1. The document discusses recurrent pregnancy loss (RPL), defined as three or more consecutive miscarriages. Common known causes of RPL include genetic factors, immune factors, anatomic abnormalities, and endocrine issues.
2. Several areas of uncertainty around RPL are discussed, such as the effectiveness of interventions like hCG, progesterone, anticoagulation therapy, and "tender loving care". The definition and distinction between early fetal demise and early embryonic demise is also unclear.
3. More research is needed to better understand unexplained RPL and identify potential underlying causes that current tests cannot detect. Larger randomized controlled trials of treatments and multicenter studies are needed to expand knowledge of RPL.
Invited Lecture delivered by Dr Sujoy Dasgupta in a CME, sponsored by Serum Institute of India Pvt Ltd in the Convocation Ceremony of Interns at Sagor Dutta Medical College
Recurrent pregnancy loss (RPL), also referred to as recurrent miscarriage or habitual abortion, is historically defined as 3 consecutive pregnancy losses prior to 20 weeks from the last menstrual period.
This Presentation is made by Dr.Laxmi Shrikhande
Invited Lecture delivered by Dr Sujoy Dasgupta in a CME, sponsored by Serum Institute of India Pvt Ltd in the Convocation Ceremony of Interns at Sagor Dutta Medical College
Recurrent pregnancy loss (RPL), also referred to as recurrent miscarriage or habitual abortion, is historically defined as 3 consecutive pregnancy losses prior to 20 weeks from the last menstrual period.
This Presentation is made by Dr.Laxmi Shrikhande
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
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
Ovulation Stimulation Protocols for IUI - Dr Dhorepatil BharatiBharati Dhorepatil
What are important factors to be considered important
Ovarian reserve
Previous ovarian response
Basic hormone profile
Role of LH
Trigger
Luteal phase support
Pregnancy rate/cycle
Invited Lecture delivered by Dr Sujoy Dasgupta in the Annual Conference of ISAR (Indian Society of Assisted Reproduction) held at Kolkata in November, 2019
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.
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
Anti-Müllerian Hormone (AMH) is critical for physiologic involution of the Mullerian ducts during sexual differentiation in the male foetus.
In women,AMH is a product of the small antral follicles in the ovaries and serves to function as an autocrine and paracrine regulator of follicular maturation
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
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
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
Ovulation Stimulation Protocols for IUI - Dr Dhorepatil BharatiBharati Dhorepatil
What are important factors to be considered important
Ovarian reserve
Previous ovarian response
Basic hormone profile
Role of LH
Trigger
Luteal phase support
Pregnancy rate/cycle
Invited Lecture delivered by Dr Sujoy Dasgupta in the Annual Conference of ISAR (Indian Society of Assisted Reproduction) held at Kolkata in November, 2019
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.
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
Anti-Müllerian Hormone (AMH) is critical for physiologic involution of the Mullerian ducts during sexual differentiation in the male foetus.
In women,AMH is a product of the small antral follicles in the ovaries and serves to function as an autocrine and paracrine regulator of follicular maturation
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
An Obstetrics and gynecology presentation: A 20 years old single female undergraduate presents to the emergency unit with fever, lower abdominal pain and abnormal vaginal discharge of 5 days duration. Discuss her management
Menopause: Symptoms, Concerns, and Management StrategiesSummit Health
Presentation about menopause, including information about common symptoms such as hot flashes, sleeplessness, and weight gain as well as other physiologic changes such as bone loss and cardiovascular risks. Dr. Gibbons and Dr. Cummings will offer recommendations on treatment and management options that can help you navigate this important life transition.
A comprehensive guide to the management of hyperglycaemia in pregnancy aimed at the primary care physician and based on latest evidenced based criteria. Includes information from latest studies such as HAPO study and ACHOIS, and involves guidelines from the IADPSG, ADA, WHO and Malaysia.
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.
Oration delivered by Dr Sujoy Dasgupta at Yuvacon, conference organized by the BOGS (Bengal Obstetric and Gynaecological Society) held on 22-23 April, 2023
Are we giving much importance to AMH in infertility practice?Sujoy Dasgupta
Dr Sujoy Dasgupta delivered "Kamini Rao Oration" on "Are we giving much importance to AMH in infertility practice?" in East Zone Yuva FOGSI Conference organized by Imphal Obstetric and Gynaecological Society (IOGS) on 24 December, 2023
Differences in the endometrial transcript profile during the receptive period between women who were refractory to implantation and those who achieved pregnancy.
