Spontaneous Abortion: Diagnosis and Treatment

ISBN-13: 9781447119203 / Angielski / Miękka / 2013 / 231 str.

Isabel Stabile; J. G. Grudzinskas; Tim Chard

Opis

Sixteen British specialists pool their extensive knowledge of spontaneous abortion in one source. Their discussion is directly applicable to clinical situations and helps identify areas of debate and alternative methods.

Spis treści

1 Definition and Clinical Presentation.- Spontaneous Abortion.- Threatened Abortion.- Inevitable Abortion.- Missed Abortion.- Anembryonic Pregnancy.- Spontaneous Abortion of a Live Fetus.- Trophoblastic Tumours.- Septic Abortion.- Recurrent Abortion.- Induced Abortion.- Ectopic Pregnancy.- Summary.- References.- 2 Spontaneous Abortions: Epidemiology.- Problems of Definition and Ascertainment.- Current Estimates of Early Reproductive Loss.- The Role of Chromosomal Anomalies.- The Role of Malformations Other Than Those Caused by.- Chromosomal Anomaly.- Sex Ratio.- Multiple Pregnancies.- Maternal Age and Parity.- Outcome of Other Pregnancies in Sibships with Spontaneous.- Abortions.- Maternal Health.- Maternal Smoking.- Alcohol Consumption.- Oral Contraceptives, Spermicides and Intrauterine Devices.- Other Environmental Hazards.- Conclusion.- References.- 3 Aetiology of Pregnancy Failure.- Numerical Chromosomal Abnormalities (Aneuploidy and Polyploidy).- Preclinical Losses.- First Trimester.- Second and Third Trimester.- Pathological Findings in First Trimester Abortuses.- Fetal Conditions.- Maternal Conditions.- Maternal Health.- References.- 4 Pathology of Spontaneous Abortion.- Anatomo-pathological Classification of Material from Abortions.- Histological Classification of Material from Abortions.- Specific Pathological Abnormalities in Abortion.- Infection.- Placental Ischaemia and Inadequate Placentation.- Immunological Factors.- Anti-phospholipid Antibodies.- Congenital Uterine Abnormalities.- Conclusions.- References.- 5 Ultrasound Diagnosis of Spontaneous Miscarriage.- Am I Pregnant?.- Is My Pregnancy Normal?.- When Is My Baby Due?.- Will I Miscarry?.- Intrauterine Haematomata.- Double Gestational Sacs.- Low Lying Placenta.- Low Ratio of Amniotic Sac to Embryo.- Uterine Abnormalities.- Embryonic Growth Delay.- Early Bradycardia.- Is My Baby Normal?.- Specific Complications of Early Pregnancy.- Early Embryonic Demise.- Anembryonic Pregnancy.- Complete and Incomplete Abortion.- Doppler Ultrasound in the Diagnosis of Pregnancy Failure.- References.- 6 Assessment of Early Pregnancy: Measurement of Fetoplacental Hormones and Proteins.- Diagnosis of Pregnancy.- Normal Pregnancy.- Control of Synthesis and Secretion.- Early Pregnancy Failure.- Threatened and Spontaneous Miscarriage.- Anembryonic Pregnancy.- Ectopic Pregnancy.- Trophoblastic Disease.- Prenatal Diagnosis: Chorionic Villus Sampling.- Conclusions.- References.- 7 The Aetiology and Management of Recurrent Miscarriage.- Incidence.- The Risk of Recurrence.- Aetiology of Recurrent Miscarriage.- Genetic Causes.- Anatomical Causes.- Infective Causes.- Chronic Maternal Disorders, Drugs and Environmental Pollutants.- Endocrine Causes.- Immunological Causes.- Investigation and Management.- Summary and Conclusions.- References.- 8 Septic Abortion.- Felicity Ashworth.- Relevance of Septic Abortion to Maternal Mortality Statistics.- Risk Factors.- Clinical Features.- Microbiology.- Complications of Septic Abortion.- Septicaemia.- Endotoxic Shock.- Acute Tubular Necrosis.- Management of Septic Abortion.- Prevention.- Antibiotic Therapy.- Curettage.- Surgery.- Management of Septic Shock.- Conclusion.- References.- 9 Miscarriage Following Assisted Conception.- Miscarriage in the Infertile Couple.- Pregnancy Diagnosis.- The Influence on Miscarriage of the Drugs used in Assisted Conception.- Anti-oestrogens.- Ovulation Induction with Gonadotrophins.- Miscarriage after IVF and Related Procedures.- Summary.- References.- 10 Abortion Following Invasive Diagnostic Procedures in the First Trimester.- Safety.- Evaluating Safety of Invasive Prenatal Diagnostic Tests.- Transabdominal versus Transcervical CVS.- CVS versus Midtrimester Amniocentesis.- Early Amniocentesis.- Accuracy.- Single Gene Defects.- Chromosomal Abnormalities.- Cost Considerations.- References.- 11 Diagnosis and Management of Ectopic Pregnancy Isabel Stabile.- Incidence of Ectopic Pregnancy.- Aetiology of Ectopic Pregnancy.- Clinical Features of Ectopic Pregnancy.- Diagnostic Tests.- Biochemical Tests.- Sonographic Tests.- Combination of Ultrasound and Biochemical Tests.- Management of Ectopic Pregnancy.- Conclusion.- References.- 12 Surgical Treatment of Spontaneous Abortion.- Cervical Cerclage in the Management of Cervical Incompetence.- Operative Procedures for Cervical Incompetence.- Choice of Patients.- Value of the Procedure.- Randomised Controlled Trials.- Management of Spontaneous Abortion.- Dilatation and Curettage.- Complications of Dilatation and Curettage.- References.- 13 Endocrine Treatment in the Prevention and Management of Spontaneous Abortion.- Prevention.- Systemic Disorders.- Reproductive System Disorders.- Empirical Treatment.- Timing of Treatment.- Endocrine Treatment of Incomplete or Missed Abortion.- Conclusion.- References.- 14 Immunotherapy of Recurrent Spontaneous Miscarriage.- Introduction: Maternal Immunity in Normal Pregnancy.- Rationale for Immunotherapy in Pregnancy Loss.- Definition of Recurrent Pregnancy Loss.- Methods of Treatment.- Leucocyte Immunisation.- Trophoblast Membrane Infusion.- Seminal Plasma.- Intravenous Immunoglobulin (IVIG).- Assessment of Outcome of Treatment: Difficulties of Interpretation.- Potential Hazards of Immunotherapy.- Future Requirements.- Conclusions.- References.