Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. Thrombophilic dimension of recurrent fetal loss in Indian patients Sonal Vora, Shrimati Shetty and Kanjaksha Ghosh We studied the prevalence of acquired and genetic thrombophilia in 198 women with recurrent fetal loss who were having three or more than three abortions. Seventy- nine women had only early pregnancy losses, that is, first trimester abortions, 30 women had only late pregnancy losses, that is, second and third trimester abortions whereas 89 had both early and late pregnancy losses. The control group included 100 age-matched fertile parous women who did not have any obstetric complications and had at least one normal healthy child. Several genetic and acquired thrombophilia markers were studied. The strongest association was observed with anticardiolipin (odds ratio 22.6, confidence interval 5.7 – 89, P U 0) followed by lupus anticoagulant, anti-b2 glycoprotein-1, antiannexin. Association of antiphospholipid antibody syndromes was detected with the time of pregnancy loss in anticardiolipin, lupus anticoagulants, which was significantly associated with early pregnancy loss as compared with second and third trimester loss. In case of b2 glycoprotein-1, antiannexin it was less significantly associated with early pregnancy loss as compared with second and third trimester loss. The risk of fetal loss with protein S deficiency was the highest risk observed for any heritable thrombophilia, followed by protein C, factor V Leiden, endothelial protein C receptor, antithrombin III deficiency and b448 fibrinogen polymorphism. Modest risks were also observed with 5,10-methylenetetrahydrofolate reductase, plasminogen activator inhibitor 4G/4G polymorphisms and b448 fibrinogen polymorphism. A combination of two or more than two genetic risk factors were observed in 55 (27.7%), whereas the genetic and acquired risk factors were observed in 107 (54%) of the cases. Thrombophilia is an important contributing factor for both early and late pregnancy losses; approximately two-thirds of our cases of unexplained fetal losses could be explained by acquired or heritable thrombophilia or both, which is in line with other western studies. Blood Coagul Fibrinolysis 19:581– 584 ß 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins. Blood Coagulation and Fibrinolysis 2008, 19:581–584 Keywords: antiphospholipid antibodies, inherited thrombophilia, recurrent spontaneous abortion National Institute of Immunohaematology (ICMR), KEM Hospital, Parel, Mumbai, India Correspondence to Dr Kanjaksha Ghosh, MD, MRCP, MRCPI, FRC Path Director, National Institute of Immunohaematology (ICMR) KEM Hospital, Parel, Mumbai 400012, India Tel: +91 22 24138518 19; fax: +91 22 24138521; e-mail: kanjakshaghosh@hotmail.com Received 22 August 2007 Revised 23 April 2008 Accepted 30 April 2008 Introduction Pregnancy loss is one of the leading problems in women’s health issues, that is, 9–13% of women in the reproductive age group are reported to have one clinically recognized fetal loss, 5% experience two or more losses whereas 1–2% suffer three or more losses [1–3]. Up to 50% of these cases remain unexplained after the standard investigations for habitual fetal losses, which include the gynecological, hormonal and karyotypic analyses. Thrombophilia, both acquired and genetic, that is, the principal risk factors for maternal thromboembolism have been implicated for increased susceptibility to adverse pregnancy outcomes such as fetal loss, recurrent spontaneous abortions (RSAs), abruptio placentae, intrauterine growth retardation (IUGR) and preeclampsia [4,5]. There is no comprehensive data on the prevalence of both acquired and genetic risk factors in cases of unex- plained fetal loss from India. Material and methods Patients Among the 198 patients tested, 79 had only early pregnancy loss (EPL), 30 had late pregnancy loss (LPL) whereas 89 patients had both EPL and LPL. Patients were included in the study only if theconventional etiological factors were found to be normal. If the patients presented immediately after abortion, the samples were collected at least 4 months after the abortion. If the patients were pregnant at the time of presentation the tests for protein C (PC), protein S (PS) and antithrombin (AT) III were repeated again 4 months after delivery and only the confirmed postdelivery results were considered. PC and PS were both measured to rule out low activity of these proteins in the presence of antiphospholipid antibodies. Controls One hundred age-matched normal healthy women who had at least one normal healthy child and did not have any Original article 581 0957-5235 ß 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins