{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T15:27:03Z","timestamp":1784042823254,"version":"3.55.0"},"reference-count":23,"publisher":"S.C. JURNALUL PENTRU MEDICINA SI VIATA S.R.L","issue":"1","license":[{"start":{"date-parts":[[2023,1,1]],"date-time":"2023-01-01T00:00:00Z","timestamp":1672531200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMedLife"],"abstract":"<jats:p>Miscarriage in the first and second trimesters of pregnancy is very common, and coagulopathy can be a contributing factor. Protein C and S deficiency are rare, inherited disorders that can increase the risk of thrombophilia. Women with these deficiencies have a higher risk of developing blood clots in the placenta, which can lead to placental insufficiency and, ultimately, to a miscarriage. We aimed to compare the levels of protein C and protein S in pregnant females with recurrent first and second-trimester pregnancy loss and normal pregnant females. We performed a detailed history, examination, and various lab tests on a cohort of 40 females with a history of recurrent first and second-trimester abortions visiting an outpatient clinic at a multi-specialty hospital in Kashmir, India. All the findings were compared with 40 women with normal pregnancies. 10% of the participants had low protein C and S levels (P=0.277), out of whom 75% (p&lt;0.001) had intrauterine growth retardation (IUGR) on ultrasound with 67% (p&lt;0.001) having reduced doppler flow in the umbilical artery. 0.05% of participants had isolated protein S deficiency with no concomitant IUGR seen. Patients with protein C and S deficiencies were treated with heparin and progesterone and followed up for pregnancy outcomes. Screening for protein C and S deficiency is mandatory in all cases of recurrent pregnancy loss. Treatment with low molecular weight heparin and progesterone should be initiated to ensure good fetal outcomes and prevent post-partum\/postoperative catastrophic venous thromboembolism events.<\/jats:p>","DOI":"10.25122\/jml-2022-0267","type":"journal-article","created":{"date-parts":[[2023,5,8]],"date-time":"2023-05-08T05:58:17Z","timestamp":1683525497000},"page":"160-166","source":"Crossref","is-referenced-by-count":16,"title":["Investigating protein C and S levels in pregnant women with recurrent early pregnancy loss versus normal pregnancy"],"prefix":"10.25122","volume":"16","author":[{"given":"Beenish","family":"Mukhtar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Department of Physiology, Santosh Deemed to be University, Ghaziabad, India","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Department of Physiology, College of Medicine, Dar Al Uloom University, Riyadh, Kingdom of Saudi Arabia","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"* Corresponding Author: Beenish Mukhtar, Department of Physiology, College of Medicine, Dar Al Uloom University, Riyadh, Kingdom of Saudi Arabia. E-mail: drbeenishshah@yahoo.com","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rinku","family":"Garg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Department of Physiology, Santosh Deemed to be University, Ghaziabad, India","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Department of Physiology, School of Medical Sciences and Research, Sharda University, Greater Noida, India","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guru","family":"Ibrahim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Department of Gynaecology and Obstetrics, Guru Multi Speciality Hospital, Kashmir, India","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jyoti","family":"Batra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Department of Biochemistry, Santosh Deemed to be University, Ghaziabad, India","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10755","published-online":{"date-parts":[[2023,1]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","unstructured":"1. Esmon C, Vigano D, Angelo S, Dangelo A, Comp P. Anticoagulation proteins C and S. Advanced Exp Med Biol. 1987;214:47-54. doi:10.1007\/978-1-4757-5985-3_4","DOI":"10.1007\/978-1-4757-5985-3_4"},{"key":"ref2","unstructured":"2. Alshammary H, Almosawi H, Hadi F. Deficiency of Protein C and Protein S in Recurrent Pregnancy Loss. Medical Journal of Babylon. 