review the evidence (RCT & meta-analyses) concerning the best practices in contemporary Recurrent Pregnancy Loss and Thrombophilia depending on Eshre guideline 2017 and other EBM sources.
review the evidence (RCT & meta-analyses) concerning the best practices in contemporary Recurrent Pregnancy Loss and Thrombophilia depending on Eshre guideline 2017 and other EBM sources.
This presentation has a complete description of Vulvo-Vaginal hematoma, its causes , clinical features and management strategy. Hematoma can happen in case of episiotomy given during childbirth
PREGNANCY OF UNKNOWN LOCATION DR. SHARDA JAIN DR. JYOTI AGARWAL DR. JYOTI BH...Lifecare Centre
PREGNANCY OF UNKNOWN LOCATION DR. SHARDA JAIN DR. JYOTI AGARWAL DR. JYOTI BHASKAR
WHY THIS PPT ??
One of our of patient’s was discharged home with presumed COMPLETE miscarriage.
Subsequently returned with pain abdomen , bleeding & ruptured EP
…We thought of reviewing
PRENANCY OF UNKNOWN LOCATION
Science, practice and evidence are dynamic processes. This is typically vivid when it relates to Polycystic Ovarian Syndrome. PCOS is the commonest hyperandrogenic disorder in women and one of the most common causes of ovulatory infertility. Although polycystic ovaries were first described by the Italian scientist Vallisneri in 1721, it was largely forgotten until the 1930s, and then renamed after its rediscoverers as Stein-Leventhal syndrome. Even then, it still wasn’t until the invention of the ultrasound scanner in the 1980s and consensus of diagnosis in the early 1990s that PCOS was recognized on a wider scale in women of reproductive age. When attempting to diagnose with precision something that is complex, it is important that we first clearly define what it is we are trying to diagnose. PCOS is today seen as a heterogeneous syndrome where a range of symptoms may be present or absent, and may overlap with other conditions, it is perhaps best viewed as a spectrum of symptoms, pathologic findings and laboratory abnormalities. PCOS can be difficult to conceptualize, even for experts, as shown by the fact that there have been several different ways of diagnosing it over the years.
More recently, the fundamental role of hyperandrogenism has been pointed out.
However, PCOS compromises other pathological conditions that strongly modify the phenotype and play a dominant role in the pathophysiology of the disorder, including insulin resistance and hyperinsulinemia, obesity and metabolic disorders, all favoring together with androgen excess, an increased susceptibility to develop type 2 diabetes mellitus (T2DM) and, possibly, cardiovascular diseases. PCOS by itself may also have some genetic component as documented by familial aggregation and recent genetic studies. All the clinical features may however change throughout the lifespan, starting from adolescence to postmenopausal age. Therefore, PCOS should be considered as a lifetime disorder.
I sincerely hope that with the recommended readings attached and lecture, you will be able to strengthen your knowledge, thereby providing evidence-based medicine practice for the management of PCOS in a successful manner to improve and better women’s Health care. The best investment you can make is an investment in yourself. The more you learn, the more you’ll earn (Warren Buffett), so read as much as you can.
Thank You.
Regards: Rafi Rozan
Endometrial hyperplasia - irregular proliferation of the endometrial glands with an increase in the gland to stroma ratio when compared with proliferative endometrium
Endometrial Ca - most common gynaecological maglinancy in the western country, endometrial hyperplasia as the precursor
Incidence of endometrial hyperplasia 3 folds higher than endometrial Ca
Fourth most common cancer in women in Peninsular Malaysia
By: Mark Meissner, M.D.
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
This presentation has a complete description of Vulvo-Vaginal hematoma, its causes , clinical features and management strategy. Hematoma can happen in case of episiotomy given during childbirth
PREGNANCY OF UNKNOWN LOCATION DR. SHARDA JAIN DR. JYOTI AGARWAL DR. JYOTI BH...Lifecare Centre
PREGNANCY OF UNKNOWN LOCATION DR. SHARDA JAIN DR. JYOTI AGARWAL DR. JYOTI BHASKAR
WHY THIS PPT ??
One of our of patient’s was discharged home with presumed COMPLETE miscarriage.
