***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 It is common practice in many centers to offer antithrombotic medications to women with unexplained recurrent miscarriage , in the presence or absence of inherited thrombophilia . Although no benefit of aspirin vs placebo has been clearly demonstrated , a double-blind placebo-controlled trial on the effect of low-molecular-weight heparin is lacking . We enrolled 258 pregnant women with a history of unexplained recurrent miscarriage ( ≥2 consecutive miscarriages before 15 weeks ' gestation ) and a negative thrombophilia workup . They were r and omly assigned to receive one daily subcutaneous injection of enoxaparin 40 mg or placebo until 35 weeks ' gestation . We included 256 women ( mean age 32 years , ≥3 miscarriages : 72 % ; mean gestational age 39 days of amenorrhea ) in the intention-to-treat analysis ; 66.6 % of 138 who  received enoxaparin  had a live birth vs 72.9 % of 118 who received placebo . The absolute difference was -6 % ( 95 % CI , -17.1 to 5.1 ) , excluding a 10 % increase in the rate of live-birth  on enoxaparin ( P = .34 ) . In this first r and omized , double-blind , placebo-controlled trial , enoxaparin ( 40 mg once daily ) did not improve the chance of a live birth in nonthrombophilic women with unexplained recurrent miscarriage . This trial is registered at www . Clinical Trials.gov as # NCT00740545 and the French National Health and Drug Safety Agency ( EudraCT # 2006 - 003350 - 18 ) BACKGROUND Venous thrombosis is one of the leading causes of maternal morbidity and mortality . OBJECTIVE In the MEGA study , we evaluated pregnancy and the postpartum period as risk factors for venous thrombosis in 285 patients and 857 control subjects . PATIENTS / METHODS Between March 1999 and September 2004 , consecutive patients with a first episode of venous thrombosis were included from six anticoagulation clinics . Partners of patients and a r and om digit dialing group were included as control subjects . Participants completed a question naire and DNA was collected . RESULTS The risk of venous thrombosis was 5-fold ( OR , 4.6 ; 95 % CI , 2.7 - 7.8 ) increased during pregnancy and 60-fold ( OR , 60.1 ; 95 % CI , 26.5 - 135.9 ) increased during the first 3 months after delivery compared with non-pregnant women . A 14-fold increased risk of deep venous thrombosis of the leg was found compared with a 6-fold increased risk of pulmonary embolism . The risk was highest in the third trimester of pregnancy ( OR , 8.8 ; 95 % CI , 4.5 - 17.3 ) and during the first 6 weeks after delivery ( OR , 84.0 ; 95 % CI , 31.7 - 222.6 ) . The risk of pregnancy-associated venous thrombosis was 52-fold increased in factor V Leiden carriers ( OR , 52.2 ; 95 % CI , 12.4 - 219.5 ) and 31-fold increased in carriers of the prothrombin 20210A mutation ( OR , 30.7 ; 95 % CI , 4.6 - 203.6 ) compared with non-pregnant women without the mutation . CONCLUSION We found an increased risk of venous thrombosis during pregnancy and the postpartum period , with an especially high risk during the first 6 weeks postpartum . The risk of pregnancy-associated venous thrombosis was highly increased in carriers of factor V Leiden or the prothrombin 20210A mutation Background A large number of studies have shown an association between inherited thrombophilia and recurrent miscarriage . It has been hypothesized that anticoagulant therapy might reduce the number of miscarriages and stillbirth in these women . In the absence of r and omized controlled trials evaluating the efficacy of anticoagulant therapy in women with inherited thrombophilia and recurrent miscarriage , a r and omized trial with adequate power that addresses this question is needed . The objective of the ALIFE2 study is therefore to evaluate the efficacy of low-molecular-weight heparin ( LMWH ) in women with inherited thrombophilia and recurrent miscarriage , with live birth as the primary outcome . Methods / Design R and omized study of LMWH plus st and ard pregnancy surveillance versus st and ard pregnancy surveillance alone . Study population : pregnant women of less than 7 weeks ’ gestation , and confirmed inherited thrombophilia with a history of 2 or more miscarriages or intra-uterine fetal deaths , or both . Setting : multi-center study in centers from the Dutch Consortium of Fertility studies ; centers outside the Netherl and s are currently preparing to participate . Intervention : LMWH enoxaparin 40 mg subcutaneously once daily started prior to 7 weeks gestational age plus st and ard pregnancy surveillance or st and ard pregnancy surveillance alone . Main study parameters/endpoints : the primary efficacy outcome is live birth . Secondary efficacy outcomes include adverse pregnancy outcomes , such as miscarriage , pre-eclampsia , syndrome