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This Month's News

Early Pregnancy Unit

Medical Gynaecology for General Practice

Criteria for referral for termination of pregnancy

Ultrasound Gynaecological Scanning

Spotlight Seminar Review

Initial investigations & management of the sub-fertile couple

Welcome to Debbie Beesley, new Choose and Book manager

Dates for your diary

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November 2010

Early Pregnancy Unit

The Department of Obstetrics and Gynaecology at Ashford and St Peter’s NHS Trust offer a highly specialised and dedicated Emergency Gynaecology Service.

The vast majority of emergencies in gynaecology are early pregnancy and require specialist consideration.

Associate Specialist Dr Catey Bass scans and assesses patients

Currently, we offer an Emergency service during working days between 9 a.m. and 1 p.m.( any follow ups are then seen between 1-3pm) where patients can present with a referral from either their family doctor or the Accident and Emergency if there are concerns of an early pregnancy problem, particularly that of ectopic pregnancy.

Patients are seen by dedicated specialist early pregnancy nurses as well as a gynaecologist who has specialist training in transvaginal early pregnancy gynaecological ultrasound. These are combined with same day HCG and progesterone hormone assay and interpretation if required.

We will see patients with a problem immediately should you wish to contact us during these hours for advice. Appointments are not required as this is a walk-in service but it would be helpful if you could provide a referral letter to expedite things for the patient.

Senior Staff Nurse Sue Bull, Sister Lesley Smith and Staff Nurse Oriel Hampson

To avoid long wait times during times of high demand please ask your patients to call in advance on 01932 722662.

A miscarriage screening service is offered automatically for women with two previous miscarriages by appointment at 7 – 8 weeks gestation when they are booked in for their pregnancy in the Maternity Department.

Please feel free to write to Mr S Banerjee, Consultant Gynaecologist and Lead Clinician for the Early Pregnancy Unit should you have any comments to make so that we can improve our services which are ever expanding to meet the understandably increasing demand.

Specialist Ultrasound Services

St Peter’s is one of eleven nationwide specialist referral centres for the management of women with chronic pelvic pain and severe endometriosis. For this, we have an unrivalled Gynaecology Ultrasound Service under the care of Prof Jeremy Wright and Mr Saikat Banerjee. They will be delighted to see a woman with chronic pelvic pain and offer her a specialist ultrasound service looking for the presence of deep disease within the pelvis as well as in the ovaries. We are one of few centres in the country to be able to offer this service.

Medical Gynaecology for General Practice

As we move in to an era where much more investigation and treatment will start in the primary care setting it is important to develop pathways so that if referral for an opinion in secondary care is required this can be an informed opinion based on the appropriate investigations rather than a request to investigate.

This is particularly important as there is a wish to reduce the number of new to follow up patients and to ensure that the patients interaction with secondary care in the outpatient setting is useful and that you as the general practitioner can have useful guidance as how to proceed.

The sea change in gynaecology is a move away from surgical interventions such as hysterectomy to more medical management of conditions such as heavy menstrual bleeding.

Initial management such as use of tranexamic acid or progestogen containing intra-uterine devices can be tried in primary care and ultra-sound examination can largely exclude intra uterine pathology such as submucous fibromyomata and polyps. If subserous fibroids or intramural fibroids are present these may not of themselves require surgical intervention and it is perfectly reasonable to try these medical interventions. For women who do not want constant medication or find the possible side effects of progestogenic IUCDs unpleasant endometrial ablation may help. There are many ways to do this but here we offer ‘Thermachoice’ balloon ablation which destroys the endometrium by heat, hot water being passed through the balloon in a controlled way. For women with a normal size uterus this offers a cost effective solution with high patient satisfaction. Amenorrhoea however is uncommon with only about 30% of women achieving this but most report significantly reduced menstrual flow. With appropriate assessment, normal ultra-sound examination, and if there is cycle irregularity endometrial sampling, these women can be directly referred. Hysterectomy is increasingly being only offered to women in whom painful periods are an issue as the pain with periods may suggest adenomyosis (islets of endometrium growing in the myometrium) for which local therapy is clearly in appropriate.

Hysterectomy though is no longer the major operation it once was although psychological barriers remain to be resolved. Most hysterectomies can now be undertaken either using the vaginal route or with laparoscopic assistance, the vessels being divided laparoscopically and the uterus removed vaginally. Although the fatigue associated with major surgery is not lost, recovery to driving and normal activities is much quicker and hospital stay usually reduced to 24-48 hours. A question many women ask is about oophorectomy at the time of surgery, and there is no easy answer to this. In the presence of endometriosis or other ovarian pathology oophorectomy is sensible as there is a high chance of further surgery, otherwise ovarian conservation is sensible. As you get older however, and ovarian function is likely to diminish there is an argument to consider oophorectomy. The incidence of ovarian cancer post hysterectomy is low, only about 1/1000 but ovarian cancer presents late and 5 year survival is depressingly poor so there are strong arguments for removing the ovaries in the peri-menopausal years.

However, the upside is that oestrogen only hormone replacement is extremely well tolerated and can be given in a myriad of ways, tablets, patches, creams gels and implants. Problems with HRT usually revolve around the progestogenic component (the culprit for PMT, acne greasy skin etc) and as there is no endometrium to be protected this is not necessary.

