Israel Medical Association Journal

The fourth edition of Recurrent Pregnancy Loss: Causes, Controversies and Treatment summarizes the controversies and discuss the scientific basis for the various causes of recurrent pregnancy loss in depth and to clarify the various treatment modalities. The book shows a radical departure from the format of the previous three editions and succeeds profoundly in satisfying its objective. This book, first published in 2007, the second edition in 2014, and the third edition in 2020 became the foremost and most comprehensive work on recurrent pregnancy loss. In the fourth edition there are new chapters on the epigenetics of recurrent pregnancy loss, biochemical pregnancies, inflammatory placental disorders, artificial intelligence, and the role of hydroxychloroquine. This edition also discusses whether the decline in male infertility is reflected in recurrent pregnancy loss.

Background: In times of war, healthcare systems face the dual challenge of attending to the medical needs of injured soldiers and civilians as well as struggling to meet the everyday healthcare demands of civilians.

Objectives: To assess the correlation between exposure to war and the likelihood of spontaneous abortion (SAB) and to compare it to a similar period in previous years.

Methods: We conducted a retrospective study comparing the rate of SAB during war to the previous years.

Results: During the Iron Swords war, 381 patients out of 3245 (11.74%) were diagnosed with SAB, compared to 530 of 4080 (13%) in 2022, 536 of 3387 (13.8%) in 2021, and 516 of 3798 (13.6%) in 2020. The median gestational age at diagnosis was similar between the groups, with most cases identified during the first trimester. The study group exhibited a significantly higher prevalence of smoking (18.47% vs. 7.75% vs. 6.3% vs. 9.3%, P = 0.03), with no differences in the prevalence of chronic diseases and in the method of pregnancy termination.

Conclusions: Exposure to stress due to war during early pregnancy appears to have no significant impact on the rate of SAB.