Subject Index

Abdomen, rigidity 4 Abnormalities

anatomical 113 carbohydrate 32-3 congenital

and abortion prevention 195 and fertility drugs 136-7, 140 and IVF 141-4 rare 150 and recurrent abortion 109 uterine 58-9

cytogenetic 22-4, 30 endocrine 105-6, 110 focal 50 karyotypic 49, 196 menstrual 33, 191 pelvic 178 structural 23 thyroid 32 uterine 70, 73 see also Chromosomes

Abortifacients 39, 123 Abortion

alloimmune factors 35 aneuploid 30 autoimmune factors 35 biochemical 135 clinical 135 complete 75, 77

and ectopic pregnancy 172, 177 and incompetent cervix 188

criminal 120 current legislation 9 following invasive diagnostic procedures 149-57 hydropic 51, 54-5 illegal 120-2, 151 incomplete 75, 77

and ectopic pregnancy 161, 175 endocrine treatment 199-200 and incompetent cervix 188-9, 191 sepsis 119-20, 124 and septic abortion 4

induced 5, 120, 199 with chemical agents 126 and contraception 18 and fetal death rate 11

inevitable 2, 4 influence of drugs used in assisted conception

135-40 late 11, 55, 103 liberalisation of laws 124, 130 material

anatomo-pathological classification 49-51

cytogenetic analysis 108 histological classification 51-5

missed 3, 68, 75-8, 152 and ectopic pregnancy 172, 175 endocrine treatment 199-200 unrecognised 24 and uterine anomalies 33

post-implantation 14 preclinical 135 recurrent 5, 16

and abortion prevention 193-8 aetiology and management 99-113 causes 214

alloimmune 111-12 anatomical 103 endocrine 105-6, 110, 113 genetic 102-3 immunological 106-7 infective 104

and chromosomal abnormalities 25-41 chronic maternal disorders, drugs and

environmental pollutants 104-5 definition 205 diagnostic tests 107 and fertility drugs 138 future risk 108, 112 and histology 59 immunological factors 58 immunotherapy 203-14

assessment of outcome 210-11 future requirements 212-14 methods of treatment 205-10 potential hazards 211-12

incidence 100 investigation and management 107-13 obstetric history 106, Ill, 113 pathology of abortus material 55 primary 99, 101 risk of recurrence 100-2 secondary 99, 101 treatment 99, 101-4, 108-13

septic 4, 119-30, 151 clinical features 121 complications 122-4 management 124-7 maternal mortality statistics 119-20 microbiology 122 prevention 124-5 risk factors 120-1 septic shock 121, 127-30

spontaneous 9-19 after IVF 140-4 current estimates of early reproductive loss

220

11-16 definitions and clinical presentation 1--6 and ectopic pregnancy 16~, 166, 177 endocrine treatment 193-200 environmental hazards 18-19 and fetal death rate 11-12 following assisted conception 133-44 history of 100, 102 hormones and proteins 91 and invasive diagnostic procedures 150-4 late 9 of live fetus 3~, 82 male factors 134 management 183, 188-91 maternal health 16-18 prevention 194-8 problems of definition and ascertainment 9-11 rate after IVF 140--2, 144 role of chromosomal anomalies 12-13 surgical treatment 183-91 see also Aetiology; Pathology; Ultrasound

sporadic 5, 55, 99, 112 causes 105, 107 chromosomal abnormalities 102 and contraception 105 and histology 59 immunological factors 58 and infection 104

subclinical 3 threatened 1-2, 82, 101

and abortion prevention 198 and ectopic pregnancy 161 hormones and proteins 91 and incompetent cervix 188-9

Abortion Act 1967 119-20 Actinomycin D 178 Adhesions, intrauterine (synechiae) 33, 191 Adnexal mass 173-5 Adrenaline 178 Aetiology

of abortion 59, 139 aneuploidy and polyploidy 21~ first trimester abortuses 2~ 1 genetic 21~1 infections 35 polygenic/multifactorial 30 recurrent 102-12 role of chorioarnnionitis 56

abortus material 51, 53 of ectopic pregnancy 160--1

Age gestational

of aborted fetuses 10 and abortion prevention 195 at CVS sampling 151 chromosomal anomalies and 13 ectopic pregnancy 166-7 invasive diagnostic procedures 152~, 157 and IVF 140 and recurrent abortion 100

maternal and abortion prevention 195 and abortion rate 3 aneuploidy and 29 environmental risks 19 and fertility drugs 136, 139 and fetal death 10 and health 41 and infertility 134 invasive diagnostic procedures 152 and IVF 141-2, 144 parity and 14-16 smoking and alcohol 17, 39~0 trisomy and 24

menstrual 67-9, 74-5, 77 parental, and infertility 134

Alcohol 16-17 and infertility 134 and maternal health 19, 39~ and recurrent abortion 105

Alleles, Tit 38 Allograft rejection 38 Alphafetoprotein (AFP) 87, 89, 91~, 165 Amenorrhea 6, 162, 173, 189, 191 Amniocentesis 40--1, 94, 155--6

early 149, 153~, 156-7 mid-pregnancy 149, 151-3 and recurrent abortion 108 safety 150-4 and septic abortion 121 transabdominal 153 and translocation 25

