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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.
The emergence of early pregnancy units into clinical practice demands educational support and the development of clear guidelines. For the inquisitive trainee, the array of information portals, both paper and electronic, can be bewildering leading to initial confusion about where to start.
This book provides a useful vade mecum that allows a ready and accurate reference source as well as encouraging more complex reading and critical analysis for those that aspire to improved practice. This compendium represents an excellent primer while providing a solid foundation from where to start.
It makes another useful addition to a burgeoning series.
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.
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.
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.