The EPT is appealing to you because 11,000 women are admitted to hospital every year as an emergency. Many thousands more are cared for in emergency clinics.

If you could support us with a regular gift of a few pounds each month, so that we can continue to support those who already use our services and those who will find us over the coming months of the New Year, we can assure our service in 2012.

If our ‘friends’ felt they could donate £5 a month – this would generate sufficient income to provide our helpline for a year.

If our Facebook friends felt they could support us with £5 a month, The EPT would have more than 2/3 of the income we need to provide all of our services for a year.

If we have helped you, then please consider helping us to ensure our services are there for the thousands of families who will need us in 2012 and the hundreds of thousands who’ve  found us and used us over the last 13 years and continue to do so.

Wising you gentle New Year

Recent research suggests that given inter-observer variability in ultrasound measurements

and the greater variation in early embryonic growth than has hitherto been assumed, a more

conservative approach to the diagnosis of early pregnancy loss is warranted.

The studies from Imperial College London, Queen Mary, University of London and the

Katholieke Universiteit Leuven, Belgium published in the November 2011 issue of

Ultrasound in Obstetrics and Gynaecology concluded that current definitions used to

diagnose miscarriage could lead to an incorrect diagnosis and they call for clearer evidence-

based guidance on detecting miscarriage through ultrasound scans.

Having carefully considered these papers, we recommend adoption of the following interim

guidance with immediate effect:

1. Ultrasound diagnosis of miscarriage should only be considered with a mean

gestation sac diameter >/= 25mm (with no obvious yolk sac), or with a fetal pole with

crown rump length >/=7mm (the latter without evidence of fetal heart activity)

2. A transvaginal ultrasound scan should be performed in all cases

3. Where there is any doubt about the diagnosis and/or a woman requests a repeat

scan, this should be performed at an interval of at least one week from the initial scan

before medical or surgical measures are undertaken for uterine evacuation. No

growth in gestation sac size or CRL is strongly suggestive of a non-viable pregnancy

in the absence of embryonic structures.

These revised values for ‘mean gestation sac diameter’ and ‘crown rump length’ do not imply

that previously used values were wrong, nor that diagnosis of miscarriage in the past has

been unsafe, This interim guidance suggests a more cautious approach is warranted,

pending more definitive data becoming available. It extends the criteria included in the

RCOG Green Top Guideline No 25, which recommended a conservative approach with

mean gestation sac diameter <20mm or fetal CRL <6mm.

Christoph Lees MRCOG on behalf of the RCOG Ultrasound Advisory Group

Kim Hinshaw FRCOG Lead author, Green Top Guideline No. 25

Philip Owen FRCOG Chair, RCOG Guidelines Committee

David Richmond FRCOG RCOG Vice President (Standards)

19th October 2011

Notes

The Ultrasound Advisory Group has representation from the Society and College of Radiographers,

International Society of Ultrasound in Obstetrics and Gynecology, British Maternal-Fetal Medicine

Society, British Medical Ultrasound Society and Royal College of Radiologists. This guidance is

endorsed by BMUS, and by the Council of the Society and College of Radiographers.

It was a detailed and varied programme which involved not only a look at where we are at now but actively invited volunteers to engage with us in creating our forthcoming publication.

The afternoon focused on person centered listening and how to ask open ended questions as part of the counselling skills module of our training programme.

The day passed very quickly and for those who could stay on a little, ended after a very pleasant meal at the Watermill Inn. If you have considered volunteering but just not got around to filling out a volunteer interest form, then we want you to know we always have space for one more volunteer. You can download the VIF form here and we’d love to have you on board.

Here are some images of the day.

A systematic review of the evidence in the literature (not including new the new data from Imperial college) concludes that the evidence base that has been used to derive the current miscarriage guidelines is based on insufficient data, poor quality studies and so cannot be relied upon in all cases. This view is supported by an opinion paper by Professor Tom Bourne that highlights the problem further and again illustrates that the cut-off values for gestation sac and embryo size may lead to a viable pregnancy being wrongly diagnosed as a miscarriage.

Three papers are also published by the London-Leuven research group based at Imperial College London and the Katholieke University in Leuven, Belgium. These represent the largest study published on the ultrasound based diagnosis of early miscarriage and include over a one thousand women.

The findings of these papers can be summarized into four important points:

1. The current UK guideline used to define miscarriage states an empty gestation sac with mean sac diameter (MSD) of over 20 mm can be classified as miscarriage. The study shows this is associated with a 0.5% risk of misclassifying a viable pregnancy as a miscarriage. The confidence intervals show that at worst the false positive rate at this cut-off could be as high as 3.0%.

2. For an MSD cutoff of 16 mm as used in the USA, the false positive rate for miscarriage is 4.4% and may be as high as 8.4%.

3. Current guidance that an absence of MSD growth may be a sign of miscarriage. The published studies show that this is not the case and that there may be little or absent growth over several days and still a pregnancy can be viable. So an absence of growth in either an embryo or gestation sac is not a definitive sign of miscarriage.