Index

Amniotic sac, low ratio of, to embryo 72-3 Amoxycillin 125 Ampicillin 125, 128-9 Amrinonemay 128 Anaemia 121, 126, 128

aplastic 41 Anaesthesia 126, 199

general 178, 189 Androgen 137 Aneuploidy 21~, 94, 156

fetal 113 and FSH 32 genes causing 29-30 recurrent 30 and recurrent abortion 102

Aniline 40 Antiandrogen 138 Antibiotics

broad spectrum 109, 128 and incompetent cervix 190 prophylactic 125 recurrent abortion treatment 35 and septic abortion 124, 126-7 and septic shock 128-30 therapy 125--6, 128

Antibodies allo- 213 anti-fetal 35--6

Index

anti-HLA 207 anti-idiotypic 37, 209 anti-sperm 36-7 anti-SS-A 36 anti-TLX 209 anticardiolipin 36, Ill, 207 antinuclear (ANA) 36, III antipatemal 213

antileukocytotic 37 cytotoxic (APCA) 112

antiphospholipid 58, 107, 1l0-1l antithyroid 195 antitrophoblast 209 auto- 36, 107

and immunotherapy 207-8, 213 thyroid 195

auto-anti-idiotypic 209 blocking 37-8, 203-4, 210, 212-13 cytotoxic 37-8, 206-8, 210 Fc receptor-blocking 210 formation 210 free 209 lupus anticoagulant (LAC) 36 monoclonal 58

enzyme-labelled 163 HA-1A 130 and immunotherapy 209-10

and recurrent abortion 104, 109 trophoblast 209

Anticardiolipin 107 antibodies 36, lll, 207 syndrome 111

Anticoagulant 36 lupus 58, 107, 111, 195

Anticoagulation, heparin 129 Anticoagulation therapy 196 Antigens 212

FA-l and FA-2 87 histocompatibility complex (MHC) 204 HLA 37-8, 107, 112, 156

sharing 206, 213 HLA-DO 58 HLA-DP 58 HLA-DR 37, 58 and immunotherapy 204 matemal37 MHC Class I and II 210 nuclear 36 paternal 37, 107 placental 38 TLX 37-8, 206, 209 trophoblast-associated 204

Antimetabolites 39 Antimicrobials, anti-anaerobic 126 Antineoplastic agents 39 Antioestrogens 135-8 ARDS (adult respiratory distress syndrome) 124,

127-8 Arsenic 40 Ascherman's syndrome 189, 191

Aspiration, laparoscopic directed 178 Aspiration, ultrasound 178 Aspirin 36, 111 Assays

for anticardiolipin antibody (ACAb) 111 chemiluminescent 63 in ectopic pregnancy 163-4, 166 enzyme 155

linked monoclonal antibody 63

221

human chorionic gonadotrophin (hCG) 63, 134-5 immunochemical 209 immunofluorometric 63, 163 laboratory 214 for placental proteins 88 radioimmunoassays 63, 106, 162

Assessment unit, early pregnancy 77 Auto-antibodies see Antibodies Azathioprine 111

Bacteraemia 191 transient 123

Bacteria 123 anaerobic 123 faecal 56 gram-negative 123 micro-aerophilic 122 non-clostridial 122

Bacteroides jragilis 122 Bacteroides melaninogenicus 122 Balloons 184 Benzene 40 Biopsy

cone 103, 121, 185 embryo 149 endometrial 30-2, 110, 113 fetal tissue 149 transabdominal chorion 149

Birth live, anomalous 25, 27, 29 order 14 stillbirth 9-10, 13,25, 27, 36 weight 16

Bladder, perforation 190 Bleeding

and abortion of live fetus 4 and abortion prevention 199 after invasive tests 152 dysfunctional uterine 6 in ectopic pregnancy 173, 179 and incompetent cervix 183-4, 189-90 intra-abdominal 178 and pregnancy diagnosis 71 septic abortion 4, 121 spontaneous 124 uterine 125-6 vaginal

complete and incomplete abortion 77 and ectopic pregnancy 6, 162, 174 hormones and proteins 91

222

and incidence of abortion 72 irregular 162 and pregnancy diagnosis 70, 95 recurrent 166 and threatened abortion 1-2

Blighted ovum see Pregnancy, anembryonic Blood

group matching 212 measurement of chemicals in maternal 149 pressure, falling 122 transfusions 191

pretransplant 38 velocity waveforms 78-82

Bowel damage 190 Bradycardia 70, 74 Brucella 35 B userelin 196

Caesarean section 109, 188 Cauterisation 34 Centrifugation 209 Cephalosporin 125 Cerclage, cervical 34, 109

choice of patients 185 and immunotherapy 211 management of cervical incompetence 183-8 operative procedures 184-5 randomised controlled trials 186-8 transabdominal 185

