Miscarriage is the most common complication of pregnancy and is associated with significant emotional, social and economic impact. The diagnosis of miscarriage is made with transvaginal ultrasound examination following rigid diagnostic criteria which ensures a safe and accurate assessment for all women. This chapter outlines the evolution of national and international guidance on the ultrasound diagnosis of miscarriage highlighting when and why changes in practice have occurred. Diagnostic criteria are illustrated with ultrasound images and practical guidance is offered through inclusion of an annotated flowchart incorporating the most up to date evidence to protect women from the risk of inappropriate intervention. Once the diagnosis of miscarriage is made options for treatment include expectant, medical and surgical management. The chapter outlines fundamental information to discuss with women to facilitate informed decision making and provides guidance on the practical aspects of management of miscarriage.

Introduction

Early pregnancy problems account for a major part of all gynaecological emergencies. Other less common gynaecological emergencies are acute pain, severe vaginal bleeding and collapse, which are covered in detail in other chapters.

All women with early pregnancy and acute gynaecological problems should receive prompt referral to a dedicated early pregnancy unit that provides efficient, evidence-based care with access to appropriate information and counselling. The National Service Framework recommends that all women should have access to an early pregnancy unit, which should be easily available (www.earlypregnancy.org.uk). Ideally, these services should also be directly accessible to GPs.

A report of the National Confidential Enquiry into Patient Outcome and Death in 2007 stated that when a patient with an acute healthcare problem arrives in hospital, he or she requires prompt clinical assessment, appropriate investigations and institution of a clear management plan. There should be an early decision regarding the need to involve all relevant specialties and other required services followed by a timely review by an appropriately trained senior clinician. This should be undertaken in an environment that is best suited to meet the patient's clinical needs. Although there is conflicting opinion on the optimal location for the assessment of emergency admissions, it has been recommended that women presenting with early pregnancy complications should undergo initial assessment in dedicated emergency assessment units. The rationale for the use of emergency assessment units is that they can reduce both the emergency department's workload and hospital length of stay.

The last decade has witnessed striking progress in assisted reproductive technology (ART) and over the past few years the success rate of ART has increased significantly due to the introduction of novcl technologies and improved embryo culture systems. Along with this rapid pace of development comes the need for clinicians to keep abreast.

This book brings fresh insights into the pathophysiology of human reproduction, providing up-to-date and practical information on the clinical and laboratory management of subfertility. Particular emphasis is placed on the clinical appraisal of the current and potential strategies to improve the management of the subfertile couple, as well as the various therapeutic options available for the management of subfertility.

The preparation of this book was driven by a desire to provide a hands-on, practical guide to assisted reproduction that would be accessible to those practising in the field of Assisted Reproduction, those working on the establishment and day-to-day running of an IVF clinic, and those with a more general interest in assisted reproduction. The contributing authors include internationally renowned clinicians and scientists actively involved in the field of reproductive medicine and those who are acknowledged in their own fields.

We are most grateful to all who have made the publication of this book possible.

Assisted human reproduction continues its worldwide spread as increasing numbers of patients are treated annually, and more clinicians and scientists enter the field each year. Demand for new knowledge remains insatiable whether on the web, in conferences or textbooks. Demand comes from so many quarters, from medical and scientific professionals, teachers, nurses, counsellors, patients and students, each needing information for their own particular ends. Comprehensive texts covering this wide demand are rare, new books mostly being highly specialised to a particular topic or technique.

Good Clinical Practice in Assisted Reproduction offers this comprehensive approach to the clinical aspects of assisted reproduction. It is unusual among the many books covering this field of biomedicine. Setting out to make data available using a simple form of presentation enabling easy searching, data are presented in 20 straightforward but detailed chapters, each debating topics essential to this form of treatment. Stressing clinical care rather than the scientific aspects of human embryology and their application, successive chapters have a simple and attractive style grouping data under sub-headings at regular intervals. Browsing is made easy without any need for constant recourse to indices or other textbooks. Tables are well laid out and direct, diagrams redrawn to a single style giving a highly attractive layout to the book. References are numerous and complete, present full details to chosen articles and offer advanced knowledge to provide data to more advanced readers in the field. Such simple and direct means of projecting its contents make this book attractive to a wide readership searching for an easy-to-read and easily accessible yet responsible text.