4. There is variation in how different clinicians will measure any given gestation sac or embryo. This is important as it may mean that an MSD measurement of 20 mm may in fact be 16 mm – leading to a higher risk of the pregnancy being misdiagnosed as a miscarriage.

5. The number of pregnancies this may have been affected by this or might be relevant to in the future is not accurately known.

It is very important to put these papers in context for both clinicians and patients. What these papers DO NOT say is that the diagnosis of miscarriage for the vast majority of women who have had or will have a miscarriage is likely to be incorrect. These papers relate to the specific situation where a women undergoes an ultrasound scan and a gestations sac is visualized, but no embryo with a heartbeat is seen. Furthermore they apply to relatively small gestation sacs of under 25 mm. The papers do not suggest there is any problem when a diagnosis of miscarriage is made in the presence of either gestations sacs with an MSD of greater than 25 mm or embryos that are more than 7 mm in size.

However these data are important and show that current criteria for the use of ultrasound to diagnose miscarriage cannot exclude the possibility of misdiagnosis. The authors suggest that the guidance be changed on the basis of this new information in order to avoid the possibility of error.

Accuracy of first-trimester ultrasound in the diagnosis of early embryonic demise: a systematic review. Jeve Y, Rana R, Bhide A, Thangaratinam S. Ultrasound Obstet Gynecol 2011. http://doi.wiley.com/10.1002/uog.10108

Limitations of current definitions of miscarriage using mean gestational sac diameter and crown–rump length measurements: a multicenter observational study. Abdallah Y, Daemen A, Kirk E, Pexsters A, Naji O, Stalder C, Gould D, Ahmed S, Guha S, Syed S, Bottomley C, Timmerman, Bourne T. Ultrasound Obstet Gynecol 2011: http://doi.wiley.com/10.1002/uog.10109

Gestational sac and embryonic growth are not useful as criteria to define miscarriage: a multicenter observational study. Abdallah Y, Daemen A, Guha S, Syed S, Naji O, Pexsters A, Kirk E, Stalder C, Gould D, Ahmed S, Bottomley C, Timmerman D, Bourne T. Ultrasound Obstet Gynecol 2011: http://doi.wiley.com/10.1002/uog.10075

Clinical implications of intra- and interobserver reproducibility of transvaginal sonographic measurements of gestational sac and crown–rump length at 6–9 weeks’ gestation. Pexsters A, Luts J, van Schoubroeck D, Bottomley C, van Calster B, van Huffel S, Abdallah Y, D’Hooghe T, Lees C, Timmerman D, Bourne T. Ultrasound Obstet Gynecol 2011: http://doi.wiley.com/10.1002/uog.8884

For decades experts have been prevented from fully understanding the bacteria as they have been unable to manipulate the genome of chlamydia trachomatis (C. trachomatis).

Now researchers in Southampton have made a significant breakthrough in accessing the chlamydial genome and believe it could pave the way for more effective treatment of the disease.

The research was carried out at the Molecular Microbiology Group at the University of Southampton in conjunction with the department of virology at the Ben-Gurion University of the Negev in Israel.

Professor Ian Clarke, from the University of Southampton, said: “We, together with our colleagues in Israel, discovered that by treating the chlamydia with calcium ions we were able to introduce a piece of foreign DNA.

“This will open up the field of chlamydia research and will enable a better understanding of chlamydial genetics. It could lead to the development of new approaches to chlamydial vaccines and therapeutic interventions.”

Their paper detailing the breakthrough in the study of chlamydia is published in the Public Library of Science journal PLoS Pathogens and carried as a news story in the UK.

The Event will this year be hosted by Les Dennis and promises to be a great night of laughs and music and a time to remember. It will begin with an invitation to light a candle in memory of the babies which have been lost. The concert will then deliver a great line up of talent including Stefan Booth, Belle Humble, Tupele Dorgu (Coronation Street and Waterloo Road) and Lisa Scott Lee (Steps).

The Baby Loss Awareness Campaign  promotes the campaign which highlights the all to common occurrence of baby loss and is a collaboration between 4 sister charities and 1 not for profit organisation: the Miscarriage Association, The Ectopic Pregnancy Trust, SANDS, ARC and Babyloss.com.

The evening is designed to raise your spirits whilst also raising awareness.

Visit the Baby Loss Awareness Campaign website for information about what might be going on in your area

Tickets cost £12  Book your ticket.

So how does an evening of entertainment, champagne, canapés and tastings to kick the Christmas season off to a brilliant start sound? What’s even better; is 100% of ticket sales will go to charity – and you can decide which charity benefits (providing they are registered with theBigGive.org.uk  and of course we hope if you go along, you’ll choose The Ectopic Pregnancy Trust.

For every £50 ticket you purchase, you will receive a £50 charity voucher at the party, to give to any charity registered with theBigGive.org.uk.

So, grab your girlfriend(s) and the boys for that matter, and book some tickets. Tickets will go on sale on the Fortnum and Mason Charity Christmas Party website, at Midday on Monday 19th September.