Cervix abnormal 185 amputation 34, 185 congenital shortening 185 dilatation 2

premature 34, 183 silent 183

examination 183-4 incompetent 34, 56, 183-8

diagnosis 109, 183-4 obstetric history 183-5, 187 and pregnancy diagnosis 70 and recurrent abortion 103

lacerations 34, 185, 190 recurrent abortion 5 resistance index (CRI) 184 septic abortion 4 tenderness 121 see also Suture

Chemicals 18,40 Chills 121 Chlamydia 152 Chlamydia trachomatis 35, 104 Chloramphenicol 125, 129 Chorioarnnionitis 56 Choriocarcinoma 4, 50, 89, 93 Chromosomes

abnormal 59 and abortion prevention 193, 198, 200 after induced ovulation 136-7

in classification of abortus material 51 diagnosis by CVS 93-4 early bradycardia 74 and fertility drugs 139 fetal 5 and fetal death 10 and immunotherapy 214 and infertility 134

Index

invasive diagnostic procedures and 152, 155-6 and maternal health 16 and normal pregnancies 4 numerical 21-4 and recurrent abortion 102-3, 108-9 role in spontaneous abortion 12-14 structural 25 testing for 91 Turner's syndrome 12-13

fetal triploidy 52 inversions 24, 27-9 normal, abortions 16-17 rearrangements 24-5, 156 sex 12, 14

polysomy 23-5 translocations 24-7

Clinics antenatal 133 fertility/infertility 133, 197-8 ovulation induction 137-8 pre-pregnancy counselling 196 preconception 198 recurrent abortion 198

Clomiphene citrate (CC) 72, 110, 135-7 and abortion prevention 196-7 and IVF 140-1 oral 138

Clostridia 123, 125-6 Clostridium perfringens 122 Clostridium telani 122 Clots, retroplacental 71 Coagulation, abnormal 207 Coagulation disorders 195-6 Coagulation system 123 Coagulopathy 199 Collagenases 56, 122 Coma 124 Conception

assisted 13 3-44 and abortion prevention 198 congenital abnormalities 136-7 and ectopic pregnancy 160, 162 rate 138

and chromosomal anomalies 13 and contraceptives 40 defective 19 delay 112 and fetal death 10-11 multiple 14 predisposition towards chromosomally abnormal

29 products 5

Index

spontaneous abortion after 144 congenital abnonnalities 141 and ectopic pregnancy 165 multiple pregnancy after 142 risk of abortion 139

Conisation 34 Consanguinity 29 Contraception

and abortion prevention 195 and ectopic pregnancy 160 intrauterine device (IUD) 17-18, 40

copper T 120 Dalkon shield 120 and septic abortion 125

oral 17-18, 105 and recurrent abortion 101 and septic abortion 120

Cord lesions 50 Cornelia de Lange syndrome 90 Corpus luteum, ruptured 6 Corpus luteum deficiency 197-8 Corticosteroids 128 Counselling 142, 194

genetic 108 pre-pregnancy 195-6 preconception 198

Cramps 2, 174, 184 Crown-rump length (CRL) 3, 66-70, 72, 74 Culdocentesis 162 Curettage 162

and abortion prevention 199-200 and adhesions 33 dilatation and 189-91 and incompetent cervix 188-9 infection after 120 management of abortion 183 and recurrent abortion 103 septic abortion and 125-6 and septic shock 130 suction 125 uterine 123, 130

Cysts adnexal 173 haemorrhagic corpus luteum 173 ovarian 134-5, 173

Cytokines 123, 130, 213 Cytomegalovirus 35, 56, 72, 104, 109 Cytotrophoblasts 39

De Novo rearrangement 29 Death

early embryonic see Abortion, missed embyronic, diagnosis and predicting 23, 67-8 fetal

abortion prevention 196 and antibodies 36 calculation of rate of 11-12 definition 9-10

from infection 35 immunological causes 107 and incompetent cervix 188-9 pathology of abortus material 53-5 result of infarction of placenta 58

223

result of thrombosis of ultraplacental vessels 58 and X-rays 39

maternal see Mortality neonatal 9

Dehydration 121 Delivery, pre-tenn 100, 141, 183-4

and incompetent cervix 185-8 Demargination 124 Diabetes 41

and abortion prevention 194-5 control 16, 32-3, 194-5 and infertility 134 pregnancy 73 and recurrent abortion 104-5, 113 subclinical 32

Diagnosis cytogenetic 155 gene probe 155 invasive procedures 149-57

abortion risks 150 non-invasive procedures 162 pre-implantation 149 prenatal 93-4, 108, 112-13, 142, 149, 156 see also Pregnancy

DIC (disseminated intravascular congestion) 128, 130

Diethylstilboestrol 33 Dilatation 34, 103, 162

of cervix 2, 34, 183 and curettage 189-91

Discharge 121 Disease

alloimmune 36-9, 107 autoimmune 107, 112 connective tissue 107 cyanotic heart 41 gestational trophoblastic 89 graft-versus-host (GVHD) 211 gynaecological 172-3 maternal 5, 41 neural tube (NTD) 30 pelvic inflammatory (PIO) 6, 160--1, 174 sexually transmitted 6 thyroid 195 trophoblastic 4, 93 Wilson's 41, 105

