprotein Z antibodies were associated with poorer outcomes . The neonate weight was higher in the women successfully treated with enoxaparin , and neonates small for gestational age were more frequent in patients treated with low-dose aspirin . No significant side effects of the treatments could be evidence d in patients or newborns . As there is no argument to prove that low-dose aspirin may have been deleterious , these results support enoxaparin use during such at-risk pregnancies Objective To compare the use of enoxaparin alone with combination therapy of prednisone , aspirin and progesterone in the treatment of women with idiopathic recurrent miscarriage ( IRM ) in terms of live births and pregnancy outcome . Methods A prospect i ve , r and omized , single-blinded , placebo-controlled trial was conducted at a tertiary referral obstetric hospital . The participants were 170 women with a diagnosis of IRM . Women were recruited after full investigative screening . Women with ≥3 fetal losses and after exclusion of all known causes of recurrent miscarriage were r and omly allocated to receive either enoxaparin alone , combination treatment consisting of prednisone , aspirin , and progesterone or placebo . Rates of live births , antenatal complications , delivery and neonatal outcomes were recorded prospect ively . Data were statistically analyzed as appropriate . Results Ten patients were dropped out after r and om assignment . Eighty-one percent of the enoxaparin ( 46/57 ) group and 85 % of the combination-treated group ( 45/53 ) were delivered of live infants compared to 48 % ( 24/50 ) of the placebo ( P < 0.05 ) . Women who were treated with combination therapy had a 4.2 % higher live birth rate  than enoxaparin group . This difference was not significant . Miscarriage rates were significantly lower in the treated groups compared with placebo ( P < 0.05 ) . There were no significant differences in late obstetric complications or neonatal mortality between groups . Conclusions A combination treatment consisting of high-dose , low- duration prednisone , progesterone and aspirin might be an effective treatment as enoxaparin alone . Both regimens were associated with a good pregnancy outcome OBJECTIVE The purpose of this study was to compare the use of low-dose aspirin alone with heparin and low-dose aspirin in the treatment of the antiphospholipid antibody syndrome . STUDY DESIGN A prospect i ve , single-center trial included 50 patients who were alternately assigned to treatment . Each patient had at least three consecutive spontaneous pregnancy losses , positive antiphospholipid antibodies on two occasions , and a complete evaluation . Data were compared by chi(2 ) analysis and Fisher 's exact test . RESULTS Viable infants were delivered of 11 of 25 ( 44 % ) women treated with aspirin and 20 of 25 ( 80 % ) women treated with heparin and aspirin ( p < 0.05 ) . There were no significant differences between the low-dose aspirin and the heparin plus low-dose aspirin groups with respect to gestational age at delivery ( 37.8 + /- 2.1 vs 37.2 + /- 3.4 weeks ) , number of cesarean sections ( 18 % vs 20 % ) , or complications . CONCLUSION Heparin plus low-dose aspirin provides a significantly better pregnancy outcome than low-dose aspirin alone does for antiphospholipid antibody-associated recurrent pregnancy loss The aim of this r and omised controlled trial was to compare efficacy and safety of two doses of low molecular weight heparin ( enoxaparin ) in pregnant women with a history of recurrent abortion secondary to antiphospholipid syndrome . A total of 60 women with a minimum of three consecutive abortions before 10 weeks ' gestation and positive lupus anticoagulant and /or anticardiolipin antibodies on at least two occasions at least 12 weeks apart were r and omised into two groups based on computer generated r and omisation list concealed in opaque envelopes . Pregnant women were treated with enoxaparin 40 mg plus low dose aspirin ( LDA ) ( n = 30 ) or enoxaparin 20 mg plus LDA ( n = 30 ) . The live birth rate was 76.67 % in enoxaparin 40 mg group and 70 % in enoxaparin 20 mg group ( p value = 0.559 ) . There were no significant differences between both groups with respect to neonatal outcome , obstetric and maternal complications during pregnancy or puerperium . No cases of severe bleeding , thrombocytopenia or spontaneous fractures were reported in both groups OBJECTIVE The purpose of this study was to conduct pilot studies for large r and omized controlled trials to compare low-molecular-weight heparin with placebo for antenatal thromboprophylaxis ( trial 1 ) , and for thromboprophylaxis after cesarean delivery ( trial 2 ) . STUDY DESIGN Multicenter r and omized controlled trials ( trial 1 , 23 units ; trial 2 , 8 units ) were conducted . Pregnant women at increased risk for thromboembolic disease were eligible for trial 1 ; women who underwent cesarean delivery were eligible for trial 2 . The interventions were once daily injections of low-molecular-weight heparin or placebo . Primary outcomes were as follows : trial 1 , confirmed symptomatic thromboembolic events and symptomatic osteoporotic fractures ; trial 2 , confirmed symptomatic thromboembolic events and wound complications . RESULTS Sixteen women were recruited for trial 1 ; 1 woman in the placebo group had a symptomatic thromboembolic event .  