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Updated in light of recent research findings on fertilization, implantation and early pregnancy, this new edition combines the expertise of a wide range of internationally renowned authors to produce an authoritative, multidisciplinary approach to the management of first-trimester complications. Several international guidelines and consensus statements have been released since publication of the first edition and this has stimulated new focussed research questions that are addressed. The book's key recommendations provide clinicians with the tools to improve the patient's experience of the management of first-trimester complications. By combining essential elements of scientific research and clinical care, Early Pregnancy continues to set a benchmark for evidence-based management and will be essential reading for obstetricians, gynaecologists, neonatologists, ultrasonographers, and nurses seeking an understanding of the reproductive science of early pregnancy.
This chapter reviews the available literature on the clinical assessment of the endometrium. It focuses on the tools available to diagnose and treat both infertility and pregnancy loss. Infertility and recurrent pregnancy loss are often attributable to implantation failure. The mechanism of implantation varies widely between species, reflecting the evolving conflicts between maternal and embryonic interests. Serum progesterone measurements are a mainstay of hormonal assessment to document ovulation and appear to correlate well with endometrial biopsy results. Doppler flow studies are non-invasive ultrasound methods used to evaluate the blood flow to the uterus and endometrium. Causes of repeat in-vitro fertilization (IVF) failure that are related to endometrial receptivity defects have recently been reviewed. Cost and side effects of treatments will be reduced as clinical assessment of the endometrium yields more information about the causes of infertility or pregnancy loss.
In recent years ultrasound diagnosis and improved understanding of problems related to early pregnancy have led to the introduction of medical and expectant management of miscarriage and selected cases of ectopic pregnancy. The commonest early pregnancy complication of spontaneous miscarriage occurs in approximately 15-20% of all pregnancies, as recorded by hospital episode statistics. The embryonic period occupies the first 8 postfertilization weeks, during which organogenesis takes place. Gynecologists and ultrasonographers acknowledge the embryonic period by speaking about fetal heart action and fetal activity before the end of organogenesis. Between 1% and 2% of fertile women will experience recurring miscarriage (RM). Recent papers testify to the high rate of abnormal chromosome type when pregnancy loss has occurred. By actuarial analysis, the success rate for the next pregnancy can be reasonably predicted based on maternal age and number of losses. High-resolution transvaginal ultrasound provides surveillance and reassurance for the majority of women.
The incidence of congenital uterine anomalies in the general population is between 0. 4% and 3. 2%. This chapter describes the principles of ultrasound diagnosis of uterine anomalies and compares the results with other available diagnostic modalities. The gold standard in the diagnosis of congenital uterine anomalies used to be a simultaneous laparotomy/ laparoscopy and hysteroscopy to visualize the serosal surface of the uterus and the endometrial cavity. The real breakthrough in ultrasound assessment of congenital uterine anomalies was the development of three-dimensional transvaginal probes. This technique involves the acquisition and storage of a volume of ultrasound information. Magnetic resonance imaging (MRI) has been shown to be effective for the diagnosis of congenital uterine anomalies with sensitivity and specificity up to 100%. The advent of three-dimensional ultrasound has greatly enhanced the ability to diagnose congenital uterine anomalies in an outpatient setting.