DRASAMSAMI DEPARTMENT OF OB GYN Shiraz University of Medical Sciences SHIRAZ IRAN A pregnancy loss miscarriage is defined as the spontaneous demise of a pregnancy before the fetus reaches viability The term therefore includes all pregnancy losses PLs from the tim ID: 935437
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Slide1
Slide2Management of RECURRENT PREGNANCY LOSS
DR.A.SAMSAMI
DEPARTMENT OF OB GYN
Shiraz University of Medical Sciences
SHIRAZ – IRAN
Slide3A pregnancy loss
(miscarriage)
is defined as the spontaneous demise of a pregnancy before the fetus reaches viability. The term therefore includes all pregnancy losses (PLs) from the time of conception until 24 weeks of gestation.
Slide4Pregnancy loss is a common complication in early pregnancy.
a prevalence of miscarriage of 5%
A population based register study showed that 13.5% of the pregnancies intended to be carried to term ended with fetal loss
Slide5The background risk of miscarriage is 20%.
Warburton D & Fraser FC (1964) Spontaneous abortion risks in man: data form reproductive histories collected in a medical genetics unit. Human Genet 16, 1-25
The
Pregnancy
Iceberg:
Slide6Recurrent Pregnancy Loss
By definition, “recurrent” pregnancy loss is defined as the loss of two or more pregnancies
.
RPL prevalence is between 0.8% and 1.4% among women with ≥2 pregnancies.
Slide7RECURRENT
MISCARRIAGE
Idiopathic
Endocrine disorders
(PCO
s
, LPD,
Thyroid disorders, Diabetes)
Thrombophilia
(Acquired and Inherited)
Autoimmune
Anatomical
Abnormalities
Geneti
c
Defects
THE PLAYERS
Slide8Slide9Pregnancy loss is a significant negative life event and the repetitive nature of RPL may intensify the grief experienced. Studies have mostly focused on women, and there is a need for studies on the emotional impact of RPL on men.
Clinicians and clinics should take the psychosocial needs of couples faced with RPL into account when offering and organizing care for these couples
.
Slide10KEY QUESTION: HOW SHOULD CARE FOR THE RPL PATIENT BE ORGANIZED?
A dedicated Recurrent Pregnancy Loss (RPL) clinic is an outpatient clinic that offers specialist investigations, support and if possible treatment of couples with RPL.
Slide11WHAT
ARE THE KNOWN RISK FACTORS OF RECURRENT PREGNANCY LOSS?
AGE
Health behavior
modifications
SMOKING CESSATION STRIVING FOR A HEALTHY, NORMAL RANGE BMI EXERCISE AVOIDING ALCOHOL
Slide12WHAT IS THE VALUE OF THROMBOPHILIA SCREENING IN WOMEN WITH RPL
?
WHICH THERAPEUTIC INTERVENTIONS SHOULD BE OFFERED TO COUPLES WITH RPL AND THROMBOPHILIA TO INCREASE THE CHANCE OF A LIVE BIRTH?
Slide13WHAT
IS THE VALUE OF SCREENING FOR GENETIC FACTORS IN THE DIAGNOSIS OF RECURRENT PREGNANCY LOSS
?
WHICH THERAPEUTIC INTERVENTIONS SHOULD BE OFFERED TO COUPLES WITH RPL DUE TO GENETIC/CHROMOSOMAL CAUSES TO INCREASE LIVE BIRTH RATE?
Slide14WHAT IS THE VALUE OF IMMUNOLOGICAL SCREENING IN THE DIAGNOSIS OF RPL
?
WHICH THERAPEUTIC INTERVENTIONS SHOULD BE OFFERED TO COUPLES WITH RPL WITH SUSPICION OF IMMUNOLOGICAL BACKGROUND TO INCREASE LIVE BIRTH RATE?
Slide15WHAT IS THE VALUE OF SCREENING FOR METABOLIC/ENDOCRINOLOGICAL ABNORMALITIES IN THE DIAGNOSIS OF RPL
?
WHICH THERAPEUTIC INTERVENTIONS SHOULD BE OFFERED TO COUPLES WITH RPL AND METABOLIC OR HORMONAL ABNORMALITIES TO INCREASE LIVE BIRTH RATE?