If you wish to purchase a ticket off-line, please email fortnums@thebiggive.org.uk

Tickets are likely to sell out very quickly so make sure you are first in the queue on the 19th September, to stand a chance of getting a ticket to this wonderfully festive evening out! You can get a reminder first thing on the 19^th September by registering here, http://www.fortnums-christmas.com  so go on, have a fabulous evening out and get in the party mood, on the countdown to Christmas 2011. And if you can’t make it yourself but think you know someone who can, persuade to nominate The Ectopic Pregnancy Trust to benefit from their shopping spree.

The weather was, on the whole, kind and if anything a little warm.  This year we had a slightly smaller team but they were no less committed and all enjoyed the race. Several popped along to see Julie Milan, one of our volunteers, who was on hand to offer pieces of flap jack, fruit and a well earned drink and grab the odd snapshot to remember the occasion by.

Take a look at some pictures of the day and then read on …………………………..

Our heartfelt thanks go to Melody Erb, Jill Ansell, Gaby Ansell, Christie Amobi, Amirah Capillaire, Joanna Pitman, Kate Pye, Nicole Devo, Becky Guile, Erin Murphy, Sheonaidh Johnston, Ruth Kirkpatrick  who chose The EPT, as their charity which means we benefited from £5 of their entrance fee and have also been seeking sponsorship and fundraising for us and 7 more, who chose to remain anonymous but kindly chose The EPT, as their charity which means we benefited from £5 of their entrance fee.

If you were there and running on behalf of the EPT, then send us your pictures and your story we’d love to publish you here on our fundraisers diary.

If you missed the adidas Women’s Challenge this year but think you might like to take part next, keep an eye on our events diary from the beginning of next year for our stop press news, when the application and entrance process opens.

In the meantime, we would like to thank our team again and wish them all as much or little time as they need to recover, after running in this amazing women only race and raising funds for The EPT and awareness of the condition.

Tom Bourne presented some recent data showing that current cut off values used to diagnose miscarriage should be used with caution and suggested a readjustment in the mean sac diameter (when the sac is empty) used to define miscarriage to 25 mm. He also illustrated how a lack of growth after a repeat scan in a gestation sac may also be associated with a viable pregnancy and should be interpreted with caution. The failure for embryonic structures to appear in a gestation sac after a repeat scan after 7 to 10 days is a poor prognostic sign. Osama Naji followed with a presentation on caesarean section scars.

This was followed by the more informal workshop style presentations/ discussion to small groups, which have become a feature of this day. This year topics included

1. Choosing the right management approach for ectopic pregnancy

2. PUL and CEMACE

3. Introduction to the National Ectopic Database nePul

4. Diagnosing miscarriage (do no harm)

5. Using ultrasound to diagnose both tubal and non tubal ectopic pregnancy

6. Psychological impacts of early pregnancy complications, who is at risk and how to manage them

The day concluded with a lecture on translational research in ectopic pregnancy from Dr Andrew Horne and questions to the panel session run by Professor Tom Bourne and Professor Nick Raine- Fenning.

Feedback from the delegates who attended on the day has been excellent. “..very thought provoking – thank you” “The day was well organised, efficiently managed and very informative. The management committee are to be commended for their open, friendly response to enquiries” and “very good conference I will be recommending it to my colleagues.” Was just some of the feedback we received.

The trustees of the EPT will meet again shortly and determine how we will progress the established educational opportunity for 2012. Make sure you keep in touch. Email leaflets@ectopic.org.uk and request you are placed on our contact database. And remember to register to receive our professional online magazine e-Topic Professional to keep ahead of what’s happening in early pregnancy medicine

- Raise awareness of the condition within the community of sexually active women and the medical profession

- Promote Best Practice

- Provide information about the treatment and condition

- Provide understanding and support for women during this process.

The Ectopic Pregnancy Trust, therefore, delivers its services through the provision of information, education and support. That includes supporting the media to report accurately and authoritatively on the condition.

Are you a journalist?

Do you need to find out more about ectopic pregnancies? Would you like to learn about the work of the Ectopic Pregnancy Trust? Then our Press Pack will give you the facts and save you time.

Please be aware of our polite request when researching for information. The use of The Ectopic Pregnancy Trust message forums for gathering information for non Ectopic Pregnancy Trust surveys or research studies is not allowed without prior permission of the Trust. For further information, please email ept@ectopic.org.uk

Download our Press Pack

To read our Press Pack you will need to have Adobe Acrobat Reader installed on your computer. You probably already have this software installed but if not – if you can’t open the document after downloading it – you can quickly download and install Adobe Acrobat Reader from the Adobe website.

Download our Press Pack

Are you a journalist or medical professional/other looking for information or case studies for your research?

Please contact us rather than use our Message Board

Our website has a message board where women can talk about their ectopic pregnancies with one another. We understand that journalists and professionals often wish to talk to women about their experiences but we ask that requests of this nature not be posted on the board as it can upset some of our visitors. Instead, please phone the Ectopic Pregnancy Trust on 020 7733 2653 or email us and we will put you in touch with women who have already expressed a willingness to talk about their experiences to the media.