Recurrent Pregnancy Loss
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More About This Title Recurrent Pregnancy Loss


Recurrent pregnancy loss is an emotional challenge for patients. This book offers a practical approach to office-based gynecologists and trainee gynecologists to learn how to identify the root causes and minimize the risks of further miscarriage in subsequent pregnancies. This book is part of the Gynecology in Practice Series, which aims to provide a clinical ‘in the office' or ‘at the bedside' guide to effective patient care for gynecologists.


Ole Bjarne Christiansen, MD, PhD, Professor of Obstetrics and Gynecology, Fertility Clinic, Rigshospitalet, Copenhagen, Denmark.


Series Foreword vii

Contributors viii

Preface to the first edition xii

1 Obtaining the Relevant History 1
Ole B. Christiansen

2 Which Investigations Are Relevant? 10
Paulien G. de Jong, Emmy van den Boogaard, Claudia R. Kowalik, Rosa Vissenberg, Saskia Middeldorp and Mariëtte Goddijn

3 NK Cells in Peripheral Blood and the Endometrium 29
Gavin Sacks

4 Cytokines and Cytokine Gene Polymorphisms in Recurrent Pregnancy Loss 38
Silvia Daher, Maria Regina Torloni and Rosiane Mattar

5 How to Assess the Prognosis after Recurrent Miscarriage 46
Howard J.A. Carp

6 Which Treatments Should be Offered? PGD/PGS, Allogeneic Lymphocyte Immunization, Intravenous Immunoglobulin 61
Henriette Svarre Nielsen and Ole B. Christiansen

7 Which Treatment Should be Offered? Heparin/Aspirin, Progesterone, Prednisolone 70
Muhammad A. Akhtar and Siobhan Quenby

8 Which Treatment Should be Offered: Metformin, hCG, GM-CSF/G-CSF, TNF-α Inhibitors, Standard IVF/ICSI 78
Ole B. Christiansen

9 Talking to Patients about Lifestyle, Behavior, and Miscarriage Risk 86
Ruth Bender Atik and Barbara E. Hepworth-Jones

10 E ndocrine and Ultrasonic Surveillance of Pregnancies in Patients with Recurrent Miscarriage 103
Adjoa Appiah and Jemma Johns

11 Obstetric Complications in Patients with Recurrent Miscarriage – How Should they be Monitored
in the Third Trimester? 115
Shehnaaz Jivraj

12 Recurrent Miscarriage after ART: A Double Challenge 128
Elisabeth C. Larsen and Ole B. Christiansen

13 How to Cope with Stress and Depression in Women with Recurrent Miscarriage 135
Keren Shakhar and Dida Fleisig

14 Recurrent Miscarriage and the Risk of Autoimmune Disease and Thromboembolic Disease 146
M. Angeles Martínez-Zamora, Ricard Cervera and Juan Balasch

15 How to Organize and Run an Early Pregnancy Unit/Recurrent Miscarriage Clinic 157
AnnMaria Ellard and Roy G. Farquharson

16 How to Organize an Early Pregnancy Unit/Recurrent Miscarriage Clinic – American Perspective 172
Joanne Kwak-Kim, Kuniaki Ota and Ae-Ra Han

17 Case Studies 180
Ole B. Christiansen

Index 191