By Luis Alberto Velásquez Cumplido
Recurrent pregnancy loss is a significant redroductive medical problem, influencing 2%–5% of couples. ... Throughout the years, proof based medications, for example, surgical correction of uterine abnormalities or asprin and heparin for antiphospholipid syndrome have improved the results for couples with repetitive pregnancy loss.
Chromosomal Abnormalities in a Male Partner Who was a Candidate for Assisted ...Apollo Hospitals
Cytogenetic analysis was performed according to standard methods on cultured cells obtained from the patient with low sperm quality in respect of morphology and motility. The patients were interviewed about their histories and their reproductive problems, family background, and possible consanguinity.
Obstetric outcomes associated with second trimester unexplained abnormal mate...Apollo Hospitals
1) To compare the adverse obstetrical outcomes in the patient population with normal blood MoMs.
2) To determine the probability of occurrence of an adverse obstetric event in relation with abnormal maternal blood
analytes.
Setting up gynecological endoscopy servicesPriya Bhave.
This presentation is about setting up Gynecological endoscopy services: the components, the challenges and finally achieving and sustaining excellence.
Successful implantation of the embryos in the uterus after IVF cycle is about 20%. It represents the bottleneck in the procedure of in vitro fertilization and embryo transfer. In this presentation we look at factors affecting implantation and how to improve it.
While we depend more and more on research to make our clinical decisions, research misconduct is a malady that seriously undermines the credibility of the evidence generated. It is universal, ubiquitous and more common than we know
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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.
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
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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.
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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
2. Dr. Priya Bhave Chittawar
MBBS 1999( Gandhi Medical College, Bhopal): with distinction in 8 subjects and 15
gold medals. Awarded 'Dr.Vishal Vikram Singh Award' for highest marks in MBBS
(1994-1999). President of India Dr. Shankar Dayal Sharma Award for the Best
Outgoing student MBBS (1994-1999).
Served in various capacities in the Students Union and awarded " Dr. Suresh Kak
Memorial Award for best All Rounder MBBS 1994-1999)
Fellowship in Reproductive Medicine (Christian Medical College, Vellore) 2008-
2010 : passed with distinction
Awarded by the Chief Minister Shri Shivraj Singh Chouhan in June 2008 for
exemplary work in emergency Obstetrics
Best Paper award for thesis on Role of GnRH antagonists in IUI- ISAR 2010
Best Paper award in ISAR 2012 for paper on “ Hysteroscopic Management of
adenomyotic myometrial cysts”
Author of Cochrane review ( Menstrual disorder and
subfertility group)
Author of Cochrane sexually transmitted infections group.
3. Nagpur Obs Gyne society
Dr. D. K. Tank Foundation
AOFOG
Merck Serono
Thanks!
4. The stories that end badly are sad, sadder still
are the ones that never began….
5.
6. What we know: KNOWN KNOWN
What we know we do not know:
KNOWN UNKNOWN
What we know but do not do:
UNKNOWN KNOWN
What we do not know that we do
not know
UNKNOWN UNKNOWN
OUTLINE….
9. Three or more consecutive
miscarriages
Risk of miscarriage in is 30% after 2
losses, 33% after 3 losses among
patients without a history of a live
birth.
15% sporadic miscarriage
By chance alone 1 in 300 couples
What?
10. Age
Genetic : embryonic and parental
Immune: autoimmune/alloimmune
Anatomic
Endocrine
Others
Why?
12. Nondisjunction during meiosis
Autosomal trisomy, monosomy X,
triplody, tetraploidy, translocations
Incidence increases with maternal
age
60% of conceptus
Genetic: Embryonic
13. Carriers of balanced chromosomal
abnormalities
3-5% of RPL couples
Risk of severely handicapped child
due to aneuploidy
Chances of miscarriage greater than
those of RPL couples who are not
carriers ( 49% vs. 30%).
(Franssen,BMJ;2006)
Genetic: paternal
16. Antiphospholipid antibody
syndrome: 15% women with RPL vs
2% with low risk Obs. hist
ACA, LA , anti beta2 glycoprotein 1
antibody
Trophoblast function, activation
complement at fetal maternal
interface, thrombosis at placental villi
Without heparin, LBR<10%
Alloimmune
17. Septum: partial, complete
Bicornuate, unicornuate uteri
Poor vascularity of the septum,
disordered myometrial
contractions
1.8-37% of RPL couples
Anatomic
19. History including family history of
miscarriages, Toxin exposure
Age, BMI,Examination; Ultrasound
TSH, HbA1c, VDRL, ACA, LAC,
Anti Beta 1 glycoprotein
Karyotyping
Karyotyping of products of
conception
Workup
25. Not a valid cause of infertility or
RPL
Reflection of an inadequate
follicular phase or an incompetent
pregnancy (Bukulmez,
OGClinNA,2004)
Luteal Phase defect
26. Similar rate of aneuploidy of products
of conception (Lathi, JARG,2007,24;
Munoz, FS,2007,94:7)
Type of aneuploidy might differ
(viable autosomal trisomies( 9,13,21)
and monosomy X significantly lower
when no fetal pole seen
Early embryonic demise is similar
event occurring earlier temporally.
