Human reproduction is remarkably inefficient; Only 420 are born alive out of 1000 fertilizations, nearly 70% of human conceptions do not survive to live birth. The stillbirth in india is highest in the world 7% to 14% in different states Odisha 8% Karnataka 14% (of course reported only) Recurrent pregnancy loss is a psychologically stressful diagnosis for couples, in approximately 50% of cases, no cause will be found. The number of evidence-based practices available for guidance is limited. This confluence of factors presents a challenge for clinicians. However, in studies of interventions aimed at reducing rates of miscarriage in women with otherwise unexplained RPL, control groups experience a live birth rate of up to 87% with no intervention. Thus, one of the most significant things we can do when caring for these complex patients is to offer them emotional support and accurate information. As more work is done in this emerging area of reproductive science, we will be able to shed more light on this complex problem.
Evidence for a significant effect in favor of progesterone for luteal phase support. Best result with synthe7c progesterone.
• Evidence that the addi7on of othe substances such as estrogen or hCG doe not improve outcomes.
• Evidence for equivalence of IM and vaginal routes of administra7on. Vaginal route is best tolerated by pa7ents.
• hCG, or hCG plus progesterone, was associated with a higher risk of OHSS. The use of hCG should therefore be avoided.
• Evidence showing a benefit from the addi7on of GnRH agonist to progesterone in luteal phase support
ESHRE Guideline on Recurrent Pregnancy Loss (RPL)Sujoy Dasgupta
Dr Sujoy Dasgupta invited to deliver a lecture on "RPL- ESHRE Guideline" in the Annual Conference of RCOG (Royal College of Obstetricians and Gynaecologists) IRC (International Representative Committee) India East held on 20-21 May, 2023
interest in stem cells is raising in different field of medicine. The question is : is it successful in Gynecology or it is still too early to say that. The present talk may help to explore this .
Evidence for a significant effect in favor of progesterone for luteal phase support. Best result with synthe7c progesterone.
• Evidence that the addi7on of othe substances such as estrogen or hCG doe not improve outcomes.
• Evidence for equivalence of IM and vaginal routes of administra7on. Vaginal route is best tolerated by pa7ents.
• hCG, or hCG plus progesterone, was associated with a higher risk of OHSS. The use of hCG should therefore be avoided.
• Evidence showing a benefit from the addi7on of GnRH agonist to progesterone in luteal phase support
ESHRE Guideline on Recurrent Pregnancy Loss (RPL)Sujoy Dasgupta
Dr Sujoy Dasgupta invited to deliver a lecture on "RPL- ESHRE Guideline" in the Annual Conference of RCOG (Royal College of Obstetricians and Gynaecologists) IRC (International Representative Committee) India East held on 20-21 May, 2023
interest in stem cells is raising in different field of medicine. The question is : is it successful in Gynecology or it is still too early to say that. The present talk may help to explore this .
Role of Stem Cells in Obstetrics and Gynecology PracticeAsha Jain
Role of Stem Cells in Obstetrics and Gynecology Practice
Talk delivered at 4th Biennial International ISCSGCON 2021
on Febuary 13,2021 by Dr. Asha Jain
Anovulation is the main symptom of PCOS. Normal Physiology of ovulation must know before induction of ovulation. Induction of ovulation is difficult. Careful monitoring gives good success.
It describes the Progesterone physiology. It describes the latest evidence as regards progesterone formulations, use of progesterone as Luteal phase support. It scrutinizes the value of serum progesterone in monitoring luteal phase
Since the first formal description of LPD in 1949 as a possible cause of infertility and recurrent miscarriage by Jones. Innumerable investigations have been undertaken in an effort to verify its existence or to characterize its pathophysiology, diagnosis, and treatment. The consensus of the literature is that LPD does exist and that its cause is multifactorial like abnormal folliculogenesis, inadequate LH surge,inadequate secretion of progesterone by the corpus luteum, aberrant end-organ response by the endometrium.
Interesting Update on Recurrent Miscarriage for Indian Gynaecologoists D...Lifecare Centre
OUTLINE….of RM
* KNOWN KNOWNWhat we know & we DO: **KNOWN UNKNOWNWhat we know but do not do: ***UNKNOWN KNOWNWhat we know that we do not know ****UNKNOWN UNKNOWNTOTALLY NEW .. Future
Healthy Choices are the key!
Healthy diet including raw foods & avoiding processed food or high fat diet is the best way to eliminate toxins from your body. Toxins damage your egg follicles.
