International Ovarian Tumor Analysis Trial (IOTA)
The International Ovarian Tumor Analysis (IOTA) group was founded in 1999 by Dirk Timmerman, Lil Valentin and Tom Bourne. Its first aim was to develop standardized terminology. In 2000, IOTA published a consensus statement on terms, definitions and measurements to describe the sonographic features of adnexal masses, which is now widely used. IOTA now covers a multitude of studies examining many aspects of gynecological ultrasonography within a network of contributing centers throughout the world. Tom Bourne can be seen being interviewed about diagnosing ovarian cancer below.
Having agreed on standardized terminology, the principal IOTA investigators from different centers prospectively collected a large cohort of patients with a persistent adnexal mass. Accurate preoperative discrimination between benign and malignant adnexal masses is known to be of pivotal value in clinical practice. Research has focused on the development of predictive models to estimate the risk of malignancy.
IOTA developed the simple rules and mathematical models based on logistic regression (LR 1-2), which are very easy to use in clinical practice to estimate the risk of malignancy. These models were prospectively and externally validated, and proved to have very good performances, close to that of subjective assessment of an expert sonographer. Moreover, these models keep to be performing well by users with different levels of ultrasound experience. Recently, with publication of the ADNEX-model, the first predictive multiclass model was introduced, able to differentiate between four subgroups of malignant tumors. This has now been incorporated into a user friendly APP to enable clinicians to us this easily in the clinic.
Currently IOTA is engaged in several new studies. The group is investigating the long-term behavior of expectantly managed adnexal pathology (IOTA phase 5). This will answer important questions about complications and malignant transformation in masses that are left in situ. Studies are being carried out to determine the best second stage test for masses that are difficult to classify by the existing models, for instance by MRI (IOTA-MRI). Other studies focus on the identification of new potential biomarkers (trans-IOTA) to be incorporated in diagnostic models.
Today there are over 50 clinical units contributing to IOTA studies, nearly every continent is represented. The group is multidisciplinary and involves gynecologists, radiologists, oncologists as well as physicists and biologists. The group believes that good communication between all these disciplines is how ideas can be turned into improvements for patients.
ASSESSMENT OF BIOMARKERS IN PREGNANCY OF UNKNOWN LOCATION AND ECTOPIC PREGNANCY (ABPEP)
A pregnancy of unknown location (PUL) is a phenomenon in early pregnancy where a woman has a positive pregnancy test but we cannot see where the pregnancy is with an ultrasound scan. The concern is that we may be missing an ectopic pregnancy (a potentially dangerous situation where the pregnancy is not in the womb).
Streamlining care for these patients
The management of women with a PUL or an ectopic pregnancy can be prolonged and variable. We now know many PUL and ectopic pregnancies can be managed safely with an expectant (a wait and see) approach and not everyone will require medical or surgical intervention. We are carrying out research that assesses a mathematical model which helps us provide individualised care and see which women are suitable for this approach. We are incorporating these models into user friendly APP's to make the use of these models user friendly.
Monitoring pregnancy of unknown location (PUL) and ectopic pregnancy without visiting the clinic
Currently, monitoring for both these conditions requires blood tests that must be taken at an early pregnancy clinic. We are developing a novel technique using urine rather than blood sample analysis that may result in fewer visits to the clinic.
Looking at novel biomarkers for PUL and ectopic pregnancy patients
We are also carrying out research looking for new hormones or markers in blood, urine or vaginal swab samples which may assist us in treating women with a PUL or ectopic pregnancy. This could lead to fewer blood tests, scans and visits to the Early Pregnancy Unit for women, which we know can be emotionally demanding.
Approved study number: 14/NS/1078- NRES Committee North Scotland
The clinical research Ph.D. fellow responsble for this project is Dr Shabnam Bobdiwala.
THE PSYCHOLOGICAL IMPACT OF EARLY PREGNANCY EVENTS (PIEPE)
Early pregnancy losses are common, with miscarriage affecting 25% of women who have been pregnant by 39 years of age. They are unique in encompassing both bereavement and a personal clinical pathology. For this reason, an understanding of the emotional implications for the woman cannot easily be extrapolated from our understanding of other illness behaviour or grief reactions.
Grief, to different degrees, and depending on the circumstances of the loss, in response to the loss of a potential child and imminent parenthood, is perhaps inevitable. Some level of anxiety relating to ones future ability to procreate is also an anticipated response.
