Improving women's health and pregnancy outcome: understanding the aetiology of ectopic pregnancy

Lead Research Organisation: University of Edinburgh
Department Name: School of Clinical Sciences

Abstract

About one in 80 pregnancies is ectopic. Most implant in the Fallopian tube. Ectopic pregnancy can cause potentially life-threatening abdominal bleeding and damage to the Fallopian tube affecting future child-bearing. We do not fully understand what causes a pregnancy to implant outside the womb but chlamydial infection is a major risk factor. This project aims to understand how Chlamydia, and two groups of molecules (endocannabinoids and integrins) contribute to the implantation of a pregnancy in Fallopian tube. Information from our laboratory already suggests that, in mouse, endocannabinoids contribute to the successful passage of the embryo from the Fallopian tube into the womb and that levels of endocannabinoids are different in women with ectopic pregnancy. We also hope to show in a laboratory model that abnormal production of endocannabinoids causes the embryo to get trapped in the human Fallopian tube and show how chlamydial infection causes it to implant by affecting integrin levels. We then propose to show that women with ectopic pregnancy have abnormal levels of endocannabinoids and integrins and that this is related to chlamydial infection. Improved understanding of ectopic pregnancy could significantly reduce the risks of this condition.

Technical Summary

Ectopic pregnancy (EP) remains a common cause of pregnancy-related death and is a considerable cause of morbidity. Chlamydia trachomatis (CT) infection is the major risk factor for EP yet our knowledge of the pathogenic events that lead from CT to EP is unclear.

We hypothesise EP is due to the result of:
a) embryo retention in the Fallopian tube (FT) due to smooth muscle dysfunction and,
b) changes in the phenotype/gene expression of the tubal epithelial cell that allow ectopic embryo implantation to occur.

The endocannabinoids are multifunctional proteins that have a pivotal role in embryo transport due to their effects on oviductal smooth muscle. Silencing of the endocannabinoid receptor 1 (CB1) in the mouse results in tubal embryo retention (but not tubal implantation). Attenuated CB1 expression in the human FT is associated with ectopic pregnancy. Although this provides a plausible explanation for arrest of the embryo in the FT, the exact mechanism leading from tubal embryo retention to tubal implantation has hitherto been unexplained. We propose that CT infection causes changes in the tubal epithelial cell that make the FT receptive to ectopic implantation. The integrins, particularly alpha v beta 3, have now been largely accepted as markers of receptivity to the presenting embryo in the uterus, and functional blockout of alpha v beta 3 results in reduced implantation in the mouse. However, it is not known whether integrins have a similar expression in the FT to the uterus, or are aberrantly expressed in EP.

The objectives of this project are to demonstrate that:

1) Endocannabinoids regulate smooth muscle contraction controlling passage of the embryo in the human FT in in-vitro models of tubal contractility and motility; and that CT infection results in aberrant integrin expression and embryo attachment in the human FT in an in-vitro model of tubal attachment.

2) Infection with Chlamydia in the CB1-knockout mouse causes altered tubal epithelial integrin expression and is the stimulus required for a retained embryo implant.

3) CB1 and integrin expression are different in the FT of women following EP in-vivo, and that these differences reflect CT infection.

The delineation of role of CT infection in EP has significant public health implications, particularly in relation to the introduction of national Chlamydia screening programmes. An explanation of the aetiology of tubal ectopic implantation has potential to be translated into preventative health measures that could significantly reduce morbidity/mortality due to EP.