Recurrent Pregnancy Loss Sharing Personal Experience (10 years) Lifecare Centre
Complete over view of the causes diagnosis management of Recurrent Pregnancy Loss
it is a personal experience of treating recurrent miscarriages with excellent result
Role of Stem Cells in Obstetrics and Gynecology PracticeAsha Jain
Role of Stem Cells in Obstetrics and Gynecology Practice
Talk delivered at 4th Biennial International ISCSGCON 2021
on Febuary 13,2021 by Dr. Asha Jain
Anovulation is the main symptom of PCOS. Normal Physiology of ovulation must know before induction of ovulation. Induction of ovulation is difficult. Careful monitoring gives good success.
It describes the Progesterone physiology. It describes the latest evidence as regards progesterone formulations, use of progesterone as Luteal phase support. It scrutinizes the value of serum progesterone in monitoring luteal phase
Since the first formal description of LPD in 1949 as a possible cause of infertility and recurrent miscarriage by Jones. Innumerable investigations have been undertaken in an effort to verify its existence or to characterize its pathophysiology, diagnosis, and treatment. The consensus of the literature is that LPD does exist and that its cause is multifactorial like abnormal folliculogenesis, inadequate LH surge,inadequate secretion of progesterone by the corpus luteum, aberrant end-organ response by the endometrium.
Interesting Update on Recurrent Miscarriage for Indian Gynaecologoists D...Lifecare Centre
OUTLINE….of RM
* KNOWN KNOWNWhat we know & we DO: **KNOWN UNKNOWNWhat we know but do not do: ***UNKNOWN KNOWNWhat we know that we do not know ****UNKNOWN UNKNOWNTOTALLY NEW .. Future
Healthy Choices are the key!
Healthy diet including raw foods & avoiding processed food or high fat diet is the best way to eliminate toxins from your body. Toxins damage your egg follicles.
Recurrent Pregnancy Loss Sharing Personal Experience (10 years) Lifecare Centre
Complete over view of the causes diagnosis management of Recurrent Pregnancy Loss
it is a personal experience of treating recurrent miscarriages with excellent result
When a lady visits her Obstetrician, she may be advised Ultrasonography Scan at some stage in pregnancy. It is a frequently asked question as to how many scans should she undergo during pregnancy? When? Why? (for what purpose?). I have explained this in simplified manner. Ultrasonography is an ideal and safe screening tool in pregnancy.
Certain investigations are part of routine care during pregnancy. Some of these tests are done with a blood sample. Others use a urine sample or a sample of tissue taken from your vagina, cervix, or rectum. These tests can help find conditions that may increase the risk of complications for you and your fetus. Many problems found by these tests can be treated during pregnancy.
It usually takes about 6 weeks to recover from your c-section but this will depend on your individual situation. If you had any problems during or after your c-section, or if you’re looking after other children at home, you may feel you need more time to recover.
The female reproductive system is a very complex system. And as with any system, occasionally, things go wrong. When treatments and therapies can't fix an issue, sometimes surgery is required. Surgery to remove a woman's uterus or womb, a major component of this system, is called hysterectomy
An abortion is a procedure to end a pregnancy. It's also sometimes known as a termination of pregnancy. The pregnancy is ended either by taking medicines or having a surgical procedure. The decision to have an abortion is yours alone.
Some women may be certain they want to have an abortion, while others may find it more difficult to make a decision.
All women requesting an abortion can discuss their options with, and receive support from their care provider, if they wish.
Vaccines help prepare the body to fight foreign invaders (pathogens such as bacteria or viruses), to prevent infection. All vaccines introduce into the body a harmless piece of a particular bacteria or virus, triggering an immune response. Most vaccines contain a weakened or killed bacteria or virus. However, scientists have developed a new type of vaccine that uses a molecule called messenger RNA (or mRNA for short) rather than part of an actual bacteria or virus. Messenger RNA is a type of RNA that is necessary for protein production. In cells, mRNA uses the information in genes to create a blueprint for making proteins. Once cells finish making a protein, they quickly break down the mRNA. mRNA from vaccines does not enter the nucleus and does not alter DNA.
Pregnancy is a period that places great physiological stress on both the mother and the fetus. When pregnancy is compounded by endocrine disorders such as hypothyroidism, the potential for maternal and fetal adverse outcomes can be immense. While a lot of attention has been focused on the adverse fetal outcomes consequent to hypothyroidism, attention is also being gradually directed towards the adverse maternal outcomes of this disorder. Role of antibody positivity in influencing outcomes in a euthyroid woman, also needs further clarification. Prompt diagnosis and treatment of hypothyroidism in pregnancy is very essential. Subclinical hypothyroidism also needs to be detected and treated to prevent adverse outcomes, especially maternal. Since women with hypothyroidism during pregnancy, especially of the autoimmune variety might have a flare up of the disorder post-partum, or might continue to require thyroxine replacement post-partum, adequate follow-up is mandatory. While targeted case finding is generally practised, recent evidence seems to indicate that universal screening might be a better option. In conclusion, routine screening, early confirmation of diagnosis and prompt treatment. Allied with regular post-partum follow up, is required to ensure favourable maternal and fetal outcomes.