Subsequently returned with pain abdomen , bleeding & ruptured EP
…We thought of reviewing
PRENANCY OF UNKNOWN LOCATION
Science, practice and evidence are dynamic processes. This is typically vivid when it relates to Polycystic Ovarian Syndrome. PCOS is the commonest hyperandrogenic disorder in women and one of the most common causes of ovulatory infertility. Although polycystic ovaries were first described by the Italian scientist Vallisneri in 1721, it was largely forgotten until the 1930s, and then renamed after its rediscoverers as Stein-Leventhal syndrome. Even then, it still wasn’t until the invention of the ultrasound scanner in the 1980s and consensus of diagnosis in the early 1990s that PCOS was recognized on a wider scale in women of reproductive age. When attempting to diagnose with precision something that is complex, it is important that we first clearly define what it is we are trying to diagnose. PCOS is today seen as a heterogeneous syndrome where a range of symptoms may be present or absent, and may overlap with other conditions, it is perhaps best viewed as a spectrum of symptoms, pathologic findings and laboratory abnormalities. PCOS can be difficult to conceptualize, even for experts, as shown by the fact that there have been several different ways of diagnosing it over the years.
More recently, the fundamental role of hyperandrogenism has been pointed out.
However, PCOS compromises other pathological conditions that strongly modify the phenotype and play a dominant role in the pathophysiology of the disorder, including insulin resistance and hyperinsulinemia, obesity and metabolic disorders, all favoring together with androgen excess, an increased susceptibility to develop type 2 diabetes mellitus (T2DM) and, possibly, cardiovascular diseases. PCOS by itself may also have some genetic component as documented by familial aggregation and recent genetic studies. All the clinical features may however change throughout the lifespan, starting from adolescence to postmenopausal age. Therefore, PCOS should be considered as a lifetime disorder.
I sincerely hope that with the recommended readings attached and lecture, you will be able to strengthen your knowledge, thereby providing evidence-based medicine practice for the management of PCOS in a successful manner to improve and better women’s Health care. The best investment you can make is an investment in yourself. The more you learn, the more you’ll earn (Warren Buffett), so read as much as you can.
Thank You.
Regards: Rafi Rozan
Endometrial hyperplasia - irregular proliferation of the endometrial glands with an increase in the gland to stroma ratio when compared with proliferative endometrium
Endometrial Ca - most common gynaecological maglinancy in the western country, endometrial hyperplasia as the precursor
Incidence of endometrial hyperplasia 3 folds higher than endometrial Ca
Fourth most common cancer in women in Peninsular Malaysia
By: Mark Meissner, M.D.
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
Thrombophilias are hypercoagulable conditions that can be acquired or inherited. Most important hypercoagulable conditions =, testing procedures, duration of anticoagulation will be discussed here. Useful for Internal Medicine Boards and Hematology boards. Some aspects on duration of anticoagulation, HIT are high-yield for USMLE exams.
Interesting Update on Recurrent Miscarriage for Indian Gynaecologoists D...Lifecare Centre
OUTLINE….of RM
* KNOWN KNOWN What we know & we DO: **KNOWN UNKNOWN What we know but do not do: ***UNKNOWN KNOWN What we know that we do not know ****UNKNOWN UNKNOWN TOTALLY NEW .. Future
Invited Lecture delivered by Dr Sujoy Dasgupta in National Youth Conference, held at Patna in August 2019. This session was sponsored by Bharat Serum and Vaccines
Thrombophilia are hereditary and/or acquired conditions that predispose patients to thrombosis.
The association between thrombophilia and recurrent pregnancy loss (RPL) has become an undisputed fact.
Women with heritable or acquired thrombophilic disorders have significantly increased risks of pregnancy loss
The Newer Concepts In Endometriosis Management : Dr Sharda JainLifecare Centre
The Newer Concepts In
Endometriosis Management
ENDOMETRIOSIS IS ENIGMA
DIAGNOSTIC DELEMMA
DEBILITATING DISEASE QOL
PROGRESSIVE DISEASE
RECURRENCE IS BIG PROBLEM
NO FINAL VERDICT ON CAUSE
NO PERMANENT CURE
The exact prevalence of endometriosis is unknown, but estimates 10% in the general female population in India but up to 50% in infertile women
The Newer Concepts for Reduced Surgery to preserve fertility in Endometrios...Lifecare Centre
The Newer Concepts for Reduced Surgery to preserve fertility in Endometriosis
ENDOMETRIOSIS IS ENIGMA
DIAGNOSTIC DILEMMA
DEBILITATING DISEASE QOL
PROGRESSIVE DISEASE
RECURRENCE IS BIG PROBLEM
NO FINAL VERDICT ON CAUSE
NO PERMANENT CURE
The exact prevalence of endometriosis is unknown, but estimates 10% in the general female population in India but up to 50% in infertile women
Anemia Free India Gynaecologist to focuss on *12gm Haemoglobin at Delivery I...Lifecare Centre
Important Highlights
Prophylactic Iron and Folic Acid Supplementation in all six target age groups.
