EPAU update - Covid 19
The early pregnancy unit is open for pre-arranged appointments following GP or Emergency Department referral. If you have bleeding and/or abdominal pain and have tested positive for Covid-19 or have symptoms, please contact your GP or 111, who will then refer you in the usual way. If an early pregnancy assessment is required during your period of isolation, you will be asked to attend after routine clinics have finished to minimize contact with other patients.
Please see Royal College Of Obstetricians & Gynaecologists recent information for pregnant women and their families.
There is no evidence currently that Covid-19 infection increases the risk of miscarriage or that it causes problems with the baby’s development. You should book as normal for antenatal care (see maternity services) and have your routine dating ultrasound scan.
Unfortunately we are unable to offer access to partners of women having emergency early pregnancy scans. This is in order to keep patient traffic through the clinic area to a safe level. Your partner must wait outside the clinic area while you are being seen. If a miscarriage or ectopic pregnancy is diagnosed, your partner will be allowed to support in the clinic room. Partners will not be allowed in the clinic room during procedures, including MVA but if you require to stay in the unit following the procedure, your partner will be allowed to stay with you.
Early Pregnancy Assessment Unit
The EPAU is our Early Pregnancy Assessment Unit and is located in the Women's Health Centre in Tuke Ward. This is approached via a door to the right of the main entrance and Mental Health Unit.
EPAU is a specialist unit that manages early pregnancy problems such as vaginal bleeding and abdominal pain. We see women in the first 18 weeks of pregnancy only. After 18 weeks, the patient is seen in the Emergency Obstetric Unit or Delivery Suite.
A nurse-led service, we are supported by sonographers and the on-call gynaecology team.
When necessary, ongoing support and advice is provided either in person or by telephone by EPAU staff.
Making an appointment
We are open from 8.00-18.00, Monday to Friday and Saturday 10.00-14.00. Appointments can be made by GPs, ED (fast track) or other health professionals by telephoning the receptionist on 020 8510 7861, or via the online form on C&H CCG website. EPAU referral form Self-referrals are accepted however, due to the current situation we are only accepting emergency referrals. For further information please call 020 8510 7861 or email firstname.lastname@example.org
Patients will be seen by a nurse and an ultrasound scan will be performed in order to visualise the pregnancy. The scan may be done externally through the abdomen, or internally through the vagina. Neither of these are harmful to the pregnancy. Depending on the outcome of the scan, blood tests may be required.
What to expect
Appointments are usually available within a few days of referral. If the patient presents to the Emergency Department with heavy bleeding or severe pain, they are normally seen on the same day or day after. If the patient has had a previous miscarriage but are otherwise well, we would advise an ultrasound scan at around 7 weeks of pregnancy.
What if a miscarriage is diagnosed?
Unfortunately, early miscarriage is very common: at least 20% of pregnancies end in miscarriage. We offer expectant, medical and surgical management under local or general anaesthetic.
This means that if a miscarriage is diagnosed, you have the option of waiting to see if the pregnancy tissues pass naturally, or taking tablets to speed up the process, or a small operation to remove the pregnancy remains. If you opt to wait for a natural miscarriage or medical treatment you will be offered follow up with one of our nurses.
We offer an outpatient procedure called MVA to remove the pregnancy tissue under local anaesthetic. This is highly effective and acceptable to patients who wish to avoid a General Anaesthetic and takes only a few minutes. Pain killers are given prior to the procedure as there will be some period-like cramps during the procedure.
If a General Anaesthetic procedure is requested/advised, this will normally be done within 2 days and you will need to be nil by mouth for 6 hours. A doctor will go through the procedure, including the risks of complications. Normally this is a day-case procedure. Whatever method is chosen to manage the miscarriage, we offer support and advice.
What if an ectopic pregnancy is diagnosed?
We offer a range of options to treat ectopic pregnancies, which are pregnancies growing outside of the womb. They account for 1-2% of all pregnancies.
Ectopic pregnancies are important because there is a risk they can rupture and cause severe internal bleeding, which may be life-threatening.
Some ectopic pregnancies will resolve on their own with close observation and follow-up. Some ectopic pregnancies can be treated with a drug called methotrexate and others require an operation. Most of the operations for ectopic pregnancy are performed through keyhole surgery. Patients requiring admission will be admitted to Priestley Ward.
We offer support and investigation for women with recurrent miscarriage, who require sequential ultrasound scans in early pregnancy for reassurance and may require special treatment if an underlying condition is found.
Gynaecological nurse specialists are available in the EPAU for advice and support.