Sickle cell disease is an inherited blood disorder affecting red blood cells. Normal red blood cells contain hemoglobin A. People with sickle cell disease have red blood cells containing mostly hemoglobin S, an abnormal type of hemoglobin. These red blood cells become sickle-shaped (crescent-shaped), and have difficulty passing through small blood vessels. There are several different types of sickle cell disease; the most common types are homozygous sickle cell disease (SS disease), and sickle-cell beta thalassemia (Sß+ or Sß0 disease).
Gestational trophoblastic disease (GTD) forms a group of disorders spanning the conditions of complete andpartial molar pregnancies through to the malignant conditions of invasive mole, choriocarcinoma and the veryrare placental site trophoblastic tumour (PSTT). There are reports of neoplastic transformation of atypicalplacental site nodules to placental site trophoblastic tumour.If there is any evidence of persistence of GTD, most commonly defined as a persistent elevation of beta humanchorionic gonadotrophin (βhCG), the condition is referred to as gestational trophoblastic neoplasia (GTN).
Menstruation and menstrual practices are still clouded by taboos and socio-cultural restrictions resulting in adolescent girls remaining ignorant of the scientific facts and hygienic health practices, which sometimes result into adverse health outcomes.
Menstrual Hygiene is vital to the empowerment and well-being of women and girls worldwide. It is about more than just access to sanitary pads and appropriate toilets – though those are important. It is also about ensuring women and girls live in an environment that values and supports their ability to manage their menstruation with dignity.
Labour and childbirth are the most challenging and painful phases of pregnancy. Most mothers-to-be dread facing it and hope it gets over quickly. When labour starts, there is usually a gap between each stage of labour, but when it comes to women going through precipitate labour, everything happens very quickly. Though in some cases it comes as a blessed relief, in others it can be a bit more complicated than that.
There is general inconsistency in the nomenclature used to describe abnormal uterine bleeding (AUB) classification system for AUB, which has been approved by the International Federation of Gynecology and Obstetrics (FIGO) Executive Board as a FIGO PALM-COEIN classification system.
Placenta previa is a condition that may happen during the second or third trimester of pregnancy. It's one of the most common causes of vaginal bleeding during these trimesters. It happens when the placenta implants in the lower part of the uterus. This causes the placenta to block part or all of the opening of the cervix to the vagina (birth canal). It can lead to problems for both the mother and baby. This can include blood loss and premature labor. EVERY PREGNANT WOMEN MUST KNOW ABOUT IT.
Molar pregnancy is one of a group of uncommonly occurring conditions called gestational trophoblastic disease (GTD) that occurs when a pregnancy does not develop properly. There are two types of gestational trophoblastic disease:
Nausea and vomiting of pregnancy commonly occurs between 5 and 18 weeks of pregnancy. Between 50 and 90 percent of women with normal pregnancies have some degree of nausea, with or without vomiting. The severity of these symptoms can vary and can last for various periods of time.
"Morning sickness" is the term often used to describe mild nausea and vomiting that occur due to pregnancy (and not due to other illness), even though symptoms may occur at any time of day. "Hyperemesis gravidarum" is the term used to describe a more severe condition. Hyperemesis may cause you to vomit multiple times throughout the day, lose weight, be unable to consume food and liquids, and typically requires evaluation in the hospital and treatment with medication(s).
Ultrasonographic determination of fetal size to assess intra-uterine growth restriction is very important in the present day. reports have shown that ethnicity plays a role in fetal growth. This chart will provide The normal and SGA fetal biometry as a ready Reckon-er. Source:- Indchemie Health Specialties Pvt. Ltd
A miscarriage, or spontaneous abortion, is an event that results in the loss of a fetus before 20 weeks of pregnancy. It typically happens during the first trimester, or first three months, of the pregnancy.
Every woman should be thinking about her health whether or not she is planning pregnancy. One reason is that about half of all pregnancies are not planned. Unplanned pregnancies are at greater risk of preterm birth and low birth weight babies. Another reason is that, despite important advances in medicine and prenatal care, about 1 in 8 babies is born too early. Researchers are trying to find out why and how to prevent preterm birth. But experts agree that women need to be healthier before becoming pregnant. By taking action on health issues and risks before pregnancy, you can prevent problems that might affect you or your baby later.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
4. CONTROVERSIES in RPL
• Is Pregnancy confirmed?
• Is there Consensus definition of RPL?
• How many losses diagnose RPL?
• What counts as a pregnancy loss?
• What about the other half?
• What are all tests to be done?
