Letters NICE on ectopic pregnancy and miscarriage

NICE guidance on ectopic pregnancy and miscarriage restricts access and choice and may be clinically unsafe

BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f197 (Published 22 January 2013) Cite this as: BMJ 2013;346:f197
  1. Tom Bourne, consultant gynaecologist1,
  2. Kurt Barnhart, professor of obstetrics and gynecology and epidemiology2,
  3. Carol B Benson, professor of radiology3,
  4. Jan Brosens, professor of obstetrics and gynaecology4,
  5. Ben Van Calster, professor in medical statistics5,
  6. George Condous, associate professor of gynaecology6,
  7. Arri Coomerasamy, professor of gynaecology7,
  8. Peter M Doubilet, professor of radiology3,
  9. Steven R Goldstein, professor of obstetrics and gynecology8,
  10. Deborah Gould, consultant obstetrician and gynaecologist9,
  11. Emma Kirk, specialist registrar in obstetrics and gynaecology10,
  12. Ben Willem Mol, professor of obstetrics and gynaecology and clinical epidemiology11,
  13. Nicholas Raine-Fenning, clinical associate professor and reader in reproductive medicine and surgery 12,
  14. Catriona Stalder, consultant in emergency gynaecology13,
  15. Dirk Timmerman, professor in obstetrics and gynaecology5
  1. 1Queen Charlotte’s and Chelsea Hospital, Imperial College, London, UK, and Department of Development and Regeneration, University Hospitals, KU Leuven, Belgium
  2. 2Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
  3. 3Harvard Medical School, Boston, USA
  4. 4Division of Reproductive Health, Warwick Medical School, University of Warwick, Coventry, UK
  5. 5Department of Development and Regeneration, KU Leuven, Belgium
  6. 6University of Sydney, Sydney, Australia
  7. 7School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
  8. 8New York University Medical Center, New York, USA
  9. 9St Mary’s Hospital, Imperial College NHS Trust, London, UK
  10. 10Whittington Hospital, London, UK
  11. 11AMC, Amsterdam, Netherlands
  12. 12Faculty of Medicine and Health Sciences, Queen’s Medical Centre, Nottingham, UK
  13. 13Queen Charlotte’s and Chelsea Hospital, Imperial College NHS Trust, London, UK
  1. t.bourne{at}imperial.ac.uk

We welcome National Institute for Health and Clinical Excellence (NICE) guidance on wider use of pregnancy tests in primary care and its focus on considering ectopic pregnancy (EP), but we are worried about recommendations that restrict access, limit choice, and may be clinically unsafe.1

  • 1 Women should not have access to care restricted. We cannot exclude EP in symptomatic women less than six weeks’ pregnant, and many women have inaccurate dates.2 NICE stipulates that women see another clinician before accessing early …

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