Intensified year-round Behaviour Change Communication (BCC) Campaign for:(a) improving compliance to IFA and deworming, (b) enhancing appropriate infant and young child feeding practices, (c) encouraging increase in intake of iron-rich food through diet and/or fortified foods (d) ensuring delayed cord clamping .
Testing and treatment of anaemia, using digital methods and point of care treatment, with special focus on pregnant women and school-going adolescents.
Addressing non-nutritional causes of anaemia
in endemic pockets with special focus on malaria, hemoglobinopathies and fluorosis
Strategies for Improving Success Rates in ART PARTLifecare Centre
Strategies for Improving Success Rates in ART
Part - 2
Strategies for Improving Success Rates in ART
Tailoring Controlled Ovarian Stimulation
Strategies for Luteal Phase in ART cycles
Endometrial Receptivity Array
How to optimize success rates in ART? : Dr Sharda JainLifecare Centre
How to optimize success rates in ART? : Dr Sharda Jain
How to improve success rates in ART?
The big debate कार्य में आनंद
Evolution of In-vitro Fertilization (IVF)
Factors Influencing IVF Success Ist Part
Strategies for Improving Success Rates in ART Second Part
Innovations & Breakthroughs in IVF Part Three
OPEN DEBATE
SOCIALEGG FREEZING : Dr Poorva Bhargav and Dr Sharda JainLifecare Centre
SOCIALEGG FREEZING : Dr Poorva Bhargav and Dr Sharda Jain
Introduction
Social egg freezing (oocyte cryopreservation for non-medical reasons) has evolved as a proactive option for women looking to extend their reproductive possibilities past their peak childbearing years
It is the process of saving or protecting eggs, or reproductive tissues so that a person can use them to have biological children in future
3. How much is the problems of
R.P.L.
15-20% of clinically detectable
pregnancies abort
5% women have RM > 2
1 % woman have RM > 3
4. Should we start after Investigation
the couple after 2nd
abortion
Yes
Women with 2 losses have identifiable problems just
as frequently as women with 3 or more losses; thus,
evaluation for causes may be initiated after 2 losses.
7. Unexplained R.P.L.
In 50% of R.P.L. cases - cause remains
undetermined
While exiting new work has focused On
• Thrombophilia
• Spermatazoal
• Embryonic and
• Endometrial characteristics to explain bad
implantation & subsequent pregnancy loss
• Tubercular endometritis
Last Word is Still Missing !
8. We Run Dedicated
Recurrent Pregnancy Loss Clinic
since 2003
Our Experience of 736 Recurrent
consecutive Miscarriages – Updated
(30th
Jan 2015)
9. ANATOMICAL /UTERINE
22.4 % Jan 2013
21% Jan 2015
INFECTIONS – Tuberculosis 39 % 33%
TB + TNF a ↑ 31% 35%
GENETIC 2.8 % 3.6%
Karyotype (Products of Conceptions) 66 % (219/348) 78%
ENDOCRINE CAUSES
- ↑ Glycosylated HB 16%
15%
- S/C Hypothyrodism 26 % 21%
- Thyroids Anti Bodies + 9 % 11%
- PCOD – ↑ LH 14% 17%
- LPD 22%
AUTOIMMUNITY
Apla Syndrome 6% 8%
Thrombophilia 3 % 7%
Diagnosis and Management of Recurrent Pregnancy Loss
In
50%
More
Than
1
cause
10. Autoimmune factors as the cause of RPL
is well established entity
screened by following tests done
1. Antiphospholipid antibody syndrome
• Anticardiolipin antibodies
• Lupus anticoagulant
• B2 Glycoprotein antibodies
11. Clinical and laboratory characteristics of
antiphospholipid antibody syndrome
Clinical Laboratory
Pregnancy morbidity – igG anticardiolipin
>1 unexplained death at >10 wk or – igM anticadiolipin
Delivery at <34wk with severe pregnancy-induced
hypertension or – Positive Lupus anticoagulant test
>3 losses before 10 wk – igG anti-b2 glycoproteine 1 a
Thrombosis – ig M anti-b2 glycoproteine 1 a
Venous –
Arterial, including stroke –
12. Points Favouring auto immune
factor as the cause of RPL
• Many previous spontaneous abortions
• No recent full term pregnancies
• Less than 35 yrs old
• Aborted concepts with normal keryotype
• Usually at least one loss after first
trimester
14. Recurrent Pregnancy loss panel
assesses laboratory and genetic
parameters which we use to detect
congenital / inherited thrombophilia
(Protien C activity, Protein S activity,
Homocystein, antithrombin III activity
factor V mutation detection)
22. THROMBOPHILIA-Associated with RM
How common?