• Should we get karyotypes on all?
• Should we get karyotypes on POC?
• What is the chance of a live birth?
• If any other impacts other than Reproductive?
5. What is a pregnancy.
PATIENT’S perception
• A positive pregnancy test from
home (or their doctors office)
that does not result in a baby.
• It also includes Bio-Chemical
Pregnancy.
FACT
• Pregnancy is defined as a clinical
pregnancy documented by
ultrasonography or histopathologic
examination
ASRM Committee Opinion Fertil Steril. 99:63, 2012
ASRM Practice Committee Fertil Steril 98:1103-1101, 2012
Kutteh experience over last 20 years of clinical
practice
6. Terminology
PREGNANCY LOSS
MISCARRIAGE
(< 20 WKS)
PREGNANCY OF
UNKNOWN
LOCATION (PUL)
EARLY EMBRYONIC
(< 6 WKS)
EMBRYONIC
(> 6 TO 9 WKS)
FETAL LOSS
(> 9 TO 20 WKS)
STILLBIRTH
(> 20 WKS)
7. Is there Consensus definition of RPL?
• Williams OB 24th Edition “most generally accepted
definition” The American Society for Reproductive
Medicine (2008) proposed that recurrent pregnancy
loss be defined as two or more failed clinical
pregnancies confirmed by either sonographic or
histopathological examination. A thorough evaluation
certainly is warranted after three losses, and
treatment is initiated earlier in couples with
concordant subfertility (Jaslow, 2010; Reddy, 2007).
Three or more spontaneous, consecutive pregnancy
losses (fathered by the same partner)
• ACOG Practice Bulletin No. 24, February 2001
• “RPL is typically defined as two or three or more
consecutive pregnancy losses”
• “Patients with two or more consecutive, spontaneous
losses are candidates for an evaluation to determine the
etiology”
8. ? What # to Define RPL
Incidence of RPL
Two 1/45
Three 1/300
Four 1/2000
Five 1/13,000
Six 1/90,000
Seven 1/600,000
Eight 1/4,000,000
Incidence based on mean sporadic
miscarriage rate of 15%
Incidence=number of miscarriages (μ =
sporadic miscarriage rate of 15%) or 6.67
times rarer.
Saravelos SH, Regan LR. Obstet Gynecol
Clinics N Am. 2014.
9. Theoretical Incidence of RPL
occurring by Chance
for Women with one, two and
three miscarriages
AGES
(years)
1
miscarriage
By chance
2
miscarriages
By chance
3 miscarriages
By chance
20-24 11% 1.21% 0.13%
25-29 12% 1.44% 0.17%
30-34 15% 2.25% 0.34%
35-39 25% 6.25% 1.56%
Saravelos SH and LiTC. Human Reprod. 27:1882-1886, 2012 Saravelos SH, Regan LR. Obstet Gynecol
Clinics N Am. 2014
Theoretical Incidence for
Sporadic miscarriages for
Women
10. Estimates of Pregnancy Loss from
Conception
1000 Fertilized Egg (27% are lost)
728 embryos implanted at 7 days (22% are lost)
568 clinically recognized pregnancies with missed
menstrual period(12% are lost)
514 pregnancies at second trimester(3% are lost)
500 full term births(420 live births 80 Stillbirth)
11. CAUSES
Genetic Factors
• Accounts For >50% Of Cases if we
include peri-implantation loses.
• Whole-chromosome Abnormalities
• Partial-chromosome Abnormalities
• Single-gene Disorders
• Micro-RNA Defects and Changes In
Gene Function Reflecting
Epigenetic Changes.
Non-Genetic Factors
• Disorders Of Thrombosis And
Hemostasis,
• Uterine Anomalies,
• Immunologic Disorders,
• Endocrine Disorders,
• Infectious Etiologies, (Non-TORCH)
• Environmental Influences Such As
Cigarette Smoking and many
others.
12. In RPL>>>
Its time to say goodbye to TORCH tests…….
Cochrane Review has categorically proven in
multiple meta-analysis that none of the “TORCH”
group of infections are responsible for
RECURRENT SPONTANEOUS ABORTIONS
13. 1
Older nulliparous patients who have delayed childbearing until their late
30s or early 40s and present with recurrent pre-embryonic (<5 weeks) or
embryonic (<10 weeks) miscarriages with or without infertility. In rare
cases, they also will have interspersed second- and third-trimester fetal
deaths.
First Group
2 Patients with recurrent severe fetal growth restriction and stillbirths, which
generally occur at progressively earlier gestational ages. These patients
have a heterogeneous set of etiologies that ultimately involve severe
uteroplacental vascular insufficiency
Second Group
3 Generally younger, often multiparous, and prone to intermittent fetal loss
at or after 10 weeks, although the occasional patient also presents with
recurrent intermittent embryonic loss.
