Recurrent Pregnancy Loss

428 Pages·2018·9.523 MB·English

by  Sumita Mehta, Bindiya Gupta

Recurrent
Pregnancy Loss
Sumita Mehta
Bindiya Gupta
Editors
123
Recurrent Pregnancy Loss
Sumita Mehta • Bindiya Gupta
Editors
Recurrent Pregnancy Loss
Editors
Sumita Mehta Bindiya Gupta
Department of Obstetrics & Gynecology Department of Obstetrics and Gynecology
Babu Jagjivan Ram Memorial Hospital UCMS & GTB Hospital
New Delhi New Delhi
India India
ISBN 978-981-10-7337-3 ISBN 978-981-10-7338-0 (eBook)
https://doi.org/10.1007/978-981-10-7338-0
Library of Congress Control Number: 2018930908
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Preface
“Let me recognize the gift in my ability to conceive and carry life however briefly.
Let me take joy in my ability to love so deeply and desire to nurture a soul unbe-
knownst to me.
Let a part of this soul be reflected in the spirit of my future children, born or
adopted, so that I may know it through them.”
Stacey Dinner-Levin
Recurrent pregnancy loss (RPL) is one area of reproductive medicine that is filled
with controversy and confusion. With much ongoing research, new concepts are
evolving and new treatment strategies are developed every now and then. Not only
is the controversy restricted to management principles, even the definition has been
variably given by two different societies.
The book has been divided into four parts for the reader’s convenience. Part I
deals with the definitions, epidemiology, and physiologic basis of a normal preg-
nancy. Etiology of recurrent pregnancy loss is a topic of much debate, and many
theories and conflicting data exist to explain its causation. Part II describes in detail
each causative factor and their respective management supported by latest evidence
and research. The last two chapters in this part have effectively summarized all the
latest recommendations and practices. An RPL couple is emotionally wrecked, and
stress further increases the risk of abortion. We have specially introduced chapters
covering this aspect. Parts III and IV discuss the areas of controversy and address
management options and latest research clarifying the role of immunological and
genetic therapy.
All the authors of the chapter are experts in their respective fields and have con-
tributed immensely by sharing their vast clinical experience, expertise, and research.
Overall, it is our honest effort to bring to you a book which has all relevant and
updated information on this topic to facilitate decision making and optimal treat-
ment for a couple with RPL.
Sumita Mehta
Bindiya Gupta
v
Contents
Part I Overview
1 Background, Epidemiology and Definition of Recurrent
Pregnancy Loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Alpana Singh, Ritu Khatuja, and Menka Verma
2 Normal Implantation, Placentation, and Fetal Development . . . . . . . 13
Taru Gupta, Shweta Singh, Sangeeta Gupta, and Nupur Gupta
3 Normal Immune Function: Journey of the Fetus . . . . . . . . . . . . . . . . . 41
Vidushi Kulshrestha
Part II Etiology and Management of RPL
4 Immunology and Pregnancy Loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Monika Gupta
5 The Evolving Role of Genetics in Recurrent Pregnancy Loss . . . . . . 67
Bindiya Gupta and Pooja Singh
6 Hormones in Recurrent Pregnancy Loss . . . . . . . . . . . . . . . . . . . . . . . 79
Nutan Agarwal and Vidushi Kulshrestha
7 Anatomic Considerations in RPL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Anshuja Singla and Sonia Chawla
8 Antiphospholipid Antibody Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . 99
K. Aparna Sharma and Kavita Khoiwal
9 Recurrent Pregnancy Loss and Inherited Thrombophilia . . . . . . . . . 113
Sumeet Singla and Sandhya Jain
10 Microbiology of Recurrent Pregnancy Loss . . . . . . . . . . . . . . . . . . . . . 129
Nilanchali Singh and Komal Rastogi
11 Male Factor in Recurrent Pregnancy Loss . . . . . . . . . . . . . . . . . . . . . . 137
Ritu Khatuja and Latika Chawla
vii
viii Contents
12 Unexplained Recurrent Miscarriage: A Dilemma . . . . . . . . . . . . . . 149
Shalini Rajaram, Vasudha Gupta, and Bindiya Gupta
13 Psychological Factors and Stress in RPL . . . . . . . . . . . . . . . . . . . . . . . 157
Sumita Mehta and Darukshan Anjum
14 Evidence-Based Clinical and Investigative Workup of 
RPL Couples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
Leena Wadhwa and Deepika
15 Evidence Based Management in Recurrent Pregnancy Loss . . . . . . . 181
Rashmi
Part III Beyond Convention
16 Establishing a One-Stop Recurrent Pregnancy Loss Clinic . . . . . . . . 197
Pooja Sikka
17 Role of Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
Vaishali Upadhyaya
18 Fetal Autopsy and Placental Examination as a 
Complimentary Tool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227
Priyanka Gogoi
19 Inflammatory Markers and Proteomic Analysis . . . . . . . . . . . . . . . . . 243
Pakhee Aggarwal
20 Emotional Support and Psychological Care of Recurrent
