Within our Women’s Health Clinic, situated behind the main maternity building, we run a specialist Early Pregnancy Assessment Unit (EPAU) which deals with a variety of problems in early pregnancy. The unit is staffed by two Early Pregnancy Nurse Practitioners, supported by Consultants, Healthcare Assistants and Administrative staff.
The phone number for the EPAU is 0191 445 2742.
Staffing
Sister Sarah Graham
Nurse Practitioner
Sister Hayley Cooper
Nurse Practitioner
Dr Cecilia McKee
Consultant Obstetrician and Gynaecologist
Dr Jill Sturt
Consultant Obstetrician and GynaecologistWho can be seen at the early pregnancy assessment unit (EPAU)?
EPAU manages problems which arise in early pregnancy, from 6 weeks to 16 weeks of pregnancy. The unit is staffed Monday – Friday, 8.30 – 4.30pm. Appointments are usually allocated following a referral from:
- GP
- Community midwife
- Accident and Emergency
- Private scan providers (amongst other sources of referral)
The most common reasons for referral include vaginal bleeding and/or mild to moderate lower abdominal pain, with a positive pregnancy test, at least 6 weeks from the last menstrual period. Mild central lower crampy discomfort can be normal in early pregnancy.
If you are pregnant, with no bleeding or pain, we would not suspect any problems with your pregnancy, and would advise you to book with your community midwife and your first ultrasound scan would take place generally around 12 weeks.
Heavy vaginal bleeding?
If you have very heavy vaginal bleeding, or severe abdominal pain, or have collapsed/fainted, we would advise you to call 999 or to attend A&E.
The early pregnancy unit will also accept self-referral from women in the following circumstances:
- Previous ectopic pregnancy (pregnancy in the fallopian tube)
- Previous molar pregnancy
- 3 previous miscarriages
If you are in any of these groups, you can contact the EPAU on 0191 445 2742 when you have a positive pregnancy test, and an appointment will be given for around 7 weeks of pregnancy, when we are likely to see your pregnancy on the scan. If you have symptoms of pain or bleeding, the appointment will be around 6 weeks. We do not offer appointments earlier than this because the likelihood is that we will not be able to make any diagnoses accurately with ultrasound, which can lead to further anxiety.
Out with the indications above, we cannot accept referrals as we have limited capacity for appointments, and need to ensure there are appointments available for those with indications as above.
What happens at my early pregnancy assessment unit appointment?
You will be asked about your medical history, menstrual history and details about your pregnancy, such as when your last period was, and when you had your first positive pregnancy test. We will discuss what symptoms you have had, particularly pain and bleeding. We will try to gain as much information as possible from hospital notes/results, however, given that these appointments are usually allocated on an urgent basis, we can often get a better idea of what has been happening by talking to you directly. You may have an examination of your tummy. The team will then go on to offer a scan, where appropriate. There will be a chaperone present for all scans.
Your scan may be:
- through the tummy (abdomen) where is it best to have a full bladder, and this will be more likely if your pregnancy is thought to be 8 weeks or more,
- internal scan (vaginal) where it is best to have an empty bladder, which is better for earlier stages of pregnancy. Vaginal scans are safe in pregnancy and can still be carried out if you are bleeding.
Please attend with a full bladder if you can, but do not be alarmed if we ask you to empty your bladder for an internal scan.
You are welcome to bring a support person/partner with you for your scan. Given the nature of the scan, and the potential findings, we would advise not to bring children to this appointment, and please make alternative childcare arrangements.
The process of the scan will be explained, and you will have the opportunity to ask any questions beforehand. Your scan will be carried out by either a Nurse Practitioner or a Doctor. Sometimes, the person carrying out the scan will be quiet for some time at the start of the procedure, as they ensure they can see the womb and other organs on the screen and can accurately tell you what they can see and what this means.
After your scan, the nurse or doctor will fully explain the findings of the scan.
What might be found on scan?
If everything appears OK on the scan, this usually means that we can see your pregnancy developing as it should be, in the womb. If we can also see a heartbeat, this is very reassuring.
Sometimes, we are looking at a very early pregnancy, too early to see a baby or a heartbeat, and if this is the case, we will offer to rescan in 2 weeks, giving the pregnancy a chance to develop.
Sadly, however, we can see pregnancies which are not developing as we would expect. These can include ectopic pregnancy (where the pregnancy is developing somewhere other than inside the womb, usually in the fallopian tube) and pregnancies inside the womb which have stopped developing, known as a missed miscarriage. If this is the case, we will explain these findings and support you through what this means, and what may need to happen next.
We can also have an inconclusive scan, where no pregnancy can clearly be seen, known as a pregnancy of unknown location (PUL). This may lead to having blood tests and further scans to try to help conclude what is happening with your pregnancy.
Follow up
You may be able to be discharged following your first appointment, and we will give you advice on the next steps of your pregnancy.
If you require follow-up, we will usually provide you with a letter detailing your next visit to EPAU before you leave and give you advice on what to expect in the meantime.
If you have sadly been diagnosed with an ectopic pregnancy or miscarriage, we will guide you through the next steps in management, which are usually made on a case-by-case basis, with your wishes at the forefront of management.
Referrals from Private Scan Providers
If you have been referred to EPAU from a private scan provider, please bring any documentation you have from the private scan, including any images or reports. Please also be aware that we may not always be able to use these images and information for diagnostic purposes, and will likely perform another scan at EPAU.
Appointment times
We always try to adhere to your given appointment time, however, given the nature of this clinic, and the potential to need to break bad news, we would ask for your patience and understanding if we run late in clinic. We understand that you may feel anxious prior to your appointment as you wait and we work as quickly as we are able to, trying to avoid delays, but this is not always possible.
Likewise, if you are not able to make your appointment, please do let us know by calling 0191 455 2742, as we can reschedule your appointment if needed, and offer your original appointment to someone else.
Students
As a teaching hospital, we may have medical, nursing or midwifery students with us in EPAU. We appreciate the opportunity this provides for learning and training but will always ask if you are happy to have the student present for your consultation or not. You are entitled to decline if you wish.
Progesterone Supplementation
Recent evidence and guidelines from NICE (National Institute for Clinical Excellence) recommends Progesterone supplementation for women who experience vaginal bleeding in early pregnancy AND have experienced a pregnancy loss (miscarriage) in the past. This supplement (a vaginal pessary) may help to reduce the risk of miscarriage in this group of women. When you are referred with vaginal bleeding, if your scan confirms a pregnancy in the womb (i.e. not an ectopic pregnancy) you may be offered this supplementation.
There is no evidence to support the use of progesterone in women with no vaginal bleeding, as it makes no difference to the outcome, and this is regardless of the number of miscarriages in the past.
If you have any questions about this, please ask when you attend your appointment.