Publications

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publication icon
Bitzer J (2012) A new age has come: the redefinition of women's health care in Journal of Family Planning and Reproductive Health Care

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Brown JK (2011) Laboratory models for studying ectopic pregnancy. in Current opinion in obstetrics & gynecology

 
Description ESHRE endometriosis guideline committee
Geographic Reach Multiple continents/international 
Policy Influence Type Membership of a guidance committee
 
Description Albert McKern Bequest Project grant
Amount £25,000 (GBP)
Organisation University of Sydney 
Department Dr Albert S McKern Research Scholarship
Sector Charity/Non Profit
Country Australia
Start 01/2010 
End 01/2011
 
Description Barbour Watson Trust Project Grant
Amount £5,860 (GBP)
Organisation Barbour Watson Trust 
Sector Charity/Non Profit
Country United Kingdom
Start 01/2011 
End 12/2011
 
Description CSO Endometriosis Research grant
Amount £117,758 (GBP)
Organisation Chief Scientist Office 
Sector Public
Country United Kingdom
Start 01/2013 
End 12/2014
 
Description CSO Project grant
Amount £261,605 (GBP)
Organisation Chief Scientist Office 
Sector Public
Country United Kingdom
Start 01/2012 
End 10/2013
 
Description Centenary Award
Amount £99,314 (GBP)
Organisation Medical Research Council (MRC) 
Sector Public
Country United Kingdom
Start 12/2012 
End 08/2013
 
Description NIHR EME Investigator led call
Amount £1,000,000 (GBP)
Funding ID 14/150/03 
Organisation NIHR Evaluation, Trials and Studies Coordinating Centre (NETSCC) 
Sector Public
Country United Kingdom
Start 04/2016 
End 10/2018
 
Description Research Training Fellowship for Clinical PhD Student
Amount £240,000 (GBP)
Organisation Wellcome Trust 
Sector Charity/Non Profit
Country United Kingdom
Start 11/2015 
End 11/2018
 
Description WoW Endometriosis Project grant
Amount £144,337 (GBP)
Organisation Wellbeing of Women 
Sector Charity/Non Profit
Country United Kingdom
Start 11/2012 
End 10/2014
 
Title Fallopian tube tissue resource 
Description Carefully characterised human Fallopian tube and serum samples collected from non-pregnant women undergoing surgery for benign gynaecological conditions and ectopic pregnancy. 
Type Of Material Biological samples 
Year Produced 2011 
Provided To Others? Yes  
Impact Collaborations with University of Melbourne leading to two publications to date: PMID: 24084529 PMID: 24074901 Other significant publications: PMID: 22002573 PMID: 21858178 PMID: 21414667 PMID: 21224062 PMID: 20978183 PMID: 20864676 PMID: 20651036 PMID: 19864448 PMID: 20047737 
 
Title Serum from women with ectopic pregnancy 
Description Serum samples collected from women with ectopic pregnancy, women with miscarriage and women with viable intrauterine pregnancy. 
Type Of Material Biological samples 
Year Produced 2012 
Provided To Others? Yes  
Impact The following publications have arisen from this resource: PMID: 23826180 PMID: 23824055 PMID: 22927907 PMID: 21047920 
URL http://europepmc.org/abstract/MED/21047920
 
Description Collaboration Imperial College London 
Organisation Imperial College Healthcare NHS Trust
Department Obstetrics and Gynaecology
Country United Kingdom 
Sector Hospitals 
PI Contribution Assay of serum samples for ectopic pregnancy biomarkers.
Collaborator Contribution Supply of serum biobank from women with early pregnancy problems.
Impact PMID: 23826180
Start Year 2011
 
Description Collaborator Aberdeen 
Organisation University of Aberdeen
Department Academic Obstetrics and Gynaecology
Country United Kingdom 
Sector Academic/University 
PI Contribution Intellectual contribution to grant applications.
Collaborator Contribution Intellectual contribution to grant applications. Patient recruitment.
Impact PMID: 22685224 HTA (£2,487,834) 2013-18 "PRE-EMPT: Preventing Recurrence of Endometriosis by Means of long acting Protestogen Therapy" S Bhattacharya (PI), K Cooper, J Gupta, J Daniels, J Clark, E Denny, E Saridogan, L Middleton, G Jones, AW Horne, C Becker Chief Scientist Office (£117,758) 2013-15 "Long term health of women diagnosed with endometriosis: a Scottish record linkage study" S Bhattacharya (PI), K Cooper, L Saraswat, S Bhattacharya, D Ayansina, AW Horne, D Miligkos Chief Scientist Office (£261,605) 2012-14 "A pilot randomised controlled trial of the efficacy of gabapentin for the management of chronic pelvic pain in women" AW Horne (PI), S Bhattacharya, HO Critchley, J Wilson, O Wu, S Jack, M Porter, S Lewis
Start Year 2011
 