Pregnancy Loss Couple . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255
Shruti Srivastava and Aparna Goyal
21 Pregnancy After Recurrent Pregnancy Loss . . . . . . . . . . . . . . . . . . . . 269
Divya Pandey
22 Future Research Strategies and Directions in Recurrent
Pregnancy Loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283
Sruthi Bhaskaran and Amita Suneja
23 Counselling of an RPL Couple. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293
Seema Singhal and Juhi Bharti
Part IV Management Options in RPL: Hype or Hope
24 Progestogens/hCG Supplementation: A Vital Role? . . . . . . . . . . . . 305
Nisha Singh
25 Cervical Cerclage: Does It Help? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 319
Bindiya Gupta and Garima Vats
Contents ix
26 Immunotherapy for Recurrent Miscarriages . . . . . . . . . . . . . . . . . . . . 327
Mala Srivastava and Ankita Srivastava
27 Preimplantation Genetic Diagnosis to Improve Pregnancy
Outcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 337
Sumita Mehta and Nidhi Arora
28 Termination of Failed Pregnancy: Surgical Versus Medical
Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 353
Anshul Grover
29 Obesity and Its Association with Recurrent Pregnancy Loss . . . . . . . 363
Anupama Bahadur and Jaya Chaturvedi
30 Minimally Invasive Surgery: Diagnostic and 
Therapeutic Role . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 371
Punita Bhardwaj, Tarun Das, Sanskriti Batra, and Shivaji Dhopte
31 Non-Pharmacological Methods for 
Management of RPL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 405
Namita Grover, Manpreet Singh, and Swati Verma
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 419
About the Editors
Sumita Mehta, DGO, DNB, FICOG, MAMS is a specialist and head at the
Department of Obstetrics and Gynecology at Babu Jagjivan Ram Memorial Hospital,
Delhi, India. She is the secretary of the Indian Society of Colposcopy and Cervical
Pathology and a national expert for the project ECHO (Extension for Community
Healthcare Outcomes) at the National Institute of Cancer Prevention and Research.
She is an executive member and has served as an editor for the Association of
Obstetricians and Gynecologists of Delhi. She is on the editorial board of journals
Heliyon and the Journal of Gynecology and Obstetrics Forecast and is a reviewer
for many international journals. Her special area of interest is in the field of gyneco-
logic oncology, especially cervical cancer. She has conducted several colposcopy
workshops throughout India and has delivered numerous lectures at various aca-
demic forums. She is the editor of 8 books and has published over 75 articles in
national and international journals of repute.
Bindiya Gupta, M.D., AIIMS is presently working as an assistant professor at
the Department of Obstetrics and Gynecology, UCMS and GTB Hospital, Delhi.
She has published over 50 articles in national and international journals and has
edited 2 books. She is presently editor for the Association of Obstetricians and
Gynecologists of Delhi and was an editorial board member of the Indian College
of Obstetricians and Gynecologists. She was web editor of NARCHI 2014–2016
and was coeditor of AOGD 2011–2012. A reviewer for various international jour-
nals, she also serves on the editorial board of two international journals. Her work
has been recognized with several awards, including the FIGO best prize paper
award from a developing country and FOGSI Junior Corion award.
xi
Contributors
Nutan Agarwal Department of Obstetrics and Gynecology, All India Institute of
Medical Sciences, New Delhi, India
Pakhee Aggarwal Obstetrics and Gynecology, Fortis Healthcare, New Delhi,
India
Fortis Memorial Hospital, Gurgaon, India
Flt Lt Rajan Dhall Hospital and Aashlok Hospital, New Delhi, India
Darukshan Anjum Obstetrics and Gynecology, Babu Jagjiwan Ram Memorial
Hospital, New Delhi, India
Nidhi Arora Apollo Center of Fetal Medicine, Indraprastha Apollo Hospital,
New Delhi, India
Anupama Bahadur Obstetrics and Gynecology, All India Institute of Medical
Sciences, Rishikesh, Uttrakhand, India
Sanskriti Batra Obstetrics and Gynecology, Institute of Obstetrics and
Gynecology, Sir Ganga Ram Hospital, New Delhi, India
Punita Bhardwaj Obstetrics and Gynecology, Institute of Obstetrics and
Gynecology, Sir Ganga Ram Hospital,, New Delhi, India
Juhi Bharti Obstetrics and Gynecology, All India Institute of Medical Sciences,
New Delhi, India
Sruthi Bhaskaran Obstetrics and Gynecology, University College of Medical
Sciences and GTB Hospital, New Delhi, India
Jaya Chaturvedi Obstetrics and Gynecology, All India Institute of Medical
Sciences, Rishikesh, Uttrakhand, India
Latika Chawla Department of Obstetrics and Gynecology, All India Institute of
Medical Sciences, Rishikesh, Uttrakhand, India
Sonia Chawla Obstetrics and Gynecology, University College of Medical
Sciences and GTB Hospital, New Delhi, India
xiii