EPAS

Services available:

• Early pregnancy ultrasound
• Specialist consultant scan and diagnostics
• Medical management of miscarriage
• Surgical management of miscarriage (including under local anaesthetic)
• Management of ectopic pregnancy and pregnancy of unknown location
• Counselling and support after pregnancy loss
• Consultant debrief and follow up
• Support for recurrent miscarriage services

EPAS is a referral based clinic and is not at this time able to provide a routine self referral service (except for certain circumstances as below). Referrals are accepted by GPs, midwives, the Emergency Department or Gynaecology team including fertility. Reasons to be referred to an early pregnancy unit commonly include: pain, bleeding, abrupt early loss of pregnancy symptoms.

Patients can self-refer if they are currently pregnant and:

• have been seen by EPAS already in the current pregnancy and have new symptoms
• have had a previous ectopic pregnancy
• have had recurrent miscarriages (3 or more miscarriages)
• have had a previous molar pregnancy

As well as ultrasound by sonographers, the nurses carry out any follow up required such as blood tests, monitoring of suspected ectopic pregnancies, management of women with miscarriage or ectopic pregnancy and monitoring women undergoing medical management for ectopic pregnancy. You may also be seen by the specialist early pregnancy consultant where the situation is more complex, and you may get referred to the on call gynaecology team for treatment.

Further information on how to get to our services can be found here.

FAQs/Commonly asked questions

What should I do if I have pain/bleeding in early pregnancy

Bleeding in early pregnancy is quite common, especially around the time of when your period would have been (an implantation bleed). It could also be a sign that there is something wrong such as a miscarriage or ectopic pregnancy.

If you are worried about pain or bleeding in early pregnancy (up to 16 weeks) you should contact:

• Your GP or Midwife, who may advise you to go to hospital or refer you to the Early Pregnancy Unit (EPAS)
• The Out of hours GP (Shropdoc)
• NHS 111: call 111 when you need medical help fast but it’s not a 999 emergency; the service is available 24 hours a day, 365 days a year, and calls are free from landlines and from mobile phones your nearest A&E department if you are bleeding heavily or if your pain is severe

From 16 weeks onwards you should contact maternity triage directly on 01952 565948.

I have been referred to EPAS – what happens next?

EPAS aim to see all women within 48 hours of referral. If your symptoms are significant you may first be seen in the Gynaecology assessment area if a scan appointment is not available. When you come to EPAS you will be seen by a team of dedicated nurses who specialise in early pregnancy problems and will support and reassure you during your time in the unit. Your symptoms will be assessed, and you will usually have an ultrasound scan. You may need to have a pregnancy test done before your scan if you are in very early preganancy and have had heavy bleeding. If this is negative you will not have a scan but we will advise and support you.

It is not always possible to give a diagnosis at your first appointment. You may also require:

• Blood tests which may need to be repeated after 2 to 3 days
• A further scan after 1-2 weeks
• Medical assessment in the gynae emergency area
• Referral to the Early Pregnancy Consultant

We know this can be a difficult and anxious time, you will be given contact cards and open access to the unit. We are always here to support and reassure you. We will explain to you what we are doing and give you written information to support this advice.

What might be the cause of pain and/or bleeding in the first 3 months of pregnancy?

The following describes the main complications of early pregnancy, all of which can be associated with pain and/or bleeding. It can be difficult to make a diagnosis based on symptoms alone.

• A threatened miscarriage
  If you have had bleeding and/or pain but your ultrasound scan confirms that your pregnancy is progressing normally, this is known as a threatened miscarriage. Many women who bleed at this stage of pregnancy go on to have a healthy baby and further follow up is not usually needed. If you have further episodes of bleeding in the same pregnancy you can contact EPAS directly for advice up until 16 weeks.
• An early miscarriage
  Unfortunately, bleeding and/or pain in early pregnancy can mean that you have had or are having a miscarriage. Sadly, early miscarriages are common. In the first 3 months, one in five women will have a miscarriage, for no apparent reason, following a positive pregnancy test.
  However, most miscarriages occur as a one-off event and there is a good chance of having a successful pregnancy in the future. If you are diagnosed with a miscarriage in EPAS you will have further counselling and support from the nurses and doctors about what it means and what happens next.
• An ectopic pregnancy
  When a pregnancy grows outside the womb it is called an ectopic pregnancy. In the UK, one in 90 pregnancies is ectopic. An ectopic pregnancy cannot turn into a healthy pregnancy, and can be dangerous. If this is suspected or confirmed, you may be advised to stay in hospital, or you may be able to go home. If you have been seen with pain (with or without bleeding) you should have been referred to EPAS to investigate for a possible ectopic pregnancy.
• Molar pregnancy
  A molar pregnancy is an uncommon condition where the placenta is abnormal and the pregnancy does not develop properly. It affects only one in 700 pregnancies. A molar pregnancy is usually diagnosed when you have an ultrasound scan. If a molar pregnancy is suspected you will be seen by a doctor who will explain what it might mean and how it is managed.

What should I do whilst I’m waiting to be seen in EPAS?

Whilst waiting for your appointment it is possible that a miscarriage might happen, or an ectopic pregnancy could rupture. Therefore if you develop heavy vaginal bleeding, or are getting worsening pain you should present to the emergency department and be referred to be seen by the on call gynaecology team.

Some people may choose to take time off and rest while waiting for their appointment. Others will prefer to continue as normal. There is no right or wrong way, and if you choose to continue with normal activities it will not increase the chances of a miscarriage from happening.

My doctor will not refer me to EPAS, what should I do?

Not all women need to be seen in early pregnancy services. National guidance recommends that women who have a small amount of bleeding (without pain) at under 6 weeks of pregnancy should repeat a pregnancy test after 7-10 days. If the pregnancy test is still positive and the bleeding has settled you should carry on as normal. If the test is negative sadly that means a miscarriage has already happened.

If the bleeding happens again or persists and a pregnancy test is still positive you should seek further help from a GP, midwife or the emergency department.

If you are having pain or bleeding over 6 weeks gestation and you cannot get a referral from your GP (for example if you cannot get an appointment) then you may consider going to the emergency department or Out of hours GP (Shropdoc), however there may be a long wait to be seen.

If you are unable to get the help or advice that you need then you can contact EPAS and we will always to do our best to help.

I have no symptoms but I have had a previous miscarriage and want a scan?

We understand that this can be a very stressful time, however EPAS are only able to offer reassurance scans for women who have had 3 or more miscarriages. If you want a scan for reassurance, you might decide to go for a private scan (try putting “early pregnancy scan” and the name of the nearest town into your search engine). Clinic standards do vary so it is best to check on each clinic’s website:

• if their sonographers (scan operators) are qualified radiographers, or midwives or nurses who are trained in ultrasound scanning
• if they offer diagnostic scans (ones that check for a heartbeat and other signs of a normally developing pregnancy)
• if they state that they refer women to NHS services if there or any concerns or uncertainties
• if they are registered with the Care Quality Commission (CQC) if in England, or adhere to the same standards if in other countries

EPAS do not endorse or recommend any particular private scan provider.