Description Collaborator Australia 
Organisation University of Melbourne
Department Department of Obstetrics and Gynaecology
Country Australia 
Sector Academic/University 
PI Contribution Contributed to laboratory based studies and recruitment to clinical trial.
Collaborator Contribution As above.
Impact PMID: 22985126 PMID: 22927907 PMID: 24084530 PMID: 24084529 PMID: 24074901 PMID: 23872290 PMID: 23824055 PMID: 23369098 PMID: 23288908 Secured MRC Centenary Award (£99,314) to continue to fund collaboration.
Start Year 2010
 
Description Collaborator Bristol 
Organisation University of Bristol
Department School of Social and Community Medicine
Country United Kingdom 
Sector Academic/University 
PI Contribution Intellectual contributions to study design. Collection of serum and tissue samples.
Collaborator Contribution Assay of serum samples for chlamydial serology.
Impact PMID: 21794209 PMID: 21224062 PMID: 21124214 PMID: 20849196
Start Year 2010
 
Description Collaborator China 
Organisation Chinese University of Hong Kong
Department Department of Obstetrics and Gynaecology
Country Hong Kong 
Sector Academic/University 
PI Contribution Cell culture experiments using cotinine.
Collaborator Contribution Access to cell line.
Impact PMID:20864676 PMID: 20651036 PMID: 21968811 PMID: 21224062 PMID: 21968811
Start Year 2009
 
Description Collaborator USA 
Organisation Cincinnati Children's Hospital Medical Center
Country United States 
Sector Hospitals 
PI Contribution Coauthor on review and original research article.
Collaborator Contribution Coauthor on review and original research article. Supplier of knockout mice for research study.
Impact PMID: 20071358 PMID: 19093002
Start Year 2007
 
Description Local collaborator (imaging) 
Organisation University of Edinburgh
Department Centre for Cardiovascular Science
Country United Kingdom 
Sector Academic/University 
PI Contribution Preparation of grant submission (currently in review) Application for ethical approval for study in humans
Collaborator Contribution Pilot data in animals demonstrating use of contrast agent in imaging of reproductive tract
Impact Grant submission to BRACCO: Pilot feasibility study to evaluate the use of SONOVUE® in EArly Pregnancy failure (PEAP study) Co-investigators include physiologist, basic scientist, radiologist, gynaecologists
Start Year 2010
 
Title Ectopic pregnancy biomarker patent 
Description The project identified two proteins with potential as serum biomarkers for the diagnosis of ectopic pregnancy. 
IP Reference GB0712801.0 
Protection Patent granted
Year Protection Granted 2007
Licensed No
Impact This led to further grant funding from the Edinburgh Bioquarter Fund and IKTF ((£19,337)
 
Title Diagnostic serum biomarker for ectopic pregnancy 
Description We have identified a panel of candidate biomarkers using hypothesis driven and unbiased discovery approaches. These biomarkers have been assessed in case-control studies. PMID: 23826180 PMID: 23824055 PMID: 22927907 PMID: 21047920 Using the data derived from these studies, a diagnostic algorithm is being developed by a team at Glasgow University with a view to using the test(s) in a future prospective study. 
Type Diagnostic Tool - Non-Imaging
Current Stage Of Development Early clinical assessment
Year Development Stage Completed 2013
Development Status Under active development/distribution
Impact Biomarkers have been assessed in a local case-control study of 120 women and using a cohort collected at Imperial College of 800 women. 
 