Third Group
In Practice……..
14. GENETICS
A timeline showing the development of genetics from Gregor Mendel’s work on pea plants to the current era of genomics
and its many applications in research, medicine, and society.
15. CHROMOSOME MUTATION:-
• The failure of chromosomes to properly separate during meiosis results in variation in the
chromosome content of gametes and subsequently in offspring arising from such gametes.
• Plants often tolerate an abnormal genetic content, but, as a result, they often manifest unique
phenotypes. Such genetic variation has been an important factor in the evolution of plants.
• In animals, genetic information is in a delicate equilibrium whereby the gain or loss of a
chromosome, or part of a chromosome, in an otherwise diploid organism often leads to lethality
or to an abnormal phenotype.
• The rearrangement of genetic information within the genome of a diploid organism may be
tolerated by that organism but may affect the viability of gametes and the phenotypes of
organisms arising from those gametes.
• Chromosomes in humans contain fragile sites—regions susceptible to breakage, which leads to
abnormal phenotypes.
16. ABNORMALITIES
• Complete haploid sets of
chromosomes are present =
Euploidy.
• Polyploidy
• 2 Sets = Diploidy
• 3 sets = Triploidy
• Like that Tetraploidy, pentaploidy, etc.
• Gains/loses of one/more
chromosomes but not a complete
set.= aneuploidy.
• Monosomy
• Di-somy
• Trisomy
• Tetrasomy, pentasomy, etc.
• A Translocation Involves
Transposition Of Chromosome
Material Usually Between
Chromosomes. Three Types are
Recognized:
• Centric Fusion Or ‘Robertsonian’
(code: ‘rob’) ,
• Reciprocal (code: ‘t’)
• Insertional (code: ‘ins’)
Variation in Composition and ArrangementVariation in Chromosome Number
17. :
Genetic Approach
to
Recurrent Fetal Loss
• Genetic consultation after 2-3 episodes
• ≈ 50 % of all first trimester spontaneous abortions show a
chromosomal abnormality (most « de novo »)
• ≈ 5% abnormal parental karyotype, esp. translocations.
• Provide risks for offspring (theoretical + empirical)
• PND Options
• Discuss implications for other family members
18. Chromosome Rearrangements
• Rarely, a parent may carry a “balanced” chromosome rearrangement
that can lead to imbalance of chromosomal material in eggs or sperm
• Mothers and fathers are equally likely to carry a rearrangement
• Rearrangements are the cause of only 2% of miscarriages, but 1/25
couples with repeated miscarriage will have such a rearrangement.
• Rearrangements can be detected by chromosome analysis of
embryonic material, or by chromosome analysis of parental blood.
• Rearrangements predict an increased risk of miscarriage and the
possibility of children with birth defects.
19. - indirect
- detection by indirect means
Prenatal Diagnosis
What can be detected today ?
• Chromosomal disorders
• detection depends on level of resolution
• Monogenic/ polygenic disorders
• Direct analysis
• gene known in detail, mutation defined.
• Indirect analysis
• gene located, linkage analysis)
• Multifactorial disorders
• Detection by indirect methods
• US, markers in maternal serum, amniotic fluid.
PND always = attempt to answer a specific question.
No screening of genes !
20. Genetic testing
• Definition: the analysis
of human DNA, RNA,
chromosomes, proteins,
and certain metabolites
in order to detect
heritable disease-related
genotype, mutations,
phenotypes, or
karyotypes for clinical
puroses
Holtzman NA, Watson MS, eds.
Promoting safe and effective genetic
testing in the United States: final report
of the Task Force on Genetic Testing.
Baltimore: Johns Hopkins University
Press, 1999
21. • Preconception care is primary prevention. The goal is to affirm
pregnancy intention, reduce any potential harm, and recognize
modifiable risk factors related to pregnancy while stratifying
pregnancies on a continuum of low- to high-risk. The Centers for
Disease Control and Prevention (CDC) has defined preconception care
as “a set of interventions
Trimester zero
Pregnancy wellness begins before the positive pregnancy test.