DNA-ase 122 Dobutarnine 128-9 Dopamine 128-9 Down's syndrome 27, 74, 94 Doxycycline 35, 125 Drugs

anticancer 18 in assisted conception 133, 144 beta-mimetic 186, 188

224

chemotherapeutic 39 effects in pregnancy 150 inotropic 128-9 oxytocic 191 and recurrent abortion 101, 104-5, 109, 111 and septic abortion 125 systemic 178 teratogenic 134

Echocardiography, M Mode 3 Education 16-17 Electrocoagulation 178 Electrodiathermy, ovarian 110 ELISA 37, 209 Embryo

biopsy 149 early demise see Abortion, missed growth delay 73-4 low ratio of amniotic sac to 72-3 transfer 108, 161

Endometriosis 37, 133, 143 Endometritis 33, 104 Endometrium

in ectopic pregnancy 165 and fertility drugs 136 progesterone deficiency 30--2

Endotoxic shock 122-3, 191 Endotoxins 121, 124, 130 Enterobacter 122 Environment

hazards 16, 18 and matemal health 40, 55 pollution 19, 104-5 risks of abortion 18-19

Epilepsy 105 Epitopes 212 Escherichia coli 122-3 Ethnicity 17 Ethylene oxide 40 Euploidy 41 Exotoxin, nephrotoxic 123 Exotoxins 122

Factor XIII deficiency 196 Fallopian tubes 134, 143

and ectopic pregnancy 160--1 False-positives 82 Fertilisation

and abortion prevention 198 errors 4, 193 and fetal death rate 11-12 in-vitro (IVF) 9, 144

abortion after 140--4 chromosomal abnormalities 12,21 and ectopic pregnancy 160, 164 and Embryo Transfer (IVF-ET) 63, 74, 143 and fertility drugs 137-8 and infertility 134

programme 133, 137 oocyte 106

Fertility. assisted 105 Fetus

anomalies 19, 55 blood sampling 149 focal abnormality of 50 grossly disorganised 50 growth delay 70 imaging 149 incomplete specimen 50 tissue biopsy 149 triploidy 52

Fever 4, 16, 35 and septic abortion 121-2, 124

Fibroids 73, 103, 134, 172-3

Index

Follicle stimulating hormone (FSH) see Hormones Formaldehyde 40 Fusobacterium 122

Gamete intrafallopian transfer (GIFT) 142. 144 Gametogenesis 12

abnormalities during 24 Gases, anaesthetic 18. 40 Genes

causing aneuploidy 29-30 defects 154-5 deletion 90 MHC-linked 214 mutant 29 recessive lethal 107. 214 and recurrent abortion 108-9, 214

Genital tract 119-20 Gentamicin 125-6. 129 Gestational sac

double 70, 72 and ectopic pregnancy 163-4, 167. 172. 176-8 and infertility 135 intrauterine 65-70. 72. 76-7 spontaneous absorption of 142

GIFT (Gamete intrafallopian transfer) 142. 144 Gonadotrophin

human chorionic (hCG) 4 and abortion prevention 197-8 in assisted conception 137-8 beta- 163-4 in diagnostic tests 162-5 in ectopic pregnancy 162. 165-6. 172. 174.

176-9 and fetal death rate 11 and immunotherapy 211 and infertility 134-5 in IVF 140--1 in pregnancy diagnosis 63-4. 67-8. 71. 87-90.

92-5 and recurrent abortion 110

human menopausal (HMG) 69 ovulation induction with 138-9

human pituitary 135

Index

menopausal urinary 135 ovulation induction with 138-40 releasing hormone (GnRH) 135, 140, 196-8

analogues (GnRHa) 139 Graft rejection 58 Gravidity 14-15 Growth retardation 36

intrauterine (IUGR) 111

Haematology disorders 41 Haematoma

intrauterine 70-1 retroplacental 50, 71 subchorionic 71

Haemoglobin, glycosylated 33, 105, 194-5 Haemoglobinopathy 41 Haemolysis 122, 128 Haemorrhage 120

after invasive tests 154 antepartum 73 and incompetent cervix 189, 191 uterine 125

Handicap 5 Health, maternal 16,41 Heart

cyanotic disease 41 dysfunction 124 insufficiency 41 movement, fetal 67-8, 70, 74-8, 82, 91

Heparin 129-30 subcutaneous III

Herpes 56 genital 104

Hirsutism 196 Histocompatibility 58

complex (MHC) antigens 204 shared parental 37-9

Histoincompatibility, maternal-fetal 37 HIV (human immunodeficiency virus) 104, 121 Hormones

abnormal patterns 139 fetoplacental 87-95 follicle stimulating (FSH) 32, 137, 196

purified 138, 141 recombinant 138

luteinising (LH) 105-Q abnormalities of secretion 196-7 and assisted conception 137-8 hypersecretion 137-8 and infertility 135 and recurrent abortion 11 0, 113 releasing hormone (LHRH) 138

steroid 88, 90, 93, 111, 166 thyroid stimulating (TSH) 195

Hyaluronidase 122 Hydrops fetalis 94 Hyperplasia, trophoblast 4 Hypoplasia, pulmonary 150, 153-4 Hypotension 121-4, 127-8

