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  3. Early Pregnancy
  • Cited by 12
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    • Publisher:
      Cambridge University Press
      Publication date:
      05 October 2010
      09 September 2010
      ISBN:
      9780511777851
      DOI:
      https://doi.org/10.1017/CBO9780511777851
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      • Subjects:
      Obstetrics and Gynecology, Reproductive Medicine, Medicine
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    Subjects:
    Obstetrics and Gynecology, Reproductive Medicine, Medicine
    Information

    Book description

    Problems in early pregnancy are among the most common conditions in gynaecology and obstetrics, and in recent years have become an increasingly studied and important field of reproductive medicine. Early Pregnancy is the first book to embrace a multidisciplinary approach to this rapidly growing field. It combines the expertise of a wide range of internationally renowned authors to produce an authoritative reference on the subject, aiming to improve patient care in early pregnancy by making key recommendations for clinicians. The chapters cover a wide range of core subjects as well as addressing the latest developments by translating research into clinical practice. By bringing together essential elements of scientific research and clinical care Early Pregnancy sets a new benchmark for evidence-based patient care and will be essential reading for all clinicians, nurses, trainees and scientific researchers with an interest in early pregnancy.

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    Contents

    Page 2 of 2

    Contents
    • Chapter 25 - Vanishing twin syndrome and long-term outcome
      pp 267-276
    • View abstract

      Summary

      This chapter describes the biological processes and some of the molecular mediators required during early implantation events and illustrates the clinical consequences when these processes are perturbed. Implantation occurs at approximately 6-7 days after fertilization. Initial adhesion of the blastocyst to the uterine wall, termed apposition, is unstable. The temporal and spatial expression of several growth factors, cytokines and adhesion molecules within the uterus and pre-implantation blastocyst suggests that they may play important roles. Reproductive pathologies resulting from implantation defects span a spectrum of clinical presentations ranging from infertility to recurrent pregnancy loss to pre-eclampsia. Infertility may result from failure of fertilization or from loss of the fertilized blastocyst prior to implantation. Pre-eclampsia, a clinical syndrome characterized by hypertension and proteinuria that develops after 20 weeks' gestation, is the leading cause of maternal mortality in the industrialized world and increases perinatal mortality five-fold.
    • Chapter 26 - Late pregnancy loss
      pp 277-286
    • View abstract

      Summary

      This chapter describes the principal putative causes of implantation failure and reviews therapeutic strategies. Recurrent implantation failure is a significant and distressing clinical problem. Adjuvant medical therapies to those required for ovarian hyperstimulation are frequently applied for improving embryo implantation and particularly when the clinician is faced with recurrent implantation failure. The appropriate management of the medically complicated patient presenting for in-vitro fertilization (IVF) can be complex and often requires an interdisciplinary approach. Standard ovarian hyperstimulation and the resultant supraphysiological estradiol levels have been shown to impact negatively on endometrial receptivity and embryo quality. Studies of mild ovarian stimulation regimens have shown encouraging results. Although fewer embryos are obtained, an increased percentage of euploid embryos per number of oocytes retrieved have been reported. Significant improvements in clinical pregnancy rates can be achieved by giving due attention to embryo transfer technique.

    Page 2 of 2

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