CRC RECURR PREG LOSS PDF

Foreword

In almost all traditions, the importance of procreation is inherent in man's very creation; both Old and New Testaments of the Bible refer to the tragic plight of barren women, eloquently describing the pain and agony of childlessness. However, records dated far earlier than the Bible con‹rm that fertility has been a constant fundamental priority and preoccupation, in all societies, throughout the ages of man. Fertility symbols are clearly identi‹ed in the relics of prehistoric times, of ancient civilizations in all parts of the world, a recognition of the concept that man's existence depends upon the renewal of fertility. The above quotation was written by Sophocles 2500 years ago. The ancient Canaanites and Greeks had gods of fertility—Ashtarte and Hermes. Today infertility is recognized as a disease by the World Health Organization, and numerous health care providers throughout the world. Recurrent pregnancy loss represents one aspect of disordered fertility. Recurrent pregnancy loss has been described as the "orphan" of infertility as this condition is often overlooked in the larger process of research and management of fertility. Recurrent pregnancy loss is a heterogeneous condition, with numerous causes, and numerous treatment options. It is multidisciplinary, involving gynecology, genetics, endocrinology, immunology, pediatrics and internal medicine. Whatever the cause and possible treatment, the psychological implications are enormous. Both partners may feel that they have failed in their parenting role. Couples have divorced with mutual recriminations, each blaming the other. Even when pregnancy does succeed, the pregnancy may be fraught with the fear of another loss. This anxiety is multiplied when the diagnosis remains unexplained

The second edition of this book will be welcomed by many investigators and clinicians working in the ‹eld of recurrent pregnancy loss. As in the ‹rst edition, there are chapters governing basic scienti‹c topics such as genetics, cytokines, mechanisms of action of antiphospholipid antibodies, and signaling between mother and fetus. The major advances in genetics, immunology, endocrinology, and thrombotic mechanisms have been described in depth. The methodology of clinical research and the application of evidence-based medicine to clinical practice have been explained comprehensively. The problems of mid-trimester loss and late obstetric complications are aired, including the problems associated with extreme prematurity and possible resulting handicaps. However, as is inevitable in clinical practice, there are many controversies, leaving the clinician in a quandary as to how to help the patient. The debates and opinion chapters have been thoroughly updated, but are still as debatable as they were in the ‹rst edition of this book. There is a new chapter on Chinese medicine (Chapter 41), and the underlying scienti‹c evidence which is most thought-provoking and fascinating.

However, at the end of the line is a patient. Therefore the chapter on psychological mechanisms and the connection between psychological mechanisms, the immune and other systems is welcome. The story told by the patient in Chapter 42 is most touching, and reminds us of the real problem at hand.

It is hoped that this book will be read by specialists working in recurrent pregnancy loss clinics, and associated disciplines, who wish to keep up to date, and generalists who wish to gain a comprehensive view of developments in the ‹eld. It is to be hoped that the advances in scienti‹c and clinical knowledge will continue as in the past, in order to improve the management of the patients and allow those still unable to have children, to ful‹ll this most basic of human desires.