of hemolysis , elevated liver enzymes and low platelets ( HELLP syndrome ) , fetal growth restriction , placental abruption , premature delivery and congenital malformations . Safety outcomes include bleeding episodes , thrombocytopenia and skin reactions . Discussion After an initial period of slow recruitment , the recruitment rate for the study has increased . Improved awareness of the study and acknowledgement of the need for evidence are thought to be contributing to the improved recruitment rates . We aim to increase the number of recruiting centers in order to increase enrollment into the ALIFE2 study .The study website can be accessed via www . ALIFE2 study .org . Trial registration The ALIFE2 study was registered on 19 March 2012 under registration number 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 Administration of heparin in the secondary prevention of placental vascular complications is still experimental . In women with a previous placental abruption , we investigated the effectiveness of enoxaparin , a low-molecular-weight heparin , in preventing these complications . Between January 2000 and January 2009 , 160 women from the NOHA First cohort , with previous abruptio placentae but no foetal loss during their first pregnancy and negative for antiphospholipid antibodies , were r and omised to either a prophylactic daily dose of enoxaparin starting from the positive pregnancy test ( n=80 ) , or no enoxaparin ( n=80 ) . The primary outcome was a composite of at least one of the following : abruptio placentae , preeclampsia , birthweight < 5th percentile , or foetal loss after 20 weeks .  Enoxaparin was associated with a lower frequency of primary outcome : 12.5 % ( n=10/80 ) vs. 31.3 % ( 25/80 ) , p=0.004 , adjusted hazard ratio = 0.37 , 95 % confidence interval ( 0.18 - 0.77 ) , p=0.011 . Enoxaparin was safe , with no obvious side-effect , no thrombocytopenia nor major bleeding event excess . This pilot study shows that enoxaparin given early during the second pregnancy decreases the occurrence of placental vascular complications in women with a previous placental abruption during their first pregnancy OBJECTIVE To compare the effect of aspirin and enoxaparin on live births in women with unexplained recurrent miscarriages  , as well as secondary outcomes including birth weight , uterine and umbilical blood flows , and congenital malformations . DESIGN Multicenter r and omized comparative cohort study . SETTING Four centers including two university hospitals , a peripheral general hospital , and a community health clinic . PATIENT(S ) One hundred seven patients were r and omized , 104 were available for analysis ; 54 were r and omized to enoxaparin and 50 to aspirin .  INTERVENTION(S ) Treatment with enoxaparin or aspirin in subsequent pregnancy . MAIN OUTCOME MEASURE(S ) Subsequent live births or miscarriage , and the incidence of obstetric complications . RESULT ( S ) Both groups had a similar live birth rate ( relative risk = 0.92 , 95 % confidence interval : 0.58 - 1.46 ) . In primary aborters , live births occurred in 17 of 18 ( 94 % ) enoxaparin-treated pregnancies compared to 18 of 22 ( 81 % ) aspirin-treated pregnancies . In the aspirin group , two pregnancies were terminated : for tricuspid insufficiency and for hemolysis , elevated liver enzymes , low platelet ( HELLP ) syndrome . One enoxaparin-treated infant was growth restricted ( 2,020 g ) at 36 weeks . Preeclampsia was found in three aspirin-treated patients . Preterm delivery , placental Doppler blood flow , apgar scores , and mean birth weights were similar in both groups . In the aspirin group , one infant underwent orchidectomy after testicular torsion in utero , and one infant had hypoglycemia and convulsions . CONCLUSION ( S ) Both regimens were associated with a high live birth rate and few late pregnancy complications OBJECTIVE To determine whether low molecular weight heparin ( LMWH ) plus low-dose aspirin ( LDA ) is comparable in efficacy and safety to unfractionated heparin ( UFH ) plus LDA in the management of pregnant women with a history of recurrent spontaneous abortion secondary to antiphospholipid syndrome ( APS ) . METHODS In a r and omized prospect i ve study , 60 women with a history of 3 or more consecutive spontaneous abortions and positive antiphospholipid antibodies were assigned in equal numbers to receive either UFH ( 5000 units , twice daily ) plus LDA , or LMWH ( enox 
    Output:
    
Literature on the efficacy and safety of enoxaparin for thromboembolism and thromboprophylaxis remains scanty , and therefore efficacy was not assessed ; in terms of safety , when including other indications for enoxaparin in pregnancy , we found that enoxaparin was associated with significantly lower complications than aspirin .