However, small-scale projects thus far have demonstrated that pregnancy losses are also recognized precipitants of longer-term psychological disorder, including anxiety, depression and post-traumatic stress.
This research project, supported by Imperial College Healthcare Charity, assesses the frequency and severity of psychological morbidity in women, and their partners and in comparison to a control group of women with healthy early pregnancies. We use self-report questionnaires, which are sent to participants 1, 3 and 9 months after a loss. By collating demographic and clinical data, we aim to assess for risk factors predicting psychological sequelae. With a better understanding of their impact, clinical management strategies may be tailored to address the womans emotional as well as physical needs. There would also be the potential to better target support and counseling.
As of the start of May 2015, we had recruited just over 600 women across 3 sites (St Mary's, Queen Charlotte's and Chelsea & Westminster). The next stage of the project is to validate the results from the self-report questionnaires by performing interviews on a portion of respondents.
The clinical research Ph.D fellow responsible for this project is Dr Jessica Farren.
PREDICTING ADVERSE PREGNANCY OUTCOME FROM EARLY PREGNANCY (EPOS)
In a recent meta-analysis by the ESHRE early pregnancy special interest group it has been suggested that bleeding and pain in early pregnancy may be associated with a significant risk of later complications in pregnancy including intra-uterine growth restriction (IUGR), pregnancy induced hypertension and pre-term labour. These data are retrospective and the characterisation of the events described is suboptimal. For example, the term bleeding in pregnancy could mean anything from a single spot of blood to heavy bleeding and passing large clots. There were no attempts to quantify pain or duration of episodes of pain and bleeding. Similarly the presence of sub-chorionic haematoma has been related to both miscarriage and premature labour. However the relative importance of the size, location and timing of these lesions is largely not known.
There is a clear need to prospectively evaluate the long-term impact of events in early pregnancy. The clinical relevance of such a study is that women can be selected as being ÃÂÃÂÃÂÃÂat risk and so offered appropriate fetal surveillance and potential early intervention when necessary. For example, those identified at risk of pre-term birth may be offered surveillance of the length of their cervix, as well as being given vaginal progesterone. However, it is clearly inappropriate and would create a vast amount of work with associated costs if all women who suffered an early pregnancy complication were offered serial scans. We urgently need to understand which early pregnancy events represent a risk to the fetus in later pregnancy and direct any surveillance strategies towards those women selected to be at risk.
The EPOS study has been designed to address these issues. We aim to assess the risk of miscarriage in pregnancies complicated by events in the first trimester as well as evaluate their impact on the longer term pregnancy outcomes. Using this information we will develop a risk prediction model to aid in risk stratification and therefore planning of clinical care. The addition of biomarker information may contribute to such a model to aid prediction of outcomes.
The official National Institutes of Health definition of a biomarker is a characteristic that is objectively measured and evaluated as an indicator of normal biologic processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention. A biomarker can be used for diagnosis of a disease, identification of individuals at risk for disease prevention, as a potential drug target, or as a potential marker for a drug response or to predict outcome. Therefore the role of identifying potential biomarkers has greatly increased, particularly as these have not previously been assessed thoroughly in early pregnancy. These can aid diagnosis, assess severity, help in monitoring of conditions and possibly aid in response to treatment. Biomarkers within the context of this study may help in the metabolic and microbiological mapping of pregnancies and aid in the development of a risk model and therefore increase its sensitivity and specificity.
The high throughout of a diverse selection of patients at Queen CharlotteÃÂÃÂÃÂÃÂs & Chelsea Hospital has enabled the study to thus far be successful in recruiting over 600 participants. Each participant is recruited in early pregnancy, from as early as 5 weeks gestation, and scanned every 2 weeks in the first trimester. Then a routine dating and anomaly scan is performed. Following this an additional third trimester growth scan is performed. Data with regards to patient demographics, symptoms, ultrasound scan findings and pregnancy outcome is collected. In addition to this, samples of blood, urine and a vaginal swab are taken at a minimum of three and maximum of six time points throughout pregnancy. The aim of this is to create a longitudinal metabolic map of pregnancies as well as identifying potential biomarkers for adverse pregnancy outcome, such as miscarriage, pre-term birth and pre-eclampsia.
The clinical research Ph.D. fellow responsible for this project is Dr Maya Al-Memar
DOCTORS VIEWS AND EXPERIENCES OF THE MEDICAL COMPLAINTS SYSTEM (the IMPACT study)
Since the recommendations from the Shipman inquiry have been implemented, the number of formal complaints being investigated by the GMC has doubled. There has been recent media coverage highlighting a rise in complaint of 23% in just one year.