22. Prenatal Diagnosis Methods
• Non invasive Techniques
• A. Fetal visualization :-
• Ultrasound
• Fetal echocardiography
• Magnetic resonance imaging (MRI)
• Radiography
• B. Screening for neural tube defects (NTDs) : -
• Measuring maternal serum alpha-
fetoprotein (MSAFP)
• C. Screening for fetal Down syndrome:
• Measuring MSAFP
• Measuring maternal unconjugated estriol
• Measuring maternal serum beta-human
chorionic gonadotropin (HCG)
• D. Separation of fetal cells from the mother's
blood:
• Invasive Techniques
• a. Fetal visualization
• Embryoscopy
• Fetoscopy
• b. Fetal tissue sampling
• Amniocentesis
• Chorionic villus sampling (CVS)
• Percutaneous umbilical blood sampling (PUBS)
• Percutaneous skin biopsy
• Other organ biopsies, including muscle and liver biopsy
• c. Preimplantation biopsy of blastocysts obtained by in vitro
fertilization
• d. Cytogenetic investigations
• Detection of chromosomal aberrations
• Fluorescent in situ hybridization
• e. Molecular genetic techniques
• Linkage analysis using microsatellite markers
• Restriction fragment length polymorphisms (RFLPs)
• Single nucleotide polymorphisms (SNPs)
24. What Are The Tests?
TEST METHOD WHEN WHAT
SIPS
1st Blood test
2nd Blood Test
9w to 13+6w
15w to 20+6w
PAPPA
AFP, HCG, UE3, and
Inhibin A
IPS
1st Blood Test and
Nuchal Translucency US
2nd Blood Test
9w to 13+6w
15w to 20+6w
PAPPA
AFP ,HCG, UE3, and
Inhibin A
QUAD Blood test
15w to 20+6w AFP, HCG, UE3, and
Inhibin A
FTS
Blood test and US: NT, nasal bones,
Ductus Venosis flow, and fetal heart
rate
11w-14w PAPPA, AFP, HCG
NIPT Blood test 10w plus Cell free fetal DNA
25. Combined or integrated screening?
• COMBINED
• Earlier diagnosis of nuchal
translucency.
• One single blood sample
• Organisation more simple
• INTEGRATED
• Two-step process
• two serum tests on different
appointments
• Cost effectiveness?
• Same sensitivity
• More complex for women and
clinicians.
• Failing to attend the second
appointment renders the test
invalid.
« Contingent screening »
The best of two worlds?
26. Prenatal Genetic Screening
First Trimester Screen (FTS) alternative to IPS or SIPS
• 11-14 weeks
• Ultrasound and one blood sample: T, nasal bone, fetal heart rate, Ductus
Venosis flow, PAPPA-A/fbHCG
• Advantage? result same day as US; fewer false positives
Non Invasive Prenatal Test (NIPT) prior to amniocentesis
• 10+ weeks
• Fetal DNA in maternal blood
• Highly accurate screen to detect T21 and T18
• Advantage?: result 10 days after blood draw. Fewest false pos.
• Does not screen for open neural tube defect
27. ~ 10% of DNA in maternal plasma is FETAL
Non Invasive Prenatal TestingNon Invasive Prenatal Testing
28. Placental origin
Increase during
pregnancy : 3-10 % of
total plasmatic DNA
Cleared from maternal
circulation in <24 h after
delivery
(1/2 life=15 min)
Non Invasive Prenatal Testing (NIPT)
Cell-free Fetal DNA
29.
30.
31. Benefits of Prenatal Diagnosis:
• Prenatal diagnosis determines the outcome of pregnancy.
• It is helpful for couples to decide whether to continue the pregnancy.
• It indicates possible complications that can arise at birth process.
• Prenatal diagnosis is helpful for the management of remaining weeks
of pregnancy.
• It prepares the couple for the birth of a child with an abnormality.
• Prenatal diagnosis can be helpful for the improvement of the
outcome of pregnancy using fetal treatment.
32. Pros & Cons:- Things to Keep in Mind
• Local resources - What prenatal screening options are available in your area?
• Not all that can be done must be done or is good to be done!
• PND is a couple’s (in the end the pregnant woman’s) free choice
• Information must be neutral and complete about all available options
• Informed choice - Before ordering the test, discuss benefits, risks and limitations
(screening vs. diagnosis)
• The ethical aspects need to be addressed thoroughly
• Each case should be an individual one
• Shared decision making
33. True Unexplained RPL? Impact of evaluation
• Current evaluation completed
• Test results all return as normal
• Chromosomes on POC are normal
• Subsequent live birth is 40% to 80%
• Depends on maternal age
• Depends on number of prior losses
• The most effective way to reduce
pregnancy losses, chromosome
abnormalities detected at the time
of prenatal diagnosis and the
demand for assisted reproductive
technology?
• Reverse the pattern of delaying
child-bearing until late in
reproductive life !!!!
