ACTIVITY NUMBER:  RES012

ACTIVITY TITLE: Recurrent Pregnancy Loss

ACCREDITATION STATEMENT

The American Society for Reproductive Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Release Date:  March 15, 2016

Expiration Date: March 15, 2019

Under Review July 2022

Estimated Time to Complete Activity: 45 minutes

NEEDS ASSESSMENT and IDENTIFICATION OF PRACTICE GAP

Clinically recognized miscarriage is common, occurring in approximately 15%-25% of pregnancies. Recurrent pregnancy loss (RPL) is defined by two or more miscarriages; that is, pregnancies with the same partner and documented by ultrasonography or histopathological examination. Up to 50% of cases of RPL will not have a clearly defined etiology.   It is estimated that fewer than 5% of women will experience two consecutive miscarriages, and only 1% experience three or more. A presumed diagnosis will be made and treated in only half of patients with RPL. Many diagnostic tests are not supported by scientific evidence, and some tests and treatments are not recommended. Clinicians are challenged to differentiate sporadic miscarriage from RPL, begin evaluation at the appropriate time, select evidence-based diagnostic tests, and provide proper intervention and sensitive counseling.

This educational activity is designed to address the Unit 5 Reproductive Endocrinology educational objectives from the Council on Resident Education in Obstetrics and Gynecology (CREOG) on this topic.

EDUCATIONAL OBJECTIVES

At the conclusion of the educational activity, participants should be able to:

1.      Describe the most common causes of recurrent first-and mid-trimester pregnancy loss.

2.      List the components of a pertinent history and focused physical examination in a patient with recurrent first- and mid-trimester pregnancy losses.

3.      Interpret the results of selected diagnostic tests and physical examination to determine the etiology of recurrent early pregnancy loss.

4.      Identify appropriate treatments for patients with a history of recurrent pregnancy loss with surgical or nonsurgical methods depending on the etiology.

5.      Describe the indications for referral to a subspecialist.

6.      Counsel patients about the prognosis for successful treatment of recurrent pregnancy loss.

TARGET AUDIENCE

This activity is designed to meet the educational needs of resident physicians in obstetrics and gynecology and other related specialties. 

ACGME COMPETENCIES

Medical Knowledge

Patient Care

Interpersonal and Communication Skills

SUCCESSFUL COMPLETION REQUIREMENTS

Successful completion of this educational activity requires the learner to:

·        View a course overview page, containing all CME and disclosure information, including acknowledgement of commercial support and disclosure of unlabeled use, prior to the start of each module.

·        Complete a 10-question pre-exam prior to the module. Learners should note any pre-exam questions answered incorrectly for clarification during module study.  

·        Be given the option of downloading a printed syllabus containing the presentation and narrative.

·        Participate in the interactive activity: Audio narration is synchronized with PowerPoint presentation that can be advanced, stopped or reversed as desired.

·        Complete a 10-question post-exam, with feedback of correct/incorrect answers, scoring a minimum of 70% in two attempts.

·        Complete the evaluation survey.

·        Print certificate of completion.

DISCLOSURES FOR PLANNERS AND FACULTY 

Ruben J.  Alvero, MD – Nothing to Disclose

Alicia Y. Armstrong, MD – Nothing to Disclose

Valerie Baker, MD – Institutional Support from IBSA

Nancy A. Bowers, BSN, RN, MPH – Nothing to Disclose

Bruce R. Carr, MD – Research support from Wyeth, Neurocrine, Boehringer Ingelheim; Consultant for Novo Nordisk

Marcelle I. Cedars, MD  – Nothing to Disclose

Bradley S. Hurst, MD – Nothing to Disclose

Raymond Ke, MD – Grant/Research: Merck

Andrew R. La Barbera, PhD, HCLD  – Nothing to Disclose

Lawrence C. Layman, MD – Nothing to Disclose

Meredith Loveless, MD – Nothing to Disclose

Patricia M. McShane, MD – Consultant, World Egg Bank

Shona C. Murray, MD - Consultant, World Egg Bank

Steven T.  Nakajima, MD –Consultant, research support, speaker’s bureau for Warner Chilcott; Stockholder for IntegraMed

Genevieve Neal-Perry, MD, PhD – Nothing to Disclose

Linda R. Nelson, MD, PhD  – Nothing to Disclose

Randall Odem, MD – Nothing to Disclose

Lubna Pal, MBBS, MS – Research grant from Ferring

Staci E. Pollack, MD – Nothing to Disclose

Robert W. Rebar, MD – Nothing to Disclose

Richard H. Reindollar – Nothing to Disclose

Nanette Santoro, MD  – Consultant for QuatRx

James H. Segars, MD – Nothing to Disclose

Mary D. Stephenson, MD, MSc –  Consultant for NoraTherapeutics

Kim L. Thornton, MD – Consultant for Parexel

Ellen Wilson, MD – Nothing to Disclose

Bo Yu, MD – Nothing to Disclose

It is the policy of the ASRM to ensure balance, independence, objectivity, and scientific rigor in all its educational activities. All faculty/authors participating in this activity were required to disclose any relationships they may have with commercial entities whose products or services are used to treat patients so that participants may evaluate the objectivity of the presentations. The content and views presented in this activity are those of the faculty/authors and do not necessarily reflect those of the ASRM or CREOG. Any discussion of off-label, experimental, or investigational use of drugs or devices will also be disclosed. The disclosure statements were reviewed by the Subcommittee for Standards of Commercial Support of the CME Committee of ASRM and any perceived conflicts of interest were resolved in accordance with the policies of the ACCME.

STATEMENT OF SUPPORT

No commercial support has been provided for this activity.