Early fetal demise vs. early
embryonic demise
27. Recommended in third miscarriage ( Greentop
no 17)
Maternal tissue contamination (
Jarret,AJOG,2001)
Failure to grow ( 20-30%)
Failure to look for other causes
Abnormal embryonic dev reported with
normal karyotype ( dimorphic embryos) with
embryoscopy.
Villi have to separated from maternal tissue
Microsatellite analysis: differentiate from
maternal tissue
Karyotyping of POC
28. Only if karyotyping of POC reveals unbalanced
numerical defects ( Greentop)
In all cases of RPL ( ASRM)
In couples at high risk of being carriers (
risk=>2.2%) (ESHRE)
Parental Karyotyping
29. Low maternal age at second miscarriage,
A history of three or more miscarriages
A history of two or more miscarriages in a
brother or sister
A history of two or more miscarriages in the
parents of either partner
increase the probability of carrier status(
Jauniaux, HR,2006)
Parental Karyotyping
30.
31. 1. Normal karyotype in the conceptus
2. Carrier status of same balanced structural
abnormality
3. Unbalanced structural abnormality1% (
Miscarriage, Stillbirth, child with handicap)
chances of having a healthy child are as high as
for non-carrier couples (over 80%)
Chances of subsequent miscarriage higher
(50%) compared to non carrier couples with
RPL (30%)
(Franssen,BMJ;2006)
Consequences of carrier state
32. LBR in PGD group 31%
LBR in natural conception 55.5%
Miscarriage rate in PGD group 0-
50% ( median 0%)
Miscarriage rate in natural
conception 34%
( Franssen, HR,2011)
PGD for carrier couples
33. Cochrane: A statistically significant
benefit in using hCG (risk ratio
(RR) 0.51, 95% confidence interval
(CI) 0.32 to 0.81; five studies, 302
women ( Jan 2013)
HCG for RPL
35. High heterogeneity ( 39%)
After excluding data from poorly
designed studies, revised RR 0.74
(CI 0.44 to 1.23).
Small numbers
Chromosomal analysis not carried
out
HCG for RPL
36.
37. PROMISE trial underway
760 women randomised
Immunomodulatory action:
upregulate TGF-β secretion in
response to trophoblast, blocks Thl
immunity to trophoblast.
Upregulates STAR
Myometrial relaxation
Progesterone for RPL
38. Three small non randomized trials
(Stray-Pederson, Liddel 1991,
Clifford 1997)
Control groups not matched and
small
No testing for APS
Livebirth rates claimed to increase
by 50% for groups receiving TLC
Tender loving care…
39. Combined aspirin/heparin
treatment versus placebo in women
with unexplained RM (
Kaandorp2010, NEJM)
NO difference in LBR
Significant side effects in treatment
group
Anticoagulation for
unexplained RPL
40. HepASA trial: no difference in LBR
between ASA alone versus ASA
and heparin (Laskin, Journal of
Rheumatology,2009)
Trial stopped prematurely due to
equivalent LBR in both groups.
Anticoagulation for RPL with
ANA/thrombophilia
44. Luteal phase defect
Early fetal demise and early embryonic
demise
Karyotying of POC
Parental karyotyping
HCG and progesterone for RPL
TLC
Anticoagulation for unexplained RPL
Anticoagulation for ANA/thrombophilia
45. Type 1 unexplained RPL: occurring by
chance
Type 2 unexplained RPL: due to an
underlying pathology that is not
currently identified by routine clinical
investigations or due to significant
environmental and lifestyle risk
factors. Younger women, higher order
miscarriages
(Saravelos, HR2012)
Unexplained RPL
47. Think septum!
A good 2D TVS.
HSG/office hysteroscopy
LBR 85% after septal resection.
Doing what we know…
48. Pool our knowledge and patient
base
Well designed RCT looking at
treatments for RPL
Multicentric
Trying to know the
unknown..
49. When you know something, to hold
that you know it. When you do not
know a thing, to allow that you do
not know it, this is knowledge
Confuscious
THANKS !!!