Company Name Icthus Therapeutics 
Description Icthus Therapeutics is a new spin out from the University of Edinburgh's College of Medicine and Veterinary Medicine focused on women's health, and in particular on endometriosis. The founders are academics and clinicians from the NHS's Centre for Reproductive Health and the Royal Infirmary of Edinburgh based at Little France. 
Year Established 2013 
Impact The company is funding 'PURFECT' - a pilot clinical trial to determine whether purified fatty acids are effective in the treatment of endometriosis-associated pelvic pain.
 
Description 13th World Congress in Endometriosis, Vancouver, 18 May 2017 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact invited speaker
Year(s) Of Engagement Activity 2017
URL http://conference.city/conference.php?e_id=132989
 
Description AEPU conference 2016 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact The Association of Early Pregnancy Units provide support and resources to help patient choice and maintain standards in Early Pregnancy Care. There are over 200 Early Pregnancy Units across the UK in NHS hospitals. The group meet on an annual basis in a conference setting.
During the last conference the Trial Coordinator presented an outline and update of the trial to the audience as well as mananging a stand to promote awareness of the trial. As a result the Trial Management Group were approapched about a number of sites that wanted to participate in the trial.
Year(s) Of Engagement Activity 2016
 
Description Association of Early Pregnancy Units Annual Meeting Newcastle 2015 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Invited lecture on work leading up to multi centre trial due to start recruitment in summer 2016.
Year(s) Of Engagement Activity 2015
 
Description DA Boyes' Society Meeting, Vancouver, Canada, 2 November 2017 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Invited speaker - talk entitled "The management of ectopic pregnancy: past, present and future"
Year(s) Of Engagement Activity 2017
 
Description ESGE Annual Meeting, Antalya, Turkey October 2017 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Invited speaker - talk entitled "NICE Guidelines on endometriosis explained"
Year(s) Of Engagement Activity 2017
 
Description ESHRE precongress course 2011 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Keynote/Invited Speaker
Geographic Reach International
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact Changes in the Fallopian tube microenvironment predisposing to tubal implantation. ESHRE Precongress Course, Stockholm, Sweden

60-70 delegates attended the talk which sparked questions and discussion afterwards.


Led to invitations to speak in Gothenburg and Munich.
Year(s) Of Engagement Activity 2011
 
Description Endo Patient Awareness Day 2015 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact 60 members of the general public (including patens and carers) attended a series of lectures and workshops arranged by our research team
Year(s) Of Engagement Activity 2015
 
Description Endometriosis Association of Ireland, Dublin, 9 September 2017 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact invited speaker - talk entitled "Learning from cancer to treat endometriosis
Year(s) Of Engagement Activity 2017
 
Description Endometriosis UK 2013 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Type Of Presentation Keynote/Invited Speaker
Geographic Reach Regional
Primary Audience Participants in your research and patient groups
Results and Impact Approx 25 patients attended this workshop where I gave an update on current research advances in endometriosis and pelvic pain.

This has generated interest from patients in participating in and facilitating future research projects in Edinburgh.
Year(s) Of Engagement Activity 2013
 
Description Endometriosis awareness event: Scottish Parliament 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Type Of Presentation Workshop Facilitator
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact 200+ MSPs and patients attended the presentations which led to interactions with parliamentarians and policymakers

The politicians have agreed to facilitate raised awareness and improved management of endometriosis through managed networks.
Year(s) Of Engagement Activity 2014
 
Description Hudson Institute, Melbourne, Australia, 5 October 2017 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact invited speaker - talk entitled "Engaging patients and clinicians to prioritise endometriosis research"
Year(s) Of Engagement Activity 2017
 
Description Lecture ESHRE Campus Course Istanbul 2016 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Lecture to a course attended by over 260 clinicians and researchers working in endometriosis which sparked lively discussion afterwards.
Year(s) Of Engagement Activity 2016
 