One hundred forty-one women were recruited for trial 2 ; 1 woman in the low molecular weight heparin group had a symptomatic thromboembolic event . CONCLUSION Poor recruitment indicates that large-scale trials using these design s would be difficult . Collection of data on the number of women that are eligible and the reasons for nonrecruitment in future trials of these interventions would allow a better underst and ing of the reasons for poor recruitment Recurrent miscarriage affects 1 - 2 % of women . In more than half of all recurrent miscarriage the cause still remains uncertain . Thrombophilia has been identified in about 50 % of women with recurrent miscarriage and thromboprophylaxis has been suggested as an option of treatment . A r and omised double-blind ( for aspirin ) multicentre trial was performed among 207 women with three or more consecutive first trimester ( < 13 weeks ) miscarriages , two or more second trimester ( 13 - 24 weeks ) miscarriages or one third trimester fetal loss combined with one first trimester miscarriage . Women were analysed for thrombophilia . After complete work-up , women were r and omly allocated before seven weeks ' gestation to either enoxaparin 40 mg and placebo ( n=68 ) , enoxaparin 40 mg and aspirin 100 mg ( n=63 ) or aspirin 100 mg ( n=76 ) . The primary outcome was live-birth rate . Secondary outcomes were pregnancy complications , neonatal outcome and adverse effects . The trial was ended prematurely because of slow recruitment . A live birth rate of 71 % [ relative risk ( RR ) 1.17 , 95 % confidence interval ( CI ) 0.92 - 1.48 ] was found for enoxaparin and placebo and 65 % [ RR 1.08 , 95 % CI 0.83 - 1.39 ] for enoxaparin and aspirin when compared to aspirin alone ( 61 % , reference group ) . In the whole study group the live birth rate was 65 % ( 95 % CI 58.66 - 71.74 ) for women with three or more miscarriages ( n=204 ) . No difference in pregnancy complications , neonatal outcome or adverse effects was observed . No significant difference in live birth rate was found with enoxaparin treatment versus aspirin or a combination of both versus aspirin in women with recurrent miscarriage Background Introduction : Recently , thrombophilia ( acquired and inherited ) has been implicated in recurrent IVF – ET failure . The objective of this study was to determine the effect and safety of thromboprophylaxis using low-molecular-weight heparin ( LMWH ) in women with recurrent in vitro fertilization (IVF)–embryo transfer ( ET ) failure and thrombophilia . Methods : Eighty-three women with history of three or more previous IVF failures and who had at least one thrombophilic defect were eligible for this study . Patients were r and omly allocated into two groups : Group A ( n = 42 ) received enoxaparin 40 mg/day , and group B ( n = 41 ) received placebo ( NaCl 0.9 % ) . Both treatments started on the day of ET and continued until delivery or foetal demise was diagnosed . The primary outcomes were the implantation , pregnancy and live birth rates . Results : Patients who received LMWH for thromboprophylaxis had a significant increase in the implantation and pregnancy rates compared with the placebo group ( 20.9 % vs. 6.1 % and 31 % vs. 9.6 % , respectively ; p < 0.001 and p < 0.05 , respectively ) . A significant increase in the live birth rate was observed in the heparin-treated group compared with placebo ( 23.8 % vs. 2.8 % , respectively ; p < 0.05 ) . The abortion rate was significantly higher in the placebo-treated group compared to the heparin-treated group ( p < 0.05 ) . The frequency of treatment complications did not differ between the two study groups . Conclusions : LMWH is a safe and effective thromboprophylactic treatment for women with thrombophilia and recurrent IVF – ET failures . The implantation rate , pregnancy and live birth rates are significantly increased with such treatment Abstract Objective : To determine whether treatment with low dose aspirin and heparin leads to a higher rate of live births than that achieved with low dose aspirin alone in women with a history of recurrent miscarriage associated with phospholipid antibodies ( or antiphospholipid antibodies ) , lupus anticoagulant , and cardiolipin antibodies ( or anticardiolipin antibodies ) . Design : R and omised controlled trial . Setting : Specialist clinic for recurrent miscarriages . Subjects : 90 women ( median age 33 ( range 22 - 43 ) ) with a history of recurrent miscarriage ( median number 4 ( range 3 - 15 ) ) and persistently positive results for phospholipid antibodies . Intervention : Either low dose aspirin ( 75 mg daily ) or low dose aspirin and 5000 U of unfractionated heparin subcutaneously 12 hourly . All women started treatment with low dose aspirin when they had a positive urine pregnancy test . Women were r and omly allocated an intervention when fetal heart activity was seen on ultrasonography . Treatment was stopped at the time of miscarriage or at 34 weeks ' gestation . Main outcome measures : Rate of live births with the two treatments . Results : There was no significant difference in the two groups in age or the number and gestation of previous miscarriages . The rate of live births with low dose aspirin and heparin was 71 % ( 32/45 pregnancies ) and 42 % ( 19/45 pregnancies ) with low dose aspirin alone ( odds ratio 3.37 ( 95 % confidence interval 1.40 to 8.10 ) ) . More than 90 % of miscarriages occurred in the first trimester . There was no difference in outcome between the two treatments in pregnancies that advanced beyond 13 weeks ' gestation . Twelve of the 51 successful pregnancies ( 24 % ) were delivered before 37 weeks ' gestation . Women r and omly allocated aspirin and heparin had a median decrease in lumbar spine bone density of 5.4 % ( range -8.6 % to 1.7 % ) . Conclusion : Treatment with aspirin and heparin leads to a significantly higher rate of live births in women with a history of recurrent miscarriage associated with phospholipid antibodies than that achieved with aspirin alone . Key messages The prognosis for pregnancies in women with recurrent miscarriage associated with phospholipid antibodies is poor 
    Output:
    
At present , the use of  LMWH  in women with inherited thrombophilia with recurrent pregnancy loss is not indicated .