Recurrent Pregnancy Loss -- Copyright -- Contents -- Series Foreword -- Contributors -- Preface to the First Edition -- 1 Obtaining the Relevant History -- Introduction -- Demographic data -- Parental Age -- BMI -- Lifestyle Factors -- Social Class -- Occupational Factors -- Partner -- Reproductive history -- Clinical Appearance of Pregnancy Losses -- Gestational Age of Pregnancy Losses -- Perinatal Data -- Disease history -- Family history -- Conclusions -- Bibliography -- 2 Which Investigations Are Relevant? -- Introduction -- Thrombophilia tests -- Tests -- Coagulation Cascade, Regulatory Mechanisms -- Inherited Thrombophilia -- Prevalence of Inherited Thrombophilia -- Pathophysiological Mechanisms Leading to Pregnancy Loss -- Strength of the Association -- Anticoagulant Therapy -- Evidence and Drawbacks -- Screening for thrombophilia in women with recurrent miscarriage -- Conclusions -- Parental and fetal karyotyping -- Parental Chromosome Abnormalities -- Parental Chromosome Abnormalities and Recurrent Miscarriage -- Testing -- Reproductive consequences of carrier status -- Treatment or prevention -- Fetal karyotype -- Testing the Fetal Karyotype -- Prognostic Value and Treatment -- Conclusions -- Tests for diagnosing uterine anomalies -- Congenital Uterine Anomalies -- Uterine Anomalies and Pregnancy Outcomes -- Diagnosis of uterine anomalies -- Prognosis of pregnancy outcome -- Treatment of Uterine Anomalies -- Conclusion -- Thyroid function tests -- Thyroid Disorders -- Diagnosis of Thyroid Disorders -- Thyroid Autoimmunity and Pregnancy Outcomes -- Treatment of Thyroid Autoimmunity -- Screening for Thyroid Autoimmunity -- Further Research on Thyroid Autoimmunity -- Conclusions -- Summary -- Bibliography -- 3 NK Cells in Peripheral Blood and the Endometrium -- Introduction -- NK cells and reproduction -- Methods of assessment.

NK cell analysis in recurrent miscarriage -- NK cell testing in practice -- Targeted immune therapy -- Immune therapy caution -- When to offer NK cell testing -- Bibliography -- 4 Cytokines and Cytokine Gene Polymorphisms in Recurrent Pregnancy Loss -- Introduction - Cytokines and pregnancy: basic concepts -- Interactions between Treg cells, Th17 cells, and cytokines and normal pregnancy and RPL -- Cytokine gene polymorphisms and RPL - an overview -- Practical evaluation of cytokines for the diagnostic of RPL -- Conclusion -- Bibliography -- 5 How to Assess the Prognosis after Recurrent Miscarriage -- Introduction -- Method of study -- Specific causes of RPL and prognosis -- Number of Miscarriages -- Maternal Age -- Karyotype of Previous Miscarriage -- Concurrent Infertility -- Late Pregnancy Losses -- Primary, Secondary, or Tertiary Aborter Status -- Parental Chromosomal Rearrangements -- Antiphospholipid Antibodies -- Hereditary Thrombophilias -- Immunological Factors -- Thyroid Dysfunction -- Uterine Anomalies -- Sperm Defects -- Psychological Stress -- Prognosis in pregnancy -- Classification of prognosis -- Good Prognosis -- Medium Prognosis Patients -- Poor Prognosis Patients -- Conclusions -- Bibliography -- 6 Which Treatments Should be Offered? PGD/PGS, Allogeneic Lymphocyte Immunization, Intravenous Immunoglobulin -- Introduction -- Preimplantation genetic testing -- Preimplantation Genetic Diagnosis (PGD) -- Preimplantation Genetic Screening (PGS) -- Active and passive immunization using lymphocyte immunization and IvIg -- Allogeneic Lymphocyte Immunization -- Intravenous Immunoglobulin (IvIg) -- Bibliography -- 7 Which Treatment Should be Offered? Heparin/Aspirin, Progesterone, Prednisolone -- Introduction -- Heparin and aspirin -- Clinical data -- Progesterone -- Scientific Rational -- Clinical Data -- Future research -- Prednisolone.