Hypothyroidism, chemical 195 Hypovolaemia 123 Hypoxaemia 124, 127 Hysterectomy II, 125-6, 190 Hysterography, radiological 184 Hysterosalpinography (HSG) 109 Hysteroscopy 109

IGF-BP (insulin-like growth-factor binding protein) 87, 90, 92, 95, 165

Illness, maternal 16, 41, 134 Immune complexes 209 Immune system 35

maternal 37, 212-13 Immunisation 38, 104, 210

active 205 leucocyte 205-8, 213 passive 205 and recurrent abortion 112

Immunity, maternal 203-4 Immunodeficiency 212 Immunogens 112 Immunoglobulin 111

intravenous (MG) 210 Immunoregulation 209,214 Immunosuppression 58 Immunotherapy 38

leucocyte 210, 212-14 passive 210 potential hazards 211-12 of recurrent abortion 203-14 trophoblast membrane infusion 208-9

Implantation and abortion prevention 197-8 double gestational sacs 72 failures 99, 103 and fertility drugs 136 and fetal death rate 11-12 frequencies 37 and infertility 133 intrauterine adhesions 33 and leiomyomas 34 luteal phase deficiency (LPD) 30 trophoblast invasion 79

Infants, low birthweight 100 Infection 35

acute 154 blood-borne 56 chronic 152, 154

maternal 104-5 congenital 109 and incompetent cervix 189-91 and infertility 134 intrauterine 9 and IUDs 40 maternal 16,41,56,72 membranous 56 pelvic 161 and recurrent abortion 104, 109, 113

225

226

recurrent in-utero 104 and septic abortion 119, 124-5 and septic shock 123 and spontaneous abortion 120-1 superimposed Clostridial 126 uterine 151 viral 104

Infertility and abortion prevention 196 causes 133, 135-6, 141 clinics 133, 197-8 fertility drugs 137 and incompetent cervix 185 luteal phase deficiency (LPD) and 32 obstetric history 105, 134 ovulation failure 135 ovulation timing 69 and pregnancy diagnosis 70 and recurrent abortion 109 refractory 106 secondary 4, 134 and spontaneous abortion 133-6 treatment 105

Insemination 106, 108, 140 Intensive care, neonatal 1 Intensive care unit 126 Interleukin-l 123, 130 Interleukin-l-alpha 56 Intervillous space 79, 81 Intrauterine devices see Contraception Inversion, chromosomal 108 Inversion, pericentric and paracentric 27-9, 103 IRP (International Reference Preparation) 163 Irradiation 18, 39 IS (International Standard) 163, 176 Ischaemia, placental 56-7 Ischaemia, uteroplacental 56-7 Isoprenaline 128 Isoproterenol 129 IVF see Fertilisation, in-vitro (lVF)

Jaundice 122

Karyotype abnormal 51-3

fetal 59 hormones and proteins 91, 94-5 and recurrent abortion 102

ambiguous 155 and aneuploidy 29 blood 108 and chromosomal anomalies 13 and fetal death 10 parental 112

Klebsiella 123 Klebsiella aerogenes 122

Index

Labour, induced 188 Labour, pre-term 107, 111,185 Lactogen, human placental (hPL) 87-8, 91, 93-4 Laparoscopy 109, 161-2

diagnostic 162, 177 exploratory 178 and incompetent cervix 190

Laparotomy 125-6, 130, 159, 162 and incompetent cervix 190-1 microsurgical 178

Lead 40 Leiomyomas 34 Leucocytes, immunisation 205-8, 213 Leucocytes, immunotherapy 210, 212-14 Leukocytosis 124 LHRH superactive analogues 110 Ligament, broad 190 Listeria 104, 152 Listeriosis 56, 104 LMP (last menstrual period) 9-11

in pregnancy diagnosis 64-5, 67, 69-70 Lung metastases 89 Lupus erythematosus, systemic (SLE) 36, 41, 107 Luteal phase deficiency (LPD) 30-2 Lymphocytes, mixing reaction (MLR) 112 Lymphocytes, trophoblast 112

Macrophages 58 Malaise 121 Malaria 35 Malformations 13-14

congenital 49, 103 fetal, and leiomyomas 34 genital 16 and IVF 142 neural tube 14

Mapping, colour flow 78 Medical Research Council (MRC) 186-8 Medical Research International (MRInt) 142 Medroxyprogesterone acetate 198 Membranes, rupture of 73, 121, 125 Menopause 10 Methotrexate 39, 117 Metronidazole 125, 129 Metroplasty, hysteroscopic 109 Micro-organisms 35 Microemboli 123 Mifepristone 178 Miscarriage I, 5

see also Abortion Mole, Breus' 51 Mole, hydatidiform 75

complete 4, 50 hormones and proteins 90, 93 and normal pregnancy 88-9 partial 4, 52-3