There is also a view that there are significantly more informal and formal internal investigations held in response to complaints raised about doctors both from patients and colleagues.
There is little or no information on the impact of these changes on individual doctors and on the way they practice medicine. Whilst the process aims to protect patients, the end result on balance may be doctors who have been made unwell and who practice medicine more defensively. It is therefore important that we better understand these issues, both for patients and doctors.
We are interested in investigating
i) the psychological impact of different levels of inquiry for the individual doctor
ii) how the process of being investigated for a complaint affects future practice
iii) whether those who have been subject to a complaint think they have been treated reasonably and fairly and
iv) ways of predicting those who are particularly at risk of getting into difficulty so that support can be offered at an earlier stage. We hope that these findings will be used to steer future policy. At the conclusion of the study, we will publish a report which will be available to all participants.
EPOS trial - the long term impact of early pregnancy events trial, Professor Phil Bennett, Predicting pregnancy complications, 2014
Peter Doubilet and Carol Benson, Harvard University, Developing guidance for the diagnosis of early pregnancy failure, 2012
Professor Arri CoomerasamyDept Gynaecology and Reproductive medicine, University of Birmingham, PROMISE active - a study into the use of progesterone in women presenting with possible miscarriage in early pregnancy, 2012
Dr Mike Peters, British Medical AssociationDoctors to Doctor Unit, The IMPACT study - investigating the IMPACT of complaints and disputes on the psychological wellbeing of Doctors, 2012
Professor Arri Coomersamy, University of Birmingham, PRISM trial - use of progesterone in women with bleeding in early pregnancy, 2012
Richard Harvey and Rosemary Fisher, Trophoblast Unit, Charing Cross Hospital, Imperial College. London, urinary and serum hCG variants in PUL and ectopic pregnancy, serum biochemistry in trophoblast disease, 2011 - 2015
Dr Maria Jalmbrant, The Maudesley Hospital, Psychological impact of early pregnancy complications, 2010
Professor Andrew Horne, University of Edinburgh, Biochemical markers in early pregnancy, 2010
Professor Jan Brosens, Imperial College, Implantation, 2009
Mr Christoph Lees, Addenbrookes HospitalCambridge University NHS Trust, Implantation studies in high risk pregnancy, early pregnancy growth, 2009
Professor Kurt Barnhart, Penn State University, USA, Early pregnancy complicationsEctopic pregnancy, 2009 - 2014
Professor George Condous, University of Sydney, Pregnancies of unknown location - IPULA trial, 2006 - 2020
Professor Lil Valentin, Malmo University Sweden, International ovarian tumor analysis trial (IOTA), 1998 - 2020
Professor Dirk Timmerman, Katholieke University of Leuven, Diagnosis of Ovarian pathologyUltrasoundEarly pregnancy, 1997 - 2020
The Psychological Consequences of Early Pregnancy Complications, Plenary lecture at the International Society for Ultrasound in Obstetrics and Gynecology World Congress, Singapore, 2018
Avoiding Diagnostic Error in Early Pregnancy, International Society for Ultrasound in Obstetrics and Gynecology (ISUOG), World Congress Singapore, 2018
Simple descriptors to classify ovarian masses - how we approach scanning masses, Beijing Obstetrics and Gynaecology Hospital, Beijing, China, 2018
The ADNEX risk prediction model – what are the variables and test performance, Beijing Obstetrics and Gynaecology Hospital, Beijing, China, 2018
IOTA Simple Rules - what they are and their test performance, Beijing Obstetrics and Gynaecology Hospital, Beijing, China, 2018
Simple Descriptors to classify ovarian masses, how we approach scanning masses, International Society for Ultrasound in Obstetrics and Gynecology, Athens, Greece, 2018
Adnexal cysts that cause acute pain in the pelvis, International Society for Ultrasound in Obstetrics and Gynecology, Athens, Greece, 2018
The ADNEX risk prediction model, what are the variables and test performance, International Society for Ultrasound in Obstetrics and Gynecology, Athens, Greece, 2018
