Second Edition
Pankaj Desai MD FICOG FICMCH
Consultant and Specialist of Obstetrics and Gynecology Janani Maternity Hospital,
Baroda, Gujarat, India
Formerly Dean of Students Medical College,
Baroda, Gujarat, India
Associate Professor and Unit Chief Department of Obstetrics and Gynecology Medical College and SSG Hospital,
Baroda, Gujarat, India
President, Federation of Obstetric and Gynaecological Societies of India (FOGSI), 2007
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Recurrent Spontaneous Miscarriages
First Edition: 2009
Second Edition: 2014
9789351521778
Printed at
5Dedicated to
My elder brother, teacher and role model
Ganesh Desai
7Preface
Recurrent spontaneous miscarriages have been my subject of study for nearly three decades now. The original quest for unraveling its mysteries started with my interest in immunology in obstetrics and gynecology. This made me come close to pre-eclampsia and miscarriages. Over a period of time, the concept of obstetric vasculopathies emerged and consolidated. The challenge of these conditions was the biggest driving force for me to study it deeper and deeper. When the first edition of this book met with a massive success, there was a choice for us—the publishers and I (the author) to reprint more prints of the first edition or to bring out a new edition. Needless to say the previous edition had already been reprinted many times. In the last five years, since the first edition got printed and published, many advances have emerged. It was also felt that some percepts in the first edition need a revisit. At the same time, there were many principles which needed reinforcement. Looking at this changed scenario, it was jointly decided to go in for a new edition.
During the initial planning of this new edition, there were some dilemmas. One big dilemma was how well to incorporate the concepts of obstetric vasculopathies into this book. Since 2008, when the first edition of this book got published, I have published a very comprehensive new book titled Obstetric Vasculopathies (with the same publishers). This book in all humility has also met with a great success and I feel blessed. But incorporating the essence of the contents of that book in this monogram in relevance to recurrent miscarriages was a challenge. However, as I started preparing this edition, I could successfully overcome as can be seen as you go through this book.
Another dilemma was to retain some chapters. Classic example for this was endometriosis and recurrent miscarriages. The picture remains cloudy as ever. At one stage, it was thought to delete this chapter completely. But then we felt that this book is also a reference book for students of this subject besides the practitioners. Therefore, keeping in mind the academic value of that review, it was decided to retain in the current edition. Irrational practices like testing TORCH 8infection in subjects of recurrent miscarriages continues to be in vogue. Reinforcing messages of evidence-based practice and clearly identifying irrational practices has been carefully attended to in this book.
In this edition many new illustrations, tables and figures have been added. Also, case studies which were representative of different conditions have been interlaced to make it easier to understand. This has been done in response to a series of feedbacks and suggestions that we have received from all over.
As I place the second edition of this book in the hands of the readers, I feel very satisfied and blessed. I hope this new edition also proves to be one more step in my pursuit of scientific excellence at the service of humanity and mankind.
PANKAJ DESAI
9Acknowledgments
Brian Tracy has beautifully said, “Develop an attitude of gratitude, and give thanks for everything that happens to you, knowing that every step forward is a step toward achieving something bigger and better than your current situation.” As I place the new edition of this book in the hands of the readers, I would like to express my heartfelt gratitude to all those who have directly or indirectly helped me.
Dr Sharad Gogate: He has kindly authored Chapter 5 - Genetics of Recurrent Miscarriages and Other Pregnancy Losses. He is Director, Surlata Hospital & Fetal Medicine Consultancy Services at Mumbai, India. He is nationally renowned as one of the finest in this field. This edition like the previous edition has been greatly enriched by this master contribution from him. I am indeed greatly obliged by his kind gesture.
Dr Jayakrishnan: He contributed the chapter on Anatomical Causes of Recurrent Spontaneous Miscarriages in the first edition. In the current edition though the chapter has been completely modified, his contribution has been a very important base on which the chapter in this edition was based.
I would also like to acknowledge with gratitude the contribution in the chapter 6 on Endocrinal Causes of Recurrent Miscarriages from the book Recurrent Miscarriages authored by me with Dr Purvi Patel (Academia Publishers: Delhi) from which this chapter draws on many points.
All my readers as well as my wife Dr Meera Desai, my daughter Ushma, my son Shlok and my son-in-law Anit need a special thanks for their great support and backing they have given me in my entire academic career in general and in this project in particular.
Thanks to Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director) and Mr Tarun Duneja (Director-Publishing) of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, and their staff, for their help in preparation of this book.
Last but not least, I bow down in prayer to the presiding deities of learning and wisdom Ma Saraswati and Lord Ganesha for their unquantifiable blessings and approval. I place this new edition of this book at their feet with complete veneration and in total reverence.