2015;12(2):348-356"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"3. Rosenberg R, Rosenberg J. Natural anticoagulant mechanisms. Journal of Clinnical Investigation. 1984;74(1):1-6. DOI: 10.1172\/JCI111389","DOI":"10.1172\/JCI111389"},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"4. Lalan DM, Jassawalla MJ, Bhalerao SA. Successful pregnancy outcome in a case of protein s deficiency. J Obstet Gynaecol India. 2012 Dec;62(Suppl 1):21-2. doi: 10.1007\/s13224-013-0363-9","DOI":"10.1007\/s13224-013-0363-9"},{"key":"ref5","doi-asserted-by":"crossref","unstructured":"5. Chaudhari H, Shah P, Pai K, DSouza N. Combined protein C and protein S deficiency with pregnancy. International Journal of Reprod Contracept Obstet and Gynaecol. Jul 2016;5(7):2450-2452 DOI: https:\/\/dx.doi. org\/10.18203\/2320-1770.ijrcog20162148","DOI":"10.18203\/2320-1770.ijrcog20162148"},{"key":"ref6","doi-asserted-by":"crossref","unstructured":"6. Warwick R, Hutton R, Goff L, Letsky E, Heard M. Changes in protein C and free protein S during pregnancy and following hysterectomy. Journal of Royal Society of Medicine. 1989;82(10):591-594. DOI: 10.1177\/014107688908201008","DOI":"10.1177\/014107688908201008"},{"key":"ref7","unstructured":"7. Vora S, Shetty S, Salvi V, Satoskar P, Ghosh K. Thrombophilia and unexplained pregnancy loss in Indian patients. Natl Med J India. 2008 May-Jun;21(3):116-9."},{"key":"ref8","doi-asserted-by":"crossref","unstructured":"8. Fu M, Liu J, Xing J, Dai Y,et al.Reference intervals for coagulation parameters in non-pregnant and pregnant women. Scientific Reports. 2022;12:1519. DOI: 10.1038\/s41598-022-05429-y","DOI":"10.1038\/s41598-022-05429-y"},{"key":"ref9","unstructured":"9. Stancu S, Poalelungi C, Carabas B, Rusu M. Umbilical cord thrombosis: a meticulous culprit of intrauterine fetal demise. EJPMR. 2016,3(11):152-158"},{"key":"ref10","doi-asserted-by":"crossref","unstructured":"10. Klaritsch P, Haeusler M, Karpf E, Schlembach D, Lang U. Spontaneous intrauterine umbilical artery thrombosis leading to severe fetal growth restriction. Placenta. 2008 Apr;29(4):374-7. doi: 10.1016\/j.placenta.2008.01.004","DOI":"10.1016\/j.placenta.2008.01.004"},{"key":"ref11","unstructured":"11. Franklin DK. Hypertensive Disorders of Pregnancy: Prevalence, Maternal Complications and Perinatal Outcomes at Lilongwe Central Hospital, Malawi. Department of General Practice and Community Medicine Faculty of Medicine, University of Oslo, Norway, 2004."},{"key":"ref12","doi-asserted-by":"crossref","unstructured":"12. Jyotsna PL, Sharma S, Trivedi SS. Coagulation inhibitors and activated protein C resistance in recurrent pregnancy losses in Indian women. Indian J Pathol Microbiol. 2011 Oct-Dec;54(4):752-5. doi: 10.4103\/0377-4929.91507","DOI":"10.4103\/0377-4929.91507"},{"key":"ref13","doi-asserted-by":"crossref","unstructured":"13. Vora S, Ghosh K, Shetty S, Salvi V, Satoskar P. Deep venous thrombosis in the antenatal period in a large cohort of pregnancies from western India. Thromb J. 2007 Jul 4;5:9. doi: 10.1186\/1477-9560-5-9","DOI":"10.1186\/1477-9560-5-9"},{"key":"ref14","doi-asserted-by":"crossref","unstructured":"14. McNamee K, Dawood F, Farquharson RG. Thrombophilia and early pregnancy loss. Best Pract Res Clin Obstet Gynaecol. 