34. Limitations
• True fetal mosaicism
• Confined placental mosaicism
• Maternal karyotype abnormality
• Insufficient counting due to low fetal fraction
• Sample from Vanishing twin
Depending on the methodology used, reasons for discordancy
between CFDNA results and fetal karyotype can include:
35. Guidelines / Genetics committee
SOGC Feb 2013
• Non-invasive prenatal testing using massive parallel sequencing of cell-free
fetal DNA to test for trisomy 21, 18, and 13 should be an option available to
women at increased risk in lieu of amniocentesis. Pretest counselling of
these women should include a discussion of the limitations of non-invasive
prenatal testing. (II-2A)
• No irrevocable obstetrical decision should be made in pregnancies with a
positive non-invasive prenatal testing result without confirmatory invasive
diagnostic testing. (II-2A)
• Although testing of cell-free fetal DNA in maternal plasma appears very
promising as a screening test for Down syndrome and other trisomies,
studies in average-risk pregnancies and a significant reduction in the cost of
the technology are needed before this can replace the current maternal
screening approach using biochemical serum markers with or without fetal
nuchal translucency ultrasound. (III-A)
36. The Other Half: What about Men and
Miscarriages?
• Men are half of the equation in a couple that is having recurrent miscarriages.
• Factors in men that may increase risk of miscarriage for a couple include
advanced age, obesity, chronic illness, environmental toxins, and lifestyle factors,
• The only test recommended by expert groups for a man in a RPL couple is a blood
test for karyotype to evaluate for a balanced translocation (genetic issue found in
3-5% of couples with RPL).
• Other tests like semen analysis, aneuploidy testing in sperm, DNA fragmentation,
and epigenetic testing have limited research and limited utility at this time.
• Lifestyle factors that focus on improving a man’s overall health and well-being
may be beneficial in decreasing miscarriage for the couple.
• The emotional impact of RPL on men is important to remember and address.
37. Possible role of male factors in
recurrent pregnancy loss
• Amongst male partners of women with RSA 3 (4%) had varicocele, 23 (30.6%)
had infection, 1 (1.3%) immunological and 1 (1.3%) had genetic abnormality
• Sperm motility, viability and sperm function tests were significantly lower in
the RPL group as compared to the control group (P = 0.000)
• Male factor might be a contributing factor towards RPL
• Both the partners should be evaluated
• Infection treated in both
Saxena P, Misro MM et al. Indian J Physiol Pharmacol.
2008 Jul-Sep;52(3):274-82
38. Preimplantation genetic diagnosis (PGD)
• Pre-implantation genetic diagnosis.
• Which genetic conditions are eligible for PGD ?
• Who determines whether a condition is eligible?
• The role of the clinical genetic service in the provision of this publically
funded process.
• The effect of resource constraints in the provision of PGD.
39. Pre-implantation genetic screening (PGS)
• Screening for large chromosomal imbalances (implantation failure, early
miscarriage, viable trisomies e.g. T21)
• Who is being offered this technology?
• Recurrent pregnancy loss
• Recurrent implantation failure
• Advanced maternal age
• ?Everyone
• What is the evidence to support use of PGS?
• Not currently covered in public system but offered by private fertility
providers
40. Preimplantation Genetic Screening (PGS)
• Conflicting evidence
• Improves implantation rate and live birth rate (Dahdouh, 2015. Fertil Steril 2015;
104:1503–1512. Meta-analysis 3 trials included)
• Intention to treat analysis. Among all attempts at PGS or expectant management among
recurrent pregnancy loss (RPL) patients, clinical outcomes including pregnancy rate, live
birth (LB) rate and clinical miscarriage (CM) rate similar. (Murugappan 2016; Human
Reproduction 31:1668–1674)
• PGS decreased chances of live birth in association with IVF. National improvements in live
birth and miscarriage rates reported with PGS in older women are likely the consequence
of favourable patient selection biases. (Kushnir 2016. Fertil Steril 106: 75–9)
• Concern of accuracy of diagnosis and high rate of false-positives. (Gleicher 2016. Reprod
Biol Endocrinol doi 10.1186/s12958-016-0193-6)
41. Limitations
• Mosaicism – some embryos considered
unsuitable for transfer develop into
healthy pregnancies (Greco 2015.
NEJM 373:2089–90).
• ?Couples choice to transfer non-
euploid embryo
• Pre and post test counseling essential
• Different platforms – inconsistent
results. Discordance in results seen in
published reports (Tortoriello 2016. J
Assist Reprod Genet 33:1467–1471)
42. Limitations of genetic testing
• Somatic mosaicism and operator error mean that genetic tests are
never 100% reliable.
• DNA testing can reveal mutations that are not necessarily expressed
as disease because, for example, they may occur in an unimportant
part of the gene, or the mutant allele is incompletely penetrant.
• Genetic testing may not detect all the disease alleles of a specific
gene.
• Genetic testing can introduce unwanted social and ethical problems.
43. SUMMARY
• Recurrent pregnancy loss is a psychologically stressful diagnosis for couples,
• in approximately 50% of cases, no cause will be found.
• The number of evidence-based practices available for guidance is limited.