• About 50% to 60% of patients with
recurrent miscarriages harbor a
coagulation defect.
• Identification of the defect, followed by
appropriate therapy, will lead to normal-
term delivery in 98%.
Roger L.Bick, Dec. 2004 Medscape
23. ACQUIRED AND CONGENITAL
THROMOBOPHILIAS
• 66% of RPL cases have atleast one
thrombophilic defect compared to 28%
controls.
• Two defects found in 21% of patients
Sarig G etal fertil steril 2002
These datas suggest that
hypercoagulable states might be an
important Factor for RPL
24. Thrombophilia - Complications
Abortion IUFD PIH
Factor V Leiden mut. ++ ++ ++
APC Resistance + ++ ++
Hyperhomocysteinemia. + + +
Antithrombin III def. ++ ++ +
Protein C deficiency + ++ +
Protien S deficiency + ++ +
25. Till now we were doing following
R.P.L. Panel
For APLA syndrome
• Lupus anticoagulant (Clotting assays)
• Anticardiolipin antibosy (ELISA)
THROMBOPHILIA
• Factor V Leiden (APCR* with genetic confirmation
of abnormal results).
• Prothrombn G20210A (genetic test)
• Antithrombin and protein C (function assays)
• Protein S (Function assay and immunology assay)
• Fasting homocysteine level
27. Key points & Recommendations
ACOG 2014
• Historically & in
today’s practice ,
much controversy
has existed
regarding the
association of
inherited
thrombophilias with
adverse pregnancy
outcomes.
Obstet. & Gynae clinics of north america
March 2014-volume 41 – number 1
28. The current 2014 march guidelines do not
recommend screening for thrombophilia
unless a personal history of
Venous thromboembolism is present.
Key points & Recommendations
ACOG 2014
Obstet. & Gynae clinics of north america
March 2014-volume 41 – number 1
29. But our survey in East Delhi among
Gynaecologists on screening pattern of R.P.L.
has suggested that up to 50% Gynaecologists
in Delhi screen contrary to the current
ACOG guidelines
30. Rationale of ACOG Recommendation on
R.P.L. & Thrombophilia
A large controversy has existed in the recent past around
the utility of screening for inherited thrombophilias in
women with a history of adverse pregnancy outcome or
loss.
Several strong arguments exits against screening in this
population. Perhaps most importantly, only weak
association have been found between hypercoagulability
and pregnancy outcome;
NO CAUSATIVE RELATIONSHIP HAS BEEN ESBLISHED
Obstet. & Gynae clinics of north america
March 2014-volume 41 – number 1
31. Rationale of ACOG Recommendation
on R.P.L. & Thrombophilia
From the standpoint of
thromboembolism prevention, some
argue that inherited genetic
aberration in clotting proteins are less
likely to be significant in the absence
of a thromboembolic event which has
shown to be cost – ineffective
Obstet. & Gynae clinics of north america
March 2014-volume 41 – number 1
32. Because of these positions & facts
recommendation are against screening for
thrombophilia in RPL cases
Hence these test should be removed from
RPL panel
“Single Take Home Message”
Rationale of ACOG Recommendation on
R.P.L. & Thrombophilia
Obstet. & Gynae clinics of north america
March 2014-volume 41 – number 1
33. ADDRESS
11 Gagan Vihar, Near Karkari
Morh Flyover, Delhi - 51
CONTACT US
9650588339, 011-22414049,
WEBSITE :
www.lifecarecentre.in
www.drshardajain.com
www.lifecareivf.com
E-MAIL ID
Sharda.lifecare@gmail.com
Lifecarecentre21@gmail.com
info@lifecareivf.com
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