Criteria for referral for termination of pregnancy

In Surrey women are normally referred to BPAS or Marie Stopes but the Gynaecology consultants will see women for termination of pregnancy on referral from the GP if they meet one or more of the following criteria:
  • Under 16 years
  • Abdominal pain suggestive of an ectopic pregnancy
  • Prolonged bleeding or hyperemesis to suggest a Molar pregnancy
  • IUCD in place
  • Allergic to Mifepristone or Misoprostol
  • Bleeding disorder
  • Chronic Adrenal problems
  • Long term corticosteroid therapy
  • Inherited Porphyria
  • Systemic Lupus Erythematosus
  • Severe learning disabilitiies
  • Refused by Marie Stopes or BPAS
Any woman about whom the GP has specific concerns who may not fall into the criteria above. Telephone discussion with consultant first

This follows agreement with NHS Surrey.

Ultrasound Gynaecological Scanning

The team of ultrasonographers based in Abbey Wing Ultrasound at St.Peter’s Hospital, Women’s Health, offer an efficient ultrasound service for all of your female clients who require a pelvic scan.

In most cases the scan will be performed transvaginally – the method of choice. The procedure is quick and relatively painless. It is excellent as a first line examination when a woman presents with problems such as infertility, amenorrhoea, irregular periods, IMB, and pelvic pain.

All the sonographers in our team are expected to meet given standards of scanning technique and report writing. We regularly discuss and reflect upon any interesting/difficult cases. The department aims to give all the sonographers opportunity to attend educational gynaecological study days.

The Abbey Wing Ultrasound is only involved in ante-natal and gynaecological work – a factor that we think enables us to specialise in our field. The department is situated within the setting of the Women’s Health building. All our ultrasound machines are less than five years old, and have a colour doppler facility.

We aim to provide you with a clearly written report and an easy access system, both for booking and queries.

Thus, our department is happy to discuss any questions that you may have at booking, or on receipt of the ultrasound result. The Lead sonographer may be contacted on 01932 722670.

Please telephone us with any very urgent requests – in these cases we aim to offer an appointment within two working days. We can also provide an instant report if requested.

How to book:
  • Via ‘CHOOSE AND BOOK’ or
  • Call our hotline – 01932 722665/2670 (method of choice for urgent cases) or
  • Fax request – 01932 722270
We also have maternity ultrasound at Ashford, please contact 01784 784671.

Spotlight Seminar Review

The Gynaecology spotlight seminar took place on October 21st at Foxhills and has received excellent feedback.

There were 25 GPs in attendance on the night and the format included four talks with a dinner beforehand.

Topics covered were:
  • Uro-gynaecology
  • Subfertility
  • Gynae-oncology
Dr Sara Coe, a GP from the Wey Family practice gave a presentation on Gynaecology from the GPs perspective and included information on primary and secondary pathways, emphasising the need for a joined up service.

To download copies of the presentations please go to the GP extranet at events section.

If you are interested in joining the mailing list for the seminars then please phone 01932 723716 or email < ahref="">

Initial investigations & management of the sub-fertile couple

Couples who present with concern about delay in conceiving benefit from a co-ordinated pathway, with their GP providing advice and initial investigation, and then referral to secondary care at the appropriate time. Potentially the GP would give them advice on:-
  • Weight, diet and exercise
  • Smoking and alcohol
  • Significance of female age
  • Folic Acid

The initial investigations would include:

For the female partner:
  • Mid luteal phase progesterone (day 21 of a 28 day cycle)
  • Day 2, FSH, LH and E2
  • Rubella immunity
  • Chlamydia screening
  • Cervical smear (if not done within the last 3 years)

For the male partner:
  • Semen analysis (and repeat if the first sample is abnormal)
  • Early referral to secondary care is appropriate if:
  • The results of the initial investigations are abnormal
  • Oligo/amenorrhoea or irregular cycles
  • History of PID, endometriosis, previous ectopic pregnancy

The Trust’s fertility clinic offers further investigation, including tubal patency testing, and treatment including ovulation induction and surgical interventions where indicated. Referral on for assisted conception is arranged when clinically appropriate, but NHS funded treatment requires PCT criteria to be met. NHS funding is restricted to childless couples and there are age and weight criteria.

Couples with fertility problems need support, accurate information and advice appropriate to their individual circumstances. GPs and hospital fertility clinics working together can provide this service very efficiently, at the same time giving the patients the care they need.

Contact :
Lead Consultant
Sue Bateman
01932 722654.

Welcome to Debbie Beesley, new Choose and Book manager

An experienced Choose and Book manager, Debbie returns to working at the trust following four years at Ealing PCT as the Choose and Book lead and Clinical Assessment service manager.

Her initial objectives at Ashford and St.Peters are to:
  • Review the entire choose and book service

  • Tackle slot issues for services that are experiencing high volumes of referral

  • Consult with GPs on any additional services they would like on Choose and Book

Debbie is happy to come out and meet practices and to support the choose and book process, dealing with any issues you might have.
Debbie Beesley

Dates for your diary

Clinical Interface Meeting

14th December 2010
12 pm.
Bessier Room at Foxhills Country Club.

Spotlight Seminar on Urology

January 27th 2011
Clubhouse at Foxhills Country Club.

Click here to download the programme

Spotlight Seminar on Trauma and Orthopaedics

March 31st 2011
Clubhouse at Foxhills Country Club.