Ectopic pregnancy still represents a cause of maternal mortality in all countries, but differentiating between an ectopic and an intrauterine pregnancy continues to be problematic for clinicians dealing with early pregnancy problems. The gapbetween present day practice and modern guidelines needs to be addressed. Utilizing high resolution transvaginal ultrasound and robust, field-tested algorithms incorporating serial hCG levels may help to improve the earlier diagnosis of ectopic pregnancy. Recent research points to a link between high uterine natural killer cell (uNK) levels and failed pregnancy, but there is a gap in knowledge about the relevance of uNK cells in reproduction and evidence-based ART practice. While evidence-based practice in the area of inherited thrombophilia and early pregnancy is necessary, the detection of abnormality combined with the absence of a test to assess the biological activity of gene mutations has led to controversy. With a low threshold for intervention and a clear absence of accurate and reproducible diagnostic tests, the usefulness of cervical cerclage to prevent pregnancy loss remains unclear.

This course for general gynecologists and reproductive endocrinologists will focus on the modern, evidence-based
management of miscarriage involving conservative, medical and surgical options driven by patient choice. Appropriate
evidence-based assessment techniques will be discussed, and up-to-the minute research will be presented on early miscarriage and uNK cells, maternal thrombophilia, and the use of abdominal cerclage and pre-pregnancy vaginal
cerclage.


LEARNING OBJECTIVES

At the conclusion of this course, participants should be able to:
1. Identify appropriate tests for the diagnosis and management of pregnancy of unknown location (PUL).
2. Perform an evidence-based assessment to determine the value of and relevant need for testing of maternal
thrombophilia in women with recurring pregnancy loss.
3. Assess the usefulness of new-frontier research on natural killer cells and its application to the investigation of recurring miscarriage.
4. Describe the latest indications for and timing of vaginal and abdominal cerclage procedures in the management of patients with a history of late pregnancy loss.

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