2012 Feb;26(1):91-102. doi: 10.1016\/j.bpobgyn.2011.10.002","DOI":"10.1016\/j.bpobgyn.2011.10.002"},{"key":"ref15","doi-asserted-by":"crossref","unstructured":"15. Tulppala M, Marttunen M, S\u00f6derstrom-Anttila V, Foudila T,et al.Low-dose aspirin in prevention of miscarriage in women with unexplained or autoimmune related recurrent miscarriage: effect on prostacyclin and thromboxane A2 production. Hum Reprod. 1997 Jul;12(7):1567-72. doi: 10.1093\/humrep\/12.7.1567.","DOI":"10.1093\/humrep\/12.7.1567"},{"key":"ref16","doi-asserted-by":"crossref","unstructured":"16. Pattison NS, Chamley LW, Birdsall M, Zanderigo AM,et al.Does aspirin have a role in improving pregnancy outcome for women with the antiphospholipid syndrome? A randomized controlled trial. Am J Obstet Gynecol. 2000;183:1008\u20131012. DOI: 10.1067\/mob.2000.106754","DOI":"10.1067\/mob.2000.106754"},{"key":"ref17","doi-asserted-by":"crossref","unstructured":"17. Hirahara F, Andoh N, Sawai K, Hirabuki T,et al.Hyperprolactinemic recurrent miscarriage and results of randomized bromocriptine treatment trials. Fertil Steril 1998;70:246-52. DOI: 10.1016\/s0015-0282(98)00164-2","DOI":"10.1016\/S0015-0282(98)00164-2"},{"key":"ref18","doi-asserted-by":"crossref","unstructured":"18. Raghupathy R, Al Mutawa E, Makhseed M, Azizieh F, Szekeres-Bartho J. Modulation of cytokine production by dydrogesterone in lymphocytes from women with recurrent miscarriage. BJOG. 2005;112:1096-101. DOI: 10.1111\/j.1471-0528.2005.00633.x","DOI":"10.1111\/j.1471-0528.2005.00633.x"},{"key":"ref19","doi-asserted-by":"crossref","unstructured":"19. Kaandorp S, Di Nisio M, Goddijn M, Middeldorp S. Aspirin or anticoagulants for treating recurrent miscarriage in women without antiphospholipid syndrome. Cochrane Database Syst Rev. 2009;1:CD004734. DOI: 10.1002\/14651858.CD004734.pub3","DOI":"10.1002\/14651858.CD004734.pub3"},{"key":"ref20","doi-asserted-by":"crossref","unstructured":"20. Mavragani CP, Ioannidis JP, Tzioufas AG, Hantoumi IE, Moutsopoulos HM. Recurrent Pregnancy Loss and Autoantibody Profile in Autoimmune Diseases. Rheumatol (Ox). 1999;38:1228\u201333. DOI: 10.1093\/rheumatology\/38.12.1228","DOI":"10.1093\/rheumatology\/38.12.1228"},{"key":"ref21","doi-asserted-by":"crossref","unstructured":"21. Ticconi C, Pietropolli A, Borelli B, Bruno V,et al.Antinuclear Autoantibodies and Pregnancy Outcome in Women With Unexplained Recurrent Miscarriage. Am J Reprod Immunol. 2016;76:396\u2013 99. DOI: 10.1111\/aji.12560","DOI":"10.1111\/aji.12560"},{"key":"ref22","doi-asserted-by":"crossref","unstructured":"22. Mekaj Y,Lulaj S, Daci F, Rafuna N,et al.Prevalence and role of antithrombin III, protein C and protein S deficiencies and activated protein C resistance in Kosovo women with recurrent pregnancy loss during first trimester of pregnancy. J Hum Reprod Sci. 2015;8(4):224-9. DOI: 10.4103\/0974-1208.170407","DOI":"10.4103\/0974-1208.170407"},{"key":"ref23","doi-asserted-by":"crossref","unstructured":"23. Lindhoff-Last E. Maternal thrombophilia and obstetric complications. J Lab Med 2004;28(1):34\u201341. https:\/\/doi.org\/10.1515\/LabMed.2004.009","DOI":"10.1515\/LabMed.2004.009"}],"container-title":["Journal of Medicine and Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/medandlife.org\/wp-content\/uploads\/23.-jml-2022-0267.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,19]],"date-time":"2024-10-19T23:15:27Z","timestamp":1729379727000},"score":1,"resource":{"primary":{"URL":"https:\/\/medandlife.org\/wp-content\/uploads\/23.-jml-2022-0267.pdf"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1]]},"references-count":23,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2023,1]]}},"alternative-id":["JMedLife-16-160"],"URL":"https:\/\/doi.org\/10.25122\/jml-2022-0267","relation":{},"ISSN":["1844-122X","1844-3117"],"issn-type":[{"value":"1844-122X","type":"print"},{"value":"1844-3117","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1]]}}}