Monosomy 12-13 and aneuploidy 29 autosomal 23

Index

IVF embryos 21-2 X 23-4. 29

Morning sickness 2 Mortality. maternal

from ectopic pregnancy 6. 159. 162. 179 from septic abortion 119-24 reduced 126-7. 130

Mosaicism 154-6 confined placental 49. 59

Mullerian fusion. incomplete 33-4 Mycoplasma 104. 109. 152 Mycoplasma hominis 35 Myomectomy 33-4 Myotoxin 122

Natural selection 200 Nausea 2. 121 Necrosis 34

acute tubular 123-4 in ectopic pregnancy 166 tumour 123. 130 uterine 126

Neisseria gonorrhoeae 122 Nephritis. interstitial 124 Neural tube defects 136-7 Noradrenaline 128 Norepinephrine 129 NPSU (National Perinatal Statistics Unit) 142

Obesity 139. 196 Occupation. hazards 18-19 Oedema. pulmonary 127 Oedema. villous 4 Oestradiol 91-2 Oestrogen 88. 136

anti- 135-8 Oligomenorrhea 196 Oocytes

abnormal 193 and chromosomal anomalies 12 collection 135. 144. 164 fertilisation 106 and fertility drugs 137 and infertility 134-5 and IVF 140 maturation 135

inhibitor (OMI) 137 over-ripe 136 preimplantation 11

Organogenesis 35 Ovaries 126

cysts 134-5. 173 and ectopic pregnancy 165 hyperstimulation syndrome (OHSS) 139 polycystic (PCO) 106. 110. 113. 133

syndrome (PCOS) 133. 138. 140. 196-7 Ovulation

and abortion prevention 198

dysfunction 105. 133 and fetal death 10 induced 69. 72. 135

chromosomal abnormalities 136-7 and fertility drugs 133. 138-40 with gonadotrophins 138-40 and IVF 142

and infertility 135 superovulation 135. 140 timing in infertility 69

Oxytocic agents 199 Oxytocin 125. 199

Pain 63 and abortion prevention 199 in ectopic pregnancy 6. 162. 173-4 and incompetent cervix 184. 190 pelvic 4 pregnancy diagnosis and 70 and septic abortion 121 suprapubic 4 and threatened abortion 2

227

PAPP-A (pregnancy associated plasma protein) 71. 87-95. 164-6

Pathogens 40-1. 122 Pathology

first trimester abortuses 24-41 fetal conditions 24-30 maternal conditions 30-9 maternal health 39-41

of spontaneous abortion 49-59 anatomo-pathological classification of abortus

material 49-51 histological classification of abortus material

51-5 specific abnormalities 56-9

Patients. private and public 17 PCWP (pulmonary capillary wedge pressure) 127-9 Pelvis

abnormalities 178 adhesions 109 infection 4 inflammatory disease (PID) 6. 160-1. 174 tenderness 2

Penicillamine 105 Penicillin 125. 129 PEP (progesterone-dependent endometrial protein)

87. 89. 165 see also Proteins. placental 14 (PP 14)

Peptococcus 122 Peptostreptococcus 122 Peritonitis 125-6. 190-1 Phenylephrine 128-9 Phenylketonuria 41 Placebo 130. 194. 198.200

and immunotherapy 207-9 Placenta

and amniocentesis 154 debris 189

228

ectopic 82 immunological reaction 58 infarction 51, 58, 107, 110 infection 56 intact 50 low-lying 70, 72 and maternal infection 16 mechanical disruption 152 pathology 49

of abortus material 53, 55 Placentation, inadequate 56-7, 59 Plasma, seminal 209-10 Plasmapheresis 36 Platelets 123-4, 128-9 Polar body analysis 149 Pollution 19, 104-5 Polymerase chain reaction (PCR) 155 Polyploidy 13, 21-4, 29, 134 Polysomy, sex chromosome 23-5 Post-mortem change 51, 53, 55 Potassium chloride 178 Pre-eclampsia 36, 56-7,111 Prednisone 36, 111 Pregnancy

anembryonic 3, 24, 50, 75-7, 82 concomitant 72 hormones and proteins 91-2 placental proteins 90

assessment of early 87-95 at-risk 195 biochemical 140-2, 144, 164 complications 39, 99, 176 diabetic 73 diagnosis

at home 64 biochemical 63 of early 87-8 and infertility 134-6 intrauterine gestational sac 64-5 invasive procedures 149-57 and NF 140 tests 88

donor 90 early, and fetal death 10 early failure see Abortion ectopic 2, 5~

and abortifacients 39 aetiology 160-1 clinical features 161-2 diagnosis 172

and management 159-79 tests 159, 162-77 ultrasound 64, 82, 92-3, 166, 173

hormones and proteins 90, 95 incidence 159~ incompetent cervix and 189 and IVF 142-3 and normal pregnancy 88-9 rate 159~ recurrent 179

risk factors 160, 162 ruptured 169 subacute 169, 177

heterotopic 142, 160-2, 167 immunised 39 immunoregulation 209, 214 intrauterine (IUP) 173-4, 176, 179 late, and fetal death 10 maintenance 88, 95, 107

and abortion prevention 197 and immunotherapy 203, 207 maternal-fetal histincompatibility 37-8 role of placenta 49

molar 177 monitoring 134, 141, 144 multiple 14, 136

and cervical incompetence 183 fertility drugs in 138-9 invasive tests and 156 and NF 142

normal 88-90 maternal immunity 203-4

ovarian 82 rates in NF programmes 140 specific complications of early 75-8 subclinical 197 see also Termination