Description Lecture at German Reproductive Biologists Annual Meeting Dusseldorf 2015 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Lecture at to approx 120 German Reproductive Biologists at their Annual Meeting in Dusseldorf (2015).
Year(s) Of Engagement Activity 2015
 
Description North London Midwives Forum 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact The Midwives forum meet on a regular basis throughout the UK in their regional settings to provide a platfrom to discuss new ideas and work collaboratively.
The Trial Coordiantor attended the North London Midwives Forum to present the trial and raise awareness in preperation to open sites to recruitment.
Year(s) Of Engagement Activity 2016
 
Description Pelvic Pain Workshop 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Type Of Presentation Workshop Facilitator
Geographic Reach National
Primary Audience Health professionals
Results and Impact Multi-disciplinary (including patient representatives)
25-30 delegates

One day meeting to discuss infrastructure for managing pelvic pain in women

Development of a pelvic pain proforma for NHS Right Care
Year(s) Of Engagement Activity 2013
 
Description Press coverage of chlamydia and ectopic pregnancy paper PMID: 21224062 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact The manuscript received coverage from the BBC, Daily Express, Daily Mail, Daily Telegraph, Metro, Daily Record and Scotsman.



Important public health message highlighting increased risk of ectopic pregnancy with chlamydial infection.
Year(s) Of Engagement Activity 2011
 
Description Press coverage of new treatment for ectopic pregnancy 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Type Of Presentation Paper Presentation
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact Press release led to articles in The Times, The Daily Mail, The Scotsman, The Daily Express, The Metro, The Scotsman, BBC Online.

See above.
Year(s) Of Engagement Activity 2013
 
Description Press coverage of smoking and ectopic pregnancy paper PMID:20864676 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact Scotsman (28/09/10) Another reason to quit: smoking linked to ectopic pregnancy (RCOG mentioned/Virginia Beckett quoted)
http://thescotsman.scotsman.com/health/Another-reason-to-quit-smoking.6553022.jp

BBC News Online (27/09/10) Smoking link to ectopic pregnancy
http://www.bbc.co.uk/news/uk-scotland-edinburgh-east-fife-11418432

Daily Mail (27/09/10) Why smoking quadruples a woman's risk of having a ectopic pregnancy
http://www.dailymail.co.uk/health/article-1315607/Why-smoking-quadruples-womans-risk-having-ectopic-pregnancy.html

Independent (27/09/10) Smokers 'have higher risk of ectopic pregnancy'
http://www.independent.co.uk/life-style/health-and-families/health-news/smokers-have-higher-risk-of-ectopic-pregnancy-2090867.html

Metro (27/09/10) Female smokers' ectopic pregnancy risk explained by scientists
http://www.metro.co.uk/news/842225-female-smokers-ectopic-pregnancy-risk-explained-by-scientists

Virgin Media (27/09/10) Smokers warned of pregnancy risk
http://latestnews.virginmedia.com/news/health/2010/09/27/smokers_warned_of_pregnancy_risk

Interview on national news
http://www.morethannews.com/MoreThanNews3/Products/WebUI/BroadcastStreaming.aspx?vdmcrypt=qSQqAFxZ4oCZ9lMA%2fuovxorNlHCDkeGbiOjSZ2u9TwE%3d

Important public health message highlighting increased risk of ectopic pregnancy with smoking.
Year(s) Of Engagement Activity 2010
URL http://www.bbc.co.uk/news/uk-scotland-edinburgh-east-fife-11418432
 
Description Press release (ESHRE Istanbul) 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Type Of Presentation Keynote/Invited Speaker
Geographic Reach International
Primary Audience Health professionals
Results and Impact Invited by conference organisers (ESHRE Annual Meeting, Istanbul) to give press conference to international press which sparked questions and discussion afterwards.

