In this Olympic new year why not challenge yourself and raise valuable funds for the EPT.

We are now a charity partner to the 100km London2Brighton challenge which looks an amazing event taking place on 12-13th May. It really does look incredible and is being coined as a journey most will walk, some jog and a few hardened types may run it all or a mixture of all three.

What a feeling of excitement and anticipation you’ll get as you set off from London with your fellow challengers, they’ll be replenishment check points every 12km, hot meals will be provided finishing with a well earned brunch in Brighton you’ll certainly deserve this when you get your last burst of energy and your bleary eyes see the stunning coastline come into view.

Join individually or as a team whatever you choose make this your ultimate fundraising endurance challenge of 2012, the Olympic year.

Also don’t forget to Check out our Events Diary for further inspiration.

Their talk “Why do pregnancies implant in the wrong place?” Will cover the following points

Early pregnancy loss in women, which is often due to defects that occur before, during or immediately after embryo implantation, is a worldwide social and economic concern. Although the human population is growing rapidly and will probably reach nine billion by 2050, nearly 15% of couples worldwide are childless because of infertility, 20% of pregnancies end in miscarriage and over 1% of pregnancies are ectopic (implant outside of the womb). There are more than 30,000 ectopic pregnancies in the UK each year and the number of ectopic pregnancies in the developing world likely exceeds this but the true number is not known. Ectopic pregnancies still kill young women. Most implant in the Fallopian tube (98%) and this can lead to rupture and internal bleeding if untreated. Ectopic pregnancy is difficult to diagnose – it can present without symptoms, or mimic a miscarriage. Scientists are now trying to identify proteins produced in the blood that appear when a pregnancy is ectopic. We do not know what causes ectopic pregnancy, but smoking and previous pelvic infection are major risk factors. In Edinburgh, we have been investigating how these risk factors lead to changes in proteins produced in the Fallopian tube causing ectopic pregnancy. Ectopic pregnancy is also difficult to treat, often requiring an operation. Sometimes it can be treated with an injection but this does not work in over 25% of cases. In Edinburgh and Melbourne, we have been using new drugs to try and treat ectopic pregnancies better and faster. Join Dr Andrew Horne and Dr Colin Duncan (clinician scientists from the MRC Centre for Reproductive Health) to hear about progress being made in diagnosing, understanding and treating ectopic pregnancy.

Edinburgh International Science Festival runs from 30 March – 15 April and the date and time of the talk will be announced by Festival organisers in February. Check the website here for further information about the festival.

C. Bottomley, V. Van Belle, A. Pexsters, A. T. Papageorghiou, F. Mukri, E. Kirk, S. Van Huffel, D. Timmerman, T. Bourne
Article first published online: 21 APR 2011

When early pregnancy viability cannot be established immediately with ultrasound, use of either a logistic regression model or a scoring system allows an individualized prediction of first-trimester outcome.

To study whether expectant management is an alternative to treatment with systemic MTX in a single dose im regimen in women with an EP and low but plateauing serum hCG concentrations in terms of tubal rupture, future pregnancy, health related quality of life and costs.

Norah M van Mello1*, Femke Mol1, Albert H Adriaanse2, Erik A Boss3, Antonius B Dijkman4, Johannes PR Doornbos5, Mark H Emanuel6, Jaap Friederich7, Loes Leeuw-Harmsen8, Jos P Lips9, Evert JP van Santbrink10, Harold R Verhoeve11, Harry Visser12, Willem M Ankum1, Fulco Veen13, Ben W Mol1 and Petra J Hajenius1

Patients with ectopic pregnancy (EP) and low serum hCG concentrations and women with a pregnancy of unknown location (PUL) and plateauing serum hCG levels are commonly treated with systemic methotrexate (MTX). However, there is no evidence that treatment in these particular subgroups of women is necessary as many of these early EPs may resolve spontaneously. The aim of this study is whether expectant management in women with EP or PUL and with low but plateauing serum hCG concentrations is an alternative to MTX treatment in terms of treatment success, future pregnancy, health related quality of life and costs.

Simultaneously with this trial, another trial is ongoing in the United Kingdom [20]. This placebo controlled trial has a similar objective, uses the same inclusion criteria and interventions (single shot MTX im and expectant management). In the UK trial, however, surgical intervention is installed in both treatment groups if inadequately declining serum hCG concentrations occur after one week of follow up. In our study, these treatment failures are treated with additional MTX injections. In the near future, meta analysis of the results of both trials will provide guidance on the present management dilemmas in women with EP or PUL with low and plateauing serum hCG concentrations.

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.