Progesterone and abortion prevention 197 antagonist RU 486 199-200 and assisted conception 137 deficiency 30-2 in ectopic pregnancy 161, 165~ and IVF 143-4 in normal pregnancy 88 in pregnancy diagnosis 90-2 in prenatal diagnosis 94 and recurrent abortion 5, 105~, 110 supplementation 110

Progestogen 135, 198 Prorenin 165 Prostacyclin 107 Prdstoglandin 199

cascade 123 E2178 F2 alpha 178

Proteins fetal 87 fetoplacental 87-95 membrane cofactor (MCP) 210

Index

PAPP-A (pregnancy associated plasma) 71, 87-95, 164~

PEP (progesterone-dependent endometrial) 87, 89, 165

placental 5 (PP5) 87-9, 93 placental 12 (PPI2) 90, 92, 165 placental 14 (PPI4) 90, 92-3, 95, 165

see also PEP PZP (pregnancy-zone) 91 Schwangerschafts 1 (SPl) 71, 87-94, 164

Index

trophoblast 87, 164 Proteus 122 Proteus mirabilis 123 Pseudogestational sac 64, 66

ectopic pregnancy 169-70, 175 Pseudomonas aeruginosa 122-3 Psychotherapy 113 Pyrexia 121, 129

puerperal 187 PZP (pregnancy-zone protein) 91

Quadruplets 142

Radiation, environmental and medical 18-19 Radioimrnunoassays 63, 106, 162 RCOG (Royal College of Obstetricians and

Gynaecologists) 186--8 Renal failure 122 Renin, active 165 Reproductive system disorders 196--8 Resection, mid-tubal 178 Resistance Index (RI) 79, 82 Resorption 14 Resuscitation 169 Rigors 121 Royal College of Obstetricians and Gynaecologists

(RCOG) 186--8 RSM (recurrent spontaneous miscarriage) see

Abortion, recurrent Rubella 56, 104

Salmonella typhi 35 Salpingectomy 179 Salpingitis 161 Salpingotomy 178 Sampling

chorionic villus (CVS) 91, 4, 23, 40-1 and amniocentesis 151-4 prenatal diagnosis 93-4 and septic abortion 121 transabdominal 149-51, 153-7 transcervical 149-53, 155, 157

cytological 149 fetal blood 149

Scanners, dynamic and static 68 Scleroderma, maternal 16 Screening 113

anticoagulant 111 prenatal 109

Sepsis 119, 126, 191 puerperal 120 uterine 120

Septic shock 121, 123, 125, 191 circulatory support 128 clinical manifestations 124 infection control 128-30

investigations 127 management 127-30 oxygenation 127-8

Septic syndrome 123 Septicaemia 123, 150-1

gram-negative 128, 130 Sibships 14, 16 Sister chromatid exchanges (SCEs) 39 SLE (systemic lupus erythematosus) 36, 41, 107 Smoking 17, 19,39, 101, 105 Socio-econornic conditions 16--17, 19 Somatostatin 11 0 Somnolence 124 Spermatozoa

abnormal 134, 193 count 134 donor 134 and ectopic pregnancy 160 motility 134

Spermicides 17-18, 40 Spina bifida 50 Staphylococcus aureus 122 Sterilisation 108 Sterility 103 Steroids see Hormones Stillbirth 9-10, 13,25,27, 36 Streptococci 123

beta haemolytic 122 Streptococcus milleri 122 Stress, physical 18 Subfertility 100, 133

diagnosis 143 ectopic pregnancy and 162 and IVF 144 and recurrent abortion 108, 112-13

Sulphatase, placental 90 Superovulation 135, 140 Surgery

avoidance 199 complications 199 conservative 178-9 contra-indications 184 in ectopic pregnancy 178 emergency 169 and infertility 133 intrauterine 33 laparoscopic 178 mutilating 126 radical 179 and recurrent abortion 109 and septic abortion 125-7 and septic shock 129 tubal 161-2, 174

Suture abdominal 186 cervical 183, 185, 188, 190 MacDonald 184, 186 prophylactic 186 Shirodkar 184, 186

Syphilis 56, 104

229

230

Tachycardia 121-2 Tachypnoea 122 Tarnoxifen 138 Tender loving care (TLC) 41,113,211 Tenderness, abdominal 121 Teratogenic action 35 Termination 77, 101-2

early 156 elective 78, 124 and infection 120 late 156 legal 124 legal grounds for 5 legalisation of 119 medical 94 selective 156 surgical 94 therapeutic 199 see also Abortion, induced