Side Effects of Prednisolone -- Other treatment options -- Estrogen -- Conclusion -- Bibliography -- 8 Which Treatment Should be Offered: Metformin, hCG, GM-CSF/G-CSF, TNF- α Inhibitors, Standard IVF/ICSI -- Introduction -- Metformin -- hCG -- GM-CSF/G-CSF -- TNF- a inhibitors -- IVF/ICSI without PGD -- Bibliography -- 9 Talking to Patients about Lifestyle, Behavior, and Miscarriage Risk -- Introduction -- A Sound Knowledge of the Facts -- A Commitment to Keeping Knowledge Updated -- Understanding the Emotional and Social Impact of Miscarriage -- The importance of information following miscarriage -- Timing -- Preconceptually -- In Early Pregnancy -- Discussing the causes of miscarriage -- Questions may include: -- Can I Be Referred for Tests? -- Will the Tests Give me Clear Answers? -- When Can I Try Again? -- When Should I Have a Scan? -- Does the Treatment I Chose for My Previous Miscarriage Affect My Future Risk? -- I am Feeling Stressed - Is This a Problem? -- Discussing the concept of risk -- Setting realistic expectations -- Advice for the best possible chance of a healthy pregnancy -- Risk and cause -- Talking to patients you have advised, after another miscarriage -- The importance of good care -- Sources of information and support -- When the trying stops -- Summary -- Further sources of information and support -- Bibiliography -- 10 Endocrine and Ultrasonic Surveillance of Pregnancies in Patients with Recurrent Miscarriage -- Introduction -- The role of endocrine surveillance -- Prediction of miscarriage -- Progesterone -- Human Chorionic Gonadotropin -- The role of ultrasound surveillance -- Prediction of miscarriage -- Subchorionic hematoma -- Vanishing twin syndrome -- First trimester screening -- Second trimester screening -- Progesterone to prevent pregnancy loss -- Further assessment -- Supportive care -- Conclusion -- Bibliography.

11 Obstetric Complications in Patients with Recurrent Miscarriage - How Should they be Monitored in the Third Trimester? -- Introduction -- Tests of fetal well-being in the third trimester - what are they and what do they mean -- Prediction of spontaneous preterm labor -- Prevention of adverse effects of prematurity -- Management of preterm prelabor rupture of membranes (PPROM) -- Management of third trimester pregnancy in diagnostic categories of recurrent miscarriage -- Chromosomal Abnormalities -- Endocrine disorders -- Thyroid Hormone Disorders -- Polycystic Ovary Syndrome (PCOS) -- Structural Uterine Abnormalities -- Prothrombotic conditions -- Primary Antiphospholipid Syndrome -- Inherited thrombophilia -- Unexplained recurrent miscarriage -- Bibliography -- 12 Recurrent Miscarriage after ART: A Double Challenge -- Introduction -- Two subsets of RM patients with a need for ART -- RM after OI with or without IUI -- RM after IVF/ICSI -- Treatment -- Bibliography -- 13 How to Cope with Stress and Depression in Women with Recurrent Miscarriage -- Stress and depression in women with recurrent miscarriage -- Recurrent miscarriage is much more than a Medical Condition -- Anxiety and Depression are Common Responses to RM -- The Grieving Process -- RM is a very Lonely Experience -- Decision making and its relation to stress and depression -- How can clinicians assist in decision processes and improve coping? -- How can Clinicians Assist in Decision Processes? -- How can Clinicians Improve Coping with Stress and Depression? -- What Types of Emotional Supports can Infertility Centers Provide to Women with RM? -- Conclusions -- Bibliography -- 14 Recurrent Miscarriage and the Risk of Autoimmune Disease and Thromboembolic Disease -- Introduction -- RM and autoimmunity -- RM and aPL -- RM and other autoantibodies.

RM, aPL, and the Risk of Autoimmune Disease -- RM and thromboembolic disease -- Hemostatic Changes in RM Patients -- Are Nonpregnant Women with a History of RM in a Prothrombotic State? -- RM, aPL, and Risk of Thrombotic Events -- Should Patients with Previous RMs Receive Thromboprophylaxis in the Long-term? -- Bibliography -- 15 How to Organize and Run an Early Pregnancy Unit/Recurrent Miscarriage Clinic -- Introduction -- Setting the scene -- Standards of practice -- Early pregnancy loss -- Diagnosis -- Management of early pregnancy loss -- Contraindications to medical management -- Protocol for medical management of miscarriage -- Surgical management of miscarriage -- Expectant management of miscarriage -- Ectopic pregnancy -- Recurrent miscarriage -- Recurrent Miscarriage Clinics -- Staffing and training implications -- Opportunities for specialist training -- Audit and research issues -- Bibliography -- 16 How to Organize an Early Pregnancy Unit/Recurrent Miscarriage Clinic - American Perspective -- Introduction -- Patient population at RPL special clinic -- Healthcare Providers -- Multidisciplinary Team Approach -- Who Serves on the Team? -- Interprofessional approach -- Roles of healthcare providers -- How to manage patient flow at special RPL clinic? -- What to offer other than medical care? -- Physical facility for the special RPL clinic -- Ultrasound unit -- Conclusion -- Bibliography -- 17 Case Studies -- Introduction -- Bibliography -- Index.