How to avoid diagnostic error in early pregnancy including the ultrasound criteria to diagnose miscarriage, International Society for Ultrasound in Obstetrics and Gynecology, Athens, Greece, 2018
Diagnosis and Management of Tubal Ectopic Pregnancy, International Society for Ultrasound in Obstetrics and Gynaecology, Athens, Greece, 2018
The eveidence based approach to managing pregnancy of unknown location (PUL), International Society for Ultrasound in Obstetrics and Gynecology, Athens, Greece, 2018
The Effect of Complaints on Doctors Lives, International Society for Ultrasound in Obstetrics and Gynecology, Athens, Greece, 2018
How to correctly classify ovarian masses –including the use of IOTA rules and models, GYNDOLOMITIDER ANDERE KONGRESS5. FORTBILDUNGSTAGUNGFÜR GYNÄKOLOGIE UNDGEBURTSHILFE, St Cassiano Italy, organised by Professor Wilfried Feichtinger, 2018
How to avoid diagnostic error when assessingcomplications in early pregnancy, GYNDOLOMITIDER ANDERE KONGRESS5. FORTBILDUNGSTAGUNGFÜR GYNÄKOLOGIE UNDGEBURTSHILFE, St Cassiano ItalyOrganised by Professor Wilfried Feitinger, 2018
Evaluating early pregnancy problems, British Fertility SocietyThe 11th Joint Conference of the UK Fertility Societies, Liverpool ACC, 2018
Avoiding Diagnostic Error in Early Pregnancy, RCOG Annual Professional Development Conference, Royal College of Obstetricians and Gynaecologists, 2017
Pregnancy of Unknown Location, ESHRE - European Society of Human Reproduction and Embryology, Geneva, 2017
The ADNEX risk prediction model – what are the variables and test performance, Obstetrics and Gynaecology Hospital at Fudan University, Shanghai, China, 2017
IOTA Simple Rules – what they are and their test performance, Obstetrics and Gynaecology Hospital ofFudan University, Shanghai, China, 2017
Simple descriptors to classify ovarian masses – how we approach scanning masses, Obstetrics and Gynaecology Hospital, Fudan University, Shanghai, China, 2017
Ultrasound to assess fibroids, Royal College of Obstetricians and Gynaecologists, World Congress Cape Town, 2017
How should we evaluate ovarian pathology: The use of IOTA Simple Rules and the ADNEX model, Royal College of Obstetricians and Gynaecologists, World Congress in Cape Town, 2017
Avoiding diagnostic error in early pregnancy, Royal College of Obstetricians and Gynaecologists, World Congress, Cape Town, 2017
The evidence based management of pregnancy of unknown location (PUL), Royal College of Obstetricians and Gynaecologists, World Congress Cape Town, 2017
The psychological impact of early baby loss, The All-Party Parliamentary Group on Baby Loss, House of Commons London, 2016
Update on Ultrasound and Fibroids, Royal College of Obstetricians and Gynaecologists, London, 2016
Why do doctors become unwell, disaffected, afraid to speak up, and leave?, Faculty of Medical Leadership and ManagementLeaders In Health Conference, ACC Liverpool, 2016
An update from the DOM trial: avoiding diagnostic error in early pregnancy, ESGE (European Society for Gynaecological Endoscopy), The Square, Congress Centre, Brussels, 2016
Ultrasound variables that are used in SIMPLE RULES to diagnose ovarian cancer and how to use them, Interntional Society for Ultrasound in Obstetrics and Gynaecology World Congress, Rome, 2016
Classifying Ovarian Tumors Using the IOTA ADNEX model, Chinese Medical Association - 16th Chinese Society for Ultrasound in Medicine Annual Meeting, Xi'an, China, 2016
Simple Rules and ADNEX - classifying ovarian masses using Simple Rules and the ADNEX model, The 2016 Fudan China-British Summit Forum in Ob/Gyn Ultrasound, Fudan University Shanghai, 2016
Avoiding Diagnostic Error in Early Pregnancy, 2016 Fudan China-British Summit Forum in Ob/Gyn Ultrasound, Fundan University, Shanghai, 2016
The Impact of complaints on doctors - why medical regulation and complaints investigations must change in the future, VU University Medical Centre AmsterdamValedictory meeting for Professor Hans Brolmann with the European Society for Gynaecological Endoscopy, Amsterdam, 2016
Death By a Thousand Arrows, Imperial College London, IMPERIAL COLLEGE ANNUAL TEACHERS’ CONFERENCE FRIDAY 10 June 2016 9.00AM– 4.30PM, 2016
Narrative presentation on IMPACT paper, United Kingdom Association for Physician Health, British Medical Association Black SuiteBMA HouseTavistock SquareLondon, 2016