Testosterone 106 Tests

abnormal coagulation 207 anticardiolipin antibody (ACAb) III antinuclear antibody 111 biochemical 162-7, 173-7 chemical 9 diagnostic, ectopic pregnancy 162-77 early diagnostic 9, 88 ELISA 37, 205 invasive prenatal diagnostic 149-57

accuracy 154-6 costs 156-7 safety 149-54

kaolin clotting time (KCT) III partial thromboplasin time (APPT) III phospholipid-dependent coagulation III pregnancy, non-invasive 95 recurrent abortion 107-8 sonographic 167-77 sperm immobilisation 37 tray agglutination 37

Tetracycline 35, 109 Tetraploidy 23

and aneuploidy 29 Thalassaemia, (X- 94 Thalassaemia, B- 94 Thrombosis 36

arterial 58 of placental vessels 107 and recurrent abortion 110 septic pelvic vein 129 venous 58, III

Thromboxane 107 Thrombus, subchorial 51 Thyroid 32, 104, 113

disease 195 TLC (tender loving care) 41, 113, 211 Tobacco 16 Toxins 39

alpha 122

myotoxin 122 Toxoplasma gondii 104 Toxoplasmosis 35, 56, 104, 109 Transducer, transvaginal 82 Transfusions 38, 191, 206 Translocation

balanced 24-7, 29, 36, 103, 108 carriers 154 chromosomal 24-7 reciprocal 25 Robertsonian 25, 27, 108 unbalanced 25, 108

Transplantations, rejection reactions 204 Trauma 40-1 Triplets 142 Triploidy 13, 23

and aneuploidy 29 fetal 52 and growth retardation 73

Trisomy 12-13, 24-5, 49 and abortion prevention 193 and aneuploidy 29 autosomal 23-4 and contraception 17 double 23 environmental risks 19 IVF embryos 22 and luteal phase deficiency (LPD) 32 and maternal age 16,41 mosaic 23 and recurrent abortion 108 smoking and alcohol 17

Trophoblast and abortion prevention 197 antigen status 204 asymmetrical 64-5 attenuated 53-4 in ectopic pregnancy 164-5, 178-9 extravillous 57 and gestational age 68 implants 5 inclusions 52 invasion, at implantation site 79 invasion of placenta 57 membrane infusion 208-9 in normal pregnancy 88 and pregnancy diagnosis 71 ring (intervillous space) 79

Tumours benign 34 necrosis factor 123, 130 placental site 4 trophoblastic 4

Turner's syndrome 12-13,90 Twin, vanishing 72 Twins 136, 142, 185

Ultrasound abortion prevention 196-9

Index

Index

amniocentesis 154 and chromosomal abnormalities 156 evs and amniocentesis 151-2 diagnosis

of anembryonic pregnancy 91-2 of early pregnancy 94 of ectopic pregnancy 166-7 of fetal death 23 of incompetent cervix 184 of spontaneous abortion 63-82

Am I pregnant? 63-4 doppler ultrasound 77-82 Is my pregnancy normal? 64-8 specific complications 75-7 When is my baby due? 68-70 Will I miscarry? 70-4

doppler 63, 77-82 ectopic pregnancy 159, 178 and fetal death 10 fetal heart activity 91-2 immunotherapy 211 incompetent cervix 34, 183, 185, 188-9 inevitable abortion 2 missed abortion 3 multiple pregnancies 14 pain and bleeding in early pregnancy 6 polycystic ovaries (peO) 106 recurrent abortion 108-9, 113 spontaneous absorption of gestation sac 142 threatened abortion 2 transabdominal (TAS)

ectopic pregnancy 162-3, 167-9, 171-5, 176 fetal heart activity 3 pregnancy diagnosis 92 spontaneous abortion 63-9, 71, 73, 75, 78

transvaginal (TVS) colour doppler 79 with colour flow 78, 82 ectopic pregnancy 160, 162-5, 167-77 fetal heart activity 3 spontaneous abortion 63-7, 70, 72, 74-9, 81-2

trophoblastic tumours 4

and uterine anomalies 33 Ureaplasma urealyticum 35 Uterus

abnormalities 33-4, 36, 70, 73, 185 congerutal 58-9, 103, 109

bicornuate 33, 109 dide1phys 33 evacuation 124-5, 188-9, 191 infection 119 lacerations 185 malformations 5 necrosis 126 perforation 125-6, 190 septate 33, 109 and septic abortion 121 T-shaped 33 tenderness 4, 126 urucornuate 33

Vaccinia 35 Variola 35 Vasoconstriction 123-4, 128-9 Vasodilation 124, 128 Ventilation 128 Vibrio fetus 35 Video display terminals (VDUs) 40, 105 Villitis 56 Virus transmission 210-12 Visualisation, hysteroscopic 33 Vomiting 2

Wilson's disease 41, 105 World Health Orgaruzation (WHO) 1

X-irradiation 39 X-rays, therapeutic 39

Yolk sac 167 and pregnancy diagnosis 66-8, 77

231