Some miscarriage tests 'unreliable'

Hundreds of viable wanted pregnancies are being lost to British women each year because of unreliable miscarriage tests, new research suggests.





The precise numbers are unclear but scientists believe there could be 400 errors every year with the potential to result in terminations.



This is more than the estimated 300 cot deaths reported each year in the UK.



Experts today called for more research and improved professional guidelines to minimise the chances of such tragedies occurring.



Pain or bleeding, or a previous history of miscarriage, may prompt doctors to carry out an ultrasound investigation early in pregnancy.



Common practice is to measure the size of the gestational sac and the embryo it contains.



If a sac of a certain size appears empty, or an embryo reaches a certain stage of development with no heartbeat, a diagnosis of miscarriage is made.



When there is doubt about the results, physicians are advised to re-measure the gestational sac seven to 10 days later.



If the sac does not grow during that time, it is assumed a miscarriage has occurred. A termination may then follow.



But according to the new findings, from a series of research papers published in the journal Ultrasound in Obstetrics, the margin of error is so high that some perfectly viable pregnancies are being lost.



One study revealed an up to 20% variation in the size of gestational sacs reported by different clinicians measuring the same pregnancies.



Professor Tom Bourne, from Imperial College London, who led a study of more than 1,000 women suspected of miscarrying, said: "Currently there is a risk that some women seeking reassurance with pain or bleeding in early pregnancy may be told they have had a miscarriage and choose to undergo surgical or medical treatment when the pregnancy is in fact healthy."



Criteria used to diagnose miscarriage varies. In the UK, one classification under Royal College of Obstetricians and Gynaecologists guidelines is an empty gestational sac measuring 20 millimetres or more. Alternatively, a foetal size of 6mm or more with no heartbeat may also indicate a miscarriage.



In the US, a smaller gestational sac threshold of 16mm is adopted. According to the research, this could result in even more wrong diagnoses.



Each year an estimated 500,000 women have miscarriages in the UK. Research suggests around 30% of these women undergo early ultrasound scans.



Prof Bourne and colleagues write in their paper: "Applying a cut-off for MSD (mean sac diameter) of 20mm could lead to 400 viable pregnancies potentially being misclassified, compared with approximately 300 'cot deaths' reported in the UK each year.



"These numbers are significant and relate to pregnancies that would be highly likely to reach term."



The researchers suggest diagnosing miscarriage on the basis of an empty sac measuring 25mm, or a foetal size of 7mm or more with no heartbeat.



Speaking at a briefing in London, Prof Bourne said a repeat scan should be undertaken 10 days after the first "in all cases".



However, he added: "It's the responsibility of the profession to put its house in order."



Another study, led by Dr Shakila Thangaratinam, from Queen Mary, University of London, indicated that current guidelines were based on old and unreliable data.



"The majority of ultrasound standards used for diagnosis of miscarriage are based on limited evidence," she said.



The experts agreed there was a need for new research involving larger numbers of patients.



Dr Tony Falconer, president of the Royal College of Obstetricians and Gynaecologists (RCOG), said: "The RCOG peer reviews its guidelines routinely and works with other organisations such as Nice (National Institute for Health and Clinical Excellence) to develop best practice advice for doctors. The findings from these papers add to our knowledge of clinical practice and will be considered when we update our guidelines.



"Miscarriage is an upsetting experience for anyone and all women who have had a miscarriage should have access to support from the NHS. Healthcare professionals must receive the best training possible to ensure that they are competent in antenatal screening and diagnoses so that mistakes are avoided."



Professor Jane Norman, director of the Tommy's Centre for Maternal and Foetal Health, University of Edinburgh, said: "In women in early pregnancy, it can often be difficult to confidently distinguish a very early ongoing pregnancy from a miscarriage. Most UK units will adhere to guidelines from the Royal College of Obstetricians (RCOG) on the management of early pregnancy loss in order to make this diagnosis.



"These new data show that following the current RCOG guidelines will give the correct diagnosis in the vast majority of women. They also provide some robust new evidence on which to further improve guidelines for diagnosis in this very important clinical condition."



Prof Bourne sought to reassure women who might be worried about the study findings.



"I don't think women should be anxious, but I do think we should get it right so we don't make any mistakes," he said. "What I'm not saying is that it's likely that someone who has had surgery for miscarriage has had a misdiagnosis of miscarriage."