Diagnostic challenges, Royal College of Obstetricians and GynaecologistsEarly pregnancy and acute Gynaecology course, RCOGSussex Place, 2016
‘The Impact of complaints procedures including GMC referral on doctors welfare and practice', Department of Primary Care & Public HealthSchool of Public HealthFaculty of MedicineImperial College London, Department of Primary Care & Public HealthSchool of Public HealthFaculty of MedicineImperial College London, Charing Cross Campus3rd Floor, Reynolds BuildingSt Dunstan's RoadLondon W6 8RP, 2016
Pattern recognition and simple descriptors to classify ovarian masses, Fondazione Policlinico Universitario A. Gemelli - RomaInternational Ovarian Tumor Analysis study day, Rome, 2016
Plenary Lecture: Are doctors allowed to be human, RCOG National Trainees Conference, 155 Bishopsgate, 2015
The expectant management of adnexal masses, how to “save the ovary”, RCOG national trainees conference, 155 Bishopsgate, London, 2015
Plenary lecture - The second victim: how do doctors respond to complaints or when errors are investigated?, International Society for Ultrasound in Obstetrics and Gynecology, Montreal, 2015
The second victim: How do doctors respond to complaints or when errors are investigated?, International Society for Ultrasound in Obstetrics and Gynecology (ISUOG), Palais De Congress, Montreal, 2015
Why changes to guidance for the diagnosis of miscarriage were not conservative and could be more rigorous, International Society of Ultrasound in Obstetrics and GynecologyWorld Congress, Montreal, 2015
Pattern recognition and descriptors to classify ovarian masses: introducing a three step strategy, International Society of Ultrasound in Obstetrics and GynecologyWorld Conference, Palais De Congress, Montreal, 2015
Uterine transplantation - pre-, intra-, post-operative, and antenatal imaging protocols, Uterine Transplant UK, The Caledonian Club, London, 2015
The impact of complaints procedures on UK Doctors, Royal College of Physicians Faculty of Forensic and Legal Medicine, Marriott Hotel Bournemouth, 2015
Translational ultrasonography in ambulatory gynaecology, Royal Society of Medicine, London, 2015
What have we learnt from the UKCTOCS trial, American Institute of Ultrasound in Medicine, New York, 2014
What is the best strategy for managing women with pregnancies of unknown location (PUL)?, The Association of Early Pregnancy Units, The Guildhall, Winchester, 2014
Masterclass - International Ovarian Tumor Analysis, The Association of Early Pregnancy Units, The Guildhall, Winchester, 2014
Prediction models for the management of pregnancy of unknown location, Meeting Mediterraneo HOT TOPICS in Diagnosi Prenatale e Ginecologica, Naples - Auditorium "Citta della Scienza", 2014
IOTA models and rules for the diagnosis of ovarian cancer, Meeting Mediterraneo HOT TOPICS in Diagnosi Prenatale e Ginecologica, Naples - Auditorium "Citta della Scienza", 2014
Developing criteria to define miscarriage, new data from the Diagnosis of Miscarriage (DOM) trial: influence of gestation, time between scans and findings on repeat scans, International Society for Ultrasound in Obstetrics and Gynaecology (ISUOG) Early pregnancy and Reproductive Medicine Course, Royal College of Obstetricians and Gynaecologists (RCOG), 2014
Making a diagnosis of early pregnancy failure, Imperial College London, Queen Charlottes HospitalCombined Reproductive medicine and early pregnancy meeting, 2014
Using IOTA simple rules and descriptors to characterise ovarian pathology, National Italian Society for Ultrasound in Obstetrics and Gynaecology (SIEOG) course in ultrasound in gynaecology - Chairman Antonia Testa, Universita Cattolica del Sacro Cuore, Rome, Italy, 2014
Characterising ovarian cysts, Queen Charlottes and Chelsea Hospital Postgraduate forum, Hammersmith Hospital, London, 2013
Diagnosing ovarian cancer: how to characterise ovarian cysts, Advances in GynaecologyReproductive and post-reproductive health, Venue: National Heart and Lung InstituteImperial CollegeLondon, 2013
Cystic structures in the pelvis that cause pain - diagnosis and management of ovarian torsion, pelvic abscess and haemorrhagic cysts, Peruvian Society for Ultrasound in Obstetrics and Gynaecology, Lima, Peru, 2013
Management of Pregnancy of Unknown Location (PUL), Peruvian Society for Ultrasound in Obstetrics and Gynaecology, Lima, Peru, 2013