http://www.eshre.eu/ESHRE/English/Annual-meeting/Istanbul-2012/page.aspx/1381

Why smoking is bad for your fallopian tube
A.W. Horne1, H.B.Z. Abidin1, Z.E.H.A. Adin1, L. Boswell1, J.K. Brown1, S. Burgess2, K.F. Lee3, W.C. Duncan1
1University of Edinburgh, MRC Centre for Reproductive Health, Edinburgh, United Kingdom;
2Moredun Research Institute, Pentlands Science Park, Edinburgh, United Kingdom;
3University of Hong Kong, Obstetrics and Gynaecology, Hong Kong, China

LA STAMPA
http://www3.lastampa.it/benessere/sezioni/gravidanza-parto/articolo/lstp/461273/

MEDICAL EXPRESS
http://medicalxpress.com/news/2012-07-bad-fallopian-tube-ectopic.html

IRISH HEALTH
http://www.irishhealth.com/article.html?id=20849

TIMES OF INDIA
http://timesofindia.indiatimes.com/life-style/health-fitness/health/Smoking-ups-risk-of-ectopic-pregnancy/articleshow/14648788.cms

EXAMINER
http://www.examiner.com/article/link-between-smoking-and-ectopic-pregnancy-found

RED ORBIT
http://www.redorbit.com/news/health/1112650500/why-smoking-is-bad-for-the-fallopian-tube/

DAILY NEWS (India)
http://www.dnaindia.com/health/report_smoking-increases-risk-of-ectopic-pregnancy-study_1710118

TOP NEWS NZ
http://topnews.net.nz/content/223345-smoking-riskier-ectopic-pregnancy


UPI
http://www.upi.com/Health_News/2012/07/07/Smoking-linked-to-ectopic-pregnancy/UPI-79661341719679/?spt=hs?=hn

DNA INDIA
http://www.dnaindia.com/health/report_smoking-increases-risk-of-ectopic-pregnancy-study_1710118

BIOSCHOLAR NEWS
http://news.bioscholar.com/2012/07/smoking-increases-risk-of-ectopic-pregnancy.html

DAILY RX
http://www.dailyrx.com/news-article/ectopic-pregnancy-risk-rises-smoking-19820.html

NEWS MEDICAL
http://www.news-medical.net/news/20120704/Cigarette-smoke-reduces-production-of-Fallopian-tube-gene-BAD.aspx

ALL VOICES
http://www.allvoices.com/contributed-news/12549837-women-with-ectopic-pregnancy-due-to-smoking
Year(s) Of Engagement Activity 2012
 
Description Public Lecture (Science Festival, Edinburgh) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? Yes
Type Of Presentation Keynote/Invited Speaker
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact ~50 people attended the lecture and it sparked questions and discussion afterwards.

Internet publicity from related charitable trust.
Year(s) Of Engagement Activity 2012
 
Description Public Talk DKNY London 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact Public lecture to approximately 60 members of the general public to raise awareness of endometriosis research.
Year(s) Of Engagement Activity 2015
 
Description Public lecture series 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact Over 200 members of the general public attended our public lecture on 'Pregnancy in the wrong place', which sparked questions and discussion afterwards.

This public lecture series has led to three further series of public lectures due to popular demand.
Year(s) Of Engagement Activity 2009
 
Description RCOG World Congress 2018, Singapore 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Oral presentation: Novel medical management of ectopic pregnancy' and 'Pelvic pain of unknown aetiology' (Plenary), and 'Research priorities in endometriosis'
Year(s) Of Engagement Activity 2018
URL http://web.rcog2018.com/client/sites/view/SP4cb78
 
Description Royal Society of Medicine, London, UK, 29 June 2017 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact invited speaker - talk title "The 1 in 10"
Year(s) Of Engagement Activity 2017
 
Description Women's Charity Lunch 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? Yes
Type Of Presentation Keynote/Invited Speaker
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact 200 women attended the talk which generated £8000 of charitable donations to the charity.

£8000 of charitable donations to the charity.
Year(s) Of Engagement Activity 2013