PA

News
Alan Bennett has criticised the “repellent” reality shows which dominate our screens
tvBut he does like Stewart Lee
Life and Style
The Google Doodle celebrating the start of the first day of autumn, 2014.
tech
Arts and Entertainment
Sheridan Smith as Cilla Black and Ed Stoppard as her manager Brian Epstein
tvCilla Episode 2 review: Grit under the glamour in part two of biopic series starring Sheridan Smith
Sport
David Moyes and Louis van Gaal
football
PROMOTED VIDEO
Life and Style
ebooksA superb mix of recipes serving up the freshest of local produce in a delicious range of styles
Life and Style
ebooksFrom the lifespan of a slug to the distance to the Sun: answers to 500 questions from readers
News
i100
Life and Style
Vote with your wallet: the app can help shoppers feel more informed about items on sale
lifeNew app reveals political leanings of food companies
News
Former Governor of Alaska Sarah Palin, left, with her daughter, Bristol
newsShe's 'proud' of eldest daughter, who 'punched host in the face'
Sport
New Zealand fly-half Aaron Cruden pictured in The Zookeeper's Son on a late-night drinking session
rugby
Arts and Entertainment
Salmond told a Scottish television chat show in 2001that he would also sit in front of a mirror and say things like,
tvCelebrity Trekkies from Alex Salmond to Barack Obama
Life and Style
Carol O'Brien, whose son Rob suffered many years of depression
healthOne mother's story of how London charity Maytree helped her son with his depression
Arts and Entertainment
The cover of Dark Side of the Moon
musicCan 'The Endless River' carry on the tradition? See for yourself
Life and Style
food + drink
News
Rob Merrick's Lobby Journalists were playing Ed Balls' Labour Party MPs. The match is an annual event which takes place ahead of the opening of the party conference
newsRob Merrick insistes 'Ed will be hurting much more than me'
News
A cabin crew member photographed the devastation after one flight
news
Voices
A new app has been launched that enables people to have a cuddle from a stranger
voicesMaybe the new app will make it more normal to reach out to strangers
Latest stories from i100
Have you tried new the Independent Digital Edition apps?

ES Rentals

    Independent Dating
    and  

    By clicking 'Search' you
    are agreeing to our
    Terms of Use.

    iJobs Job Widget
    iJobs General

    Pharmaceutical Computer System Validation Specialist

    £300 - £350 Per Day: Clearwater People Solutions Ltd: Pharmaceutical Computer ...

    High Level Teaching Assistant (HTLA)

    £70 - £90 per day: Randstad Education Birmingham: Higher Level Teaching Assist...

    Teaching Assistant

    £50 - £80 per day: Randstad Education Birmingham: Randstad Education is the UK...

    Senior Java Developer - API's / Webservices - XML, XSLT

    £400 - £450 Per Day: Clearwater People Solutions Ltd: Our client is currently ...

    Day In a Page

    Secret politics of the weekly shop

    The politics of the weekly shop

    New app reveals political leanings of food companies
    Beam me up, Scottie!

    Beam me up, Scottie!

    Celebrity Trekkies from Alex Salmond to Barack Obama
    Beware Wet Paint: The ICA's latest ambitious exhibition

    Beware Wet Paint

    The ICA's latest ambitious exhibition
    Pink Floyd have produced some of rock's greatest ever album covers

    Pink Floyd have produced some of rock's greatest ever album covers

    Can 'The Endless River' carry on the tradition?
    Sanctuary for the suicidal

    Sanctuary for the suicidal

    One mother's story of how London charity Maytree helped her son with his depression
    A roller-coaster tale from the 'voice of a generation'

    Not That Kind of Girl:

    A roller-coaster tale from 'voice of a generation' Lena Dunham
    London is not bedlam or a cradle of vice. In fact it, as much as anywhere, deserves independence

    London is not bedlam or a cradle of vice

    In fact it, as much as anywhere, deserves independence
    Vivienne Westwood 'didn’t want' relationship with Malcolm McLaren

    Vivienne Westwood 'didn’t want' relationship with McLaren

    Designer 'felt pressured' into going out with Sex Pistols manager
    Jourdan Dunn: Model mother

    Model mother

    Jordan Dunn became one of the best-paid models in the world
    Apple still coolest brand – despite U2 PR disaster

    Apple still the coolest brand

    Despite PR disaster of free U2 album
    Scottish referendum: The Yes vote was the love that dared speak its name, but it was not to be

    Despite the result, this is the end of the status quo

    Boyd Tonkin on the fall-out from the Scottish referendum
    Manolo Blahnik: The high priest of heels talks flats, Englishness, and why he loves Mary Beard

    Manolo Blahnik: Flats, Englishness, and Mary Beard

    The shoe designer who has been dubbed 'the patron saint of the stiletto'
    The Beatles biographer reveals exclusive original manuscripts of some of the best pop songs ever written

    Scrambled eggs and LSD

    Behind The Beatles' lyrics - thanks to Hunter Davis's original manuscript copies
    'Normcore' fashion: Blending in is the new standing out in latest catwalk non-trend

    'Normcore': Blending in is the new standing out

    Just when fashion was in grave danger of running out of trends, it only went and invented the non-trend. Rebecca Gonsalves investigates
    Dance’s new leading ladies fight back: How female vocalists are now writing their own hits

    New leading ladies of dance fight back

    How female vocalists are now writing their own hits