The characteristics of endometriomas and identifying other sites of endometriosis in the pelvis, Peruvian Society for Ultrasound in Obstetrics and Gynaecology, Lima, Peru, 2013
The characteristics of endometriomas and identifying other sites of endometriosis in the pelvis, Peruvian Society for Ultrasound in Obstetrics and Gynaecology, Lima, Peru, 2013
Invited lecture: Pattern recognition and simple descriptors to classify ovarian masses, International Society for Ultrasound in Obstetrics and Gynecology World Congress, Sydney, Australia, 2013
Invited lecture: Assigning risk rather than predicting location is the key to managing pregnancies of unknown location, International Society for Ultrasound in Obstetrics and Gynecology World Congress, Sydney, Australia, 2013
Plenary Lecture: Safe criteria on which to make a diagnosis of miscarriage, International Society for Ultrasound in Obstetrics and Gynecology - World Congress, Sydney, Australia, 2013
A history of the development and future plans for the IOTA project, British Medical Ultrasound Society (BMUS), London, 2013
An intuitive approach to scanning: pattern recognition and using “descriptors” to characterize ovarian pathology, British Medical Ultrasound Society (BMUS), London, 2013
A different intuitive approach: using “descriptors” to characterize ovarian pathology, International Ovarian Tumor Analysis Trial (IOTA) - International meeting, KU Leuven, Belgium, 2013
Diagnosing miscarriage - not as easy as you might think, Victor Bonney Society, Royal College of Obstetricians and Gynaecologists, London, 2012
Early pregnancy units: Be careful or you might do more harm than good, Association of early pregnancy units, Annual meeting, Solihull, 2012
Pregnancies of unknown location (PUL), Early First Trimester Sonography: Guidelines for Diagnosing Miscarriage and Excluding a Viable Intrauterine PregnancyConsensus Conference, Society of Radiologists in Ultrasound, October 23-24, 2012, SRU consensus conference, Baltimore, USA, 2012
Diagnosis of miscarriage using crown-rump length and mean sac diameter: recent research, Early First Trimester Sonography: Guidelines for Diagnosing Miscarriage and Excluding a Viable Intrauterine PregnancyConsensus Conference, Society of Radiologists in Ultrasound, October 23-24, 2012, Baltimore, USA, 2012
Ovarian tumours, 22nd World Congress on Ultrasound in Obstetrics and GynecologyInternational Society for Ultrasound in Obstetrics and Gynecology, Copenhagen, 2012
Characterising ovarian cysts in pre-menopausal women, the research behind the new RCOG guidelines, International Society for Ultrasound in Obstetrics and Gynaecology and the RCOG advanced meeting on gynaecological ultrasound, Royal College of Obstetricians and Gynaecologists, London, 2012
What ultrasound criteria can we use to define miscarriage: why did the RCOG amend their guidance?, Combined International Society for Ultrasound in Obstetrics and Gynaecology and RCOG advanced meeting in gynaecological ultrasound, Royal College of Obstetricians and Gynaecologists, 2012
Pattern recognition and the assessment of ovarian pathology, Royal College of Obstetricians and Gynaecologists and International Society for Ultrasound in Obstetrics and Gynecology, Royal College of Obstetricians and Gynaecology, London, 2011
Discriminating between benign and malignant ovarian masses, Royal College of Obstetricians and Gynaeclogists Senior Staff conference, Royal College of Obstetricians and Gynaecologists, London, 2011
Research Student Supervision
Abdullah,DY, Pre pregnancy study of endometrium and implantation
Al-Memar,M, Early pregnancy events and impact on short and long-term outcomes, EPOS Study
Bobdiwala,S, The Assessment of Biomarkers in Pregnancy of Unknown Location and Ectopic Pregnancy (ABPEP)
Farren,J, Psychological impact of early pregnancy events
Guha,S, Rationalising follow up for pregnancies of unknown location
Nagi,O, Natural History of Caesarean Section scars
Pexsters,A, Aspects of early embryonic growth and biochemistry
Priesler,J, The diagnosis of miscarriage (DOM) trial
Sasso,S, Long term impact of early pregnancy events
Shah,H, Confidence of visualisation of cardiac structures at the 20 week anomaly scan using 2D ultrasound and 2D ultrasound with volumetric Fetal Intelligent Navigation echocardiography (5D Heart)