• This confluence of factors presents a challenge for clinicians. However,
• in studies of interventions aimed at reducing rates of miscarriage in women with
otherwise unexplained RPL, control groups experience a live birth rate of up to
87% with no intervention.
• Thus, one of the most significant things we can do when caring for these complex
patients is to offer them emotional support and accurate information.
• As more work is done in this emerging area of reproductive science, we will be
able to shed more light on this complex problem.
Editor's Notes
I am Dr. Sujnanendra Mishra. BOGS Fogsian From Bolangir, feel proud to be here with my teachers, friends and colleagues.
I am confused, What to tell on a topic with little experience before an audience filled with experts on the matter. Shall try to deliver my commitment with humility.
Terminologies speaks its Confusing quality. RPL many terms many causes, Many solutions, Not full prove.
Terminologies
I think, Consensus on the matter has reached to define RPL as loss of two or more pregnancies proven sonologically or histologically.
Incidence of RPL has probably has its own mathematics. The ratio of about15% is maintained. Next loss will be 6.67 times rarer.
If we see the Relation of Age:- Sharp increase in incidence of RPL after 34 completed years. So also sporadic abortions on the left.
Human reproduction is remarkably inefficient; Only 420 are born alive out of 1000 fertilizations, nearly 70% of human conceptions do not survive to live birth. The stillbirth in india is highest in the world 7% to 14% in different states Odisha 8% Karnataka 14% (of course reported only) https://data.gov.in/node/92025/datastore/export/xls.
Just to recapitulate these are the causes.
RCOG green top Guidelines no 17 clearly recommends screening for TORCH in these cases should be abandoned.
The first are older nulliparous patients who have delayed childbearing until their late 30s or early 40s and present with recurrent pre-embryonic (<5 weeks) or embryonic (<10 weeks) miscarriages with or without infertility. In rare cases, they also will have interspersed second- and third-trimester fetal deaths. When the products of conception (POCs) from these patients are accessible and can be karyotyped, they most often display aneuploidy (eg, trisomies, triploidy, or less commonly, deletions and insertions). We really do not understand the pathogenesis of maternal age-associated chromosomal instability and there is not much that we can offer to these patients beyond encouragement, and ultimately donor egg in vitro fertilization.
The second RPL population consists of patients with recurrent severe fetal growth restriction and stillbirths, which generally occur at progressively earlier gestational ages. These patients have a heterogeneous set of etiologies that ultimately involve severe uteroplacental vascular insufficiency. Some are due to antiphospholipid antibody (APA) syndrome, others are associated with severe chronic hypertension with associated decidual vasculopathy, and a few are associated with poorly understood alloimmune etiologies like chronic intervillositis.1 Treatment options are also limited in this population, except for APA syndrome patients, who often benefit from heparin and low-dose aspirin therapy.
the third population of RPL patients. These women are generally younger, often multiparous, and prone to intermittent fetal loss at or after 10 weeks, although the occasional patient also presents with recurrent intermittent embryonic loss. As a general rule of thumb, these losses tend to occur around the same gestational age, or at least in the same trimester. Given the intermittent pattern of occurrence, genetic causes can be suspected. Indeed, in about 3% of RPL cases, usually involving early losses, a parental-derived unbalanced chromosomal translocation will be found.
Group 1 and 3 often have genetic causes.
Read the slide.
Improper Meiosis results in abnormal genetic content. Plants usually tolerate such mutation resulting in a different sepsis but animals can’t tolerate such changes. Few abnormalities may not be compatible to organogenesis which result in demise.
Slide
Not in all but there are indications where we can consider genetic testing.
Prevention must start before implantation at “0” trimester
Methods are many to enumerate but few are only in use. Here are all possible procedures under Non invasive and invasive.
Use of Ultrasound is applicable for few abnormalities with structural changes but simple and accurate.
Nipt detection rate for t21 is 99%. Maternal blood sample. 2-4% give no result due to technical reasons. Serum Integrated Prenatal Screening (SIPS). Integrated Prenatal Screening (IPS). Quadruple (“Quad”) Screen.
Pappalysin-1, also known as pregnancy-associated plasma protein A, is a protein encoded by the PAPPA gene in humans. First Trimester Combined Screening (FTS)
Combined screening includes a nuchal translucency scan and a blood test and is offered between 11 and 14 weeks of pregnancy. The Integrated and Serum Integrated tests require women to have two serum tests on different appointments for the risk result to be generated. Failing to attend the second appointment renders the test invalid and so there is a responsibility for busy healthcare professionals (usually a midwife) to trace defaulters and ensure they complete the screening cycle.
Nipt detection rate for t21 is 99%. Maternal blood sample. 2-4% give no result due to technical reasons. women choose NIPT as a first line test.