Recurrent Pregnancy Loss: Evidence-Based Evaluation, Diagnosis and Treatment PDF
Preview Recurrent Pregnancy Loss: Evidence-Based Evaluation, Diagnosis and Treatment
RReeccuurrrreenntt PPrreeggnnaannccyy LLoossss EEvviiddeennccee--BBaasseedd EEvvaalluuaattiioonn,, DDiiaaggnnoossiiss aanndd TTrreeaattmmeenntt AAsshheerr BBaasshhiirrii AAvvii HHaarrlleevv AAsshhookk AAggaarrwwaall EEddiittoorrss 112233 Recurrent Pregnancy Loss Asher Bashiri (cid:129) Avi Harlev Ashok Agarwal Editors Recurrent Pregnancy Loss Evidence-Based Evaluation, Diagnosis and Treatment Editors Asher Bashiri Avi Harlev Director Maternity C and Recurrent Recurrent Pregnancy Loss Clinic Pregnancy Loss Clinic Fertility and IVF Unit Department of Obstetrics and Department of Obstetrics and Gynecology Gynecology Soroka University Medical Center Soroka University Medical Center Faculty of Health Sciences Ben Gurion University of the Negev Ben-Gurion University of the Negev Be’er Sheva, Israel Be’er Sheva , Israel Ashok Agarwal American Center for Reproductive Medicine Cleveland Clinic Cleveland , OH , USA ISBN 978-3-319-27450-8 ISBN 978-3-319-27452-2 (eBook) DOI 10.1007/978-3-319-27452-2 Library of Congress Control Number: 2015960757 Springer Cham Heidelberg New York Dordrecht London © Springer International Publishing Switzerland 2016 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. T he publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper Springer International Publishing AG Switzerland is part of Springer Science+Business Media (www.springer.com) To my father who supported me To my mother who gave me the spirit To my children who gave me the power To my wife who showed me the way To all my brothers and sisters who were there for me And to all my mentors who helped me to treat the patients. -Prof. Asher Bashiri We dedicate this book to our patients for the privilege of trying our best to learn, diagnose, and treat RPL—a complex medical disorder. -Asher Bashiri, MD -Avi Harlev, MD -Ashok Agarwal, PhD Foreword Recurrent pregnancy loss, depending on the defi nition, affects 2–3 % of all women attempting to get a child, and there are indications that the incidence may be increasing. It spite of its high incidence and the anger and grief that are suffered by the affected couples, the research activity on the topic as mea- sured by the number of publications and presentations at scientifi c congresses is low compared with the activity in other areas of involuntary childlessness. The result of this relative inactivity is that our knowledge about causes and treatments of recurrent pregnancy loss is limited. Still approximately 1/3 of all patients with recurrent pregnancy loss 5 years after getting the diagnosis have not got the desired child in spite of all what can be offered to them. It is often stated that in 50 % of couples with recurrent pregnancy loss a cause can be found; however, more correctly I think that in 50 % of couples a risk factor can be found, which is not the same as fi nding a cause. With all what is known today very few cases of recurrent pregnancy loss are caused by a single pathogenic factor; the vast majority may have a multifactorial back- ground involving the interaction of multiple genetic and environmental risk factors. This complexity renders the research in recurrent pregnancy loss very diffi cult because you need very large patient and control populations to be able to detect causal factors, the importance of which can be confi rmed in other studies, and you need large populations of patients to test therapeutic interventions to be able to detect any effect. Since very few dedicated recur- rent pregnancy loss clinics exist, it is diffi cult to collect the large populations of patients needed for good studies. Several books about recurrent pregnancy loss have been published in the recent years, and some would pose the question: why publish a new book? Reading a book reviewing a particular disease area has advantages compared with reading the original articles in the area. Because much research in recur- rent pregnancy loss is based on small and few studies, there are large “white” areas on the map, and where there is knowledge there is in most cases sub- stantial controversy. A book provides an easily accessible overview on a large research area, and the contributions from various authors can highlight the areas of agreement and areas of controversy. T he book by Bashiri, Harlev, and Agarwal provides an extensive overview of all relevant aspects of recurrent pregnancy loss seen from both the health- care giver’s and patient’s perspectives. Contributions from prominent researches in the fi eld will focus on both well-known risk factors for recurrent pregnancy loss such as uterine, endocrine, and chromosomal abnormalities vii viii Foreword but much focus will also be on the fi elds of genetic and immunological fac- tors associated with recurrent pregnancy loss, since in these areas diagnostic techniques are developing rapidly and new knowledge relating to recurrent pregnancy loss is accordingly accumulating fast. More “soft” topics that have previously often been ignored such as the relevance of lifestyle factors in recurrent pregnancy loss and the importance of understanding and coping with the emotions of the couples suffering from the problem will be exten- sively dealt with. T he book will be an interesting read for all people meeting and taking care of couples with recurrent pregnancy loss: scientists, physicians, nurses, and midwifes. I hope it will stimulate more high-quality research in the area and improve healthcare givers’ skills in managing these often deeply stressed and depressed patients. Copenhagen, Denmark Ole B. Christiansen, DMSc Aalborg, Denmark Pref ace Most current guidelines defi ne recurrent pregnancy loss (RPL) as two or more consecutive pregnancy losses before 20–22 weeks of gestation. Initially, RPL was defi ned as three consecutive pregnancy losses; however, signifi cant developments in medicine, such as the introduction of low molec- ular weight heparin, advanced laboratory tests like antiphospholipid anti- bodies, and advanced imaging modalities including 3D ultrasound, contributed signifi cantly to this change. Thus, we should reconsider the rel- evant medical developments that infl uence the defi nition of RPL, evaluation, and treatment of this specifi c condition. D espite the research and the above-mentioned developments, we are still far from understanding the total picture of RPL. More than 50 % of RPL cases are considered unexplained even after a thorough RPL etiology workup. This means that research must be expanded and consist mainly of multicenter trials. This approach will help overcome the methodologic weaknesses of the current studies, which are mostly small study groups that make it diffi cult to draw valid conclusions. A s a consequence, patients suffering from RPL can be very frustrated, and the inaccessible nature of professional evaluation and treatment due to the very few specialized RPL clinics serves to increase their frustration. This means that most patients will see their general gynecologist, who is not well equipped with all the needs of those patients and unfortunately will not have the chance to refer to clinics that have such knowledge and resources. The reason for writing the book is to put RPL on the front line of OB-GYN research. Our book consists of the most updated literature on RPL, with chap- ters written by leading international experts in the fi eld. The primary intended audience is OB-GYN specialists, who can get the best overview on this topic and have all the information necessary to evaluate and treat the patients. Other specialists who could benefi t include hematologists, rheumatologists, endocrinologists, immunologists, radiologists, psychiatrists, psychologists, and social workers. The fact that we still have several approaches to some topics means that we still don't have the best answers in all situations, but this book will help to increase awareness of RPL for all specialists in the fi eld, even if they don’t treat these patients directly. ix
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