Early Pregnancy Unit

What is EPAU?

The Early Pregnancy Assessment Unit (EPAU) provides outpatient care to women with problems or concerns in early pregnancy up to 16 weeks and 6 days of their pregnancy.  Ultrasound scans are undertaken to confirm the location and viability of a pregnancy following a referral. 

The service is open Monday to Friday 7:30am – 8pm and patients require a referral from a health professional to attend the unit. We do not routinely offer a walk-in or self-referral service. Referrals to EPAU are accepted from your GP, Midwife, the Walk in Centre, GP Out of Hours, and the Emergency Department.   

Patients can self-refer into our EPAU service for an early ultrasound scan after 6 weeks gestation if they have previously experienced:

• A previous ectopic pregnancy.
• Previous molar pregnancy.

The EPAU service manages early pregnancy problems such as:

• Vaginal bleeding.
• Mild central abdominal pain.
• Ultrasound scan in a private facility that identified no fetal heartbeat.

 

Where is the EPAU located?

The EPAU is temporarily located on Ward 31 on the third floor of the main hospital building.  Follow the signs for Ward 31 Gynaecology. 

 

What will happen at my appointment?

On arrival to the unit, you will be greeted by a member of our reception team who will confirm your details for the appointment, and you will be asked to provide a urine sample. 

You will then be seen by a member of the nursing team, and they will complete your height and weight.  You will then be called into a triage room where the nurse will complete a full set of observations (blood pressure, pulse, oxygen saturations and temperature).  The nurse will then complete a triage and ask you some questions based on your presenting complaint and your past medical history.  It is helpful if you bring a list of medications to your appointment.   

You will then be asked to take a seat outside of the ultrasound scan room, and the sonographer will call you in and ask you some questions.  We appreciate that this can be stressful, and we will endeavour to obtain as much as we can from your hospital notes.  Sometimes however, we can obtain a better understanding by asking you directly. 

The appointment will take around 30 minutes, however it may take longer depending on the ultrasound scan findings. 

Please be aware that the team do try to keep the clinic running on time, but if a patient before you may have unfortunately received upsetting news then this can impact on waiting times. 

 

What will happen during the scan?

You will be offered a trans-abdominal followed by a trans-vaginal ultrasound scan.  For an abdominal scan you will need a full bladder and you will be asked to lower your clothing to bare the lower part of your stomach. A small amount of cold gel is placed over the lower part of your stomach, and the sonographer will pass a probe over the area moving from side to side to gain the best possible image. The sonographer may apply gentle pressure to obtain a clearer image.

A trans-vaginal scan is an internal scan which provides the best images of your pregnancy when you are less than 12 weeks pregnant.  It is completely safe and does not cause miscarriage. It is important as it lets us see pregnancies earlier than we would through a scan completed over the stomach. The vaginal probe should not cause any discomfort.  Before this part of the scan, you will be asked to go to the toilet to empty your bladder completely. You will then be asked to undress from the waist down and lie down on the bed with a sheet covering your lower half. A condom like cover and sterile lubricating gel are placed over the vaginal probe before it is gently inserted into the vagina.  

The sonographer scanning you can take a few moments before telling you the results of your scan, this is to ensure they are obtaining the best images and providing you with the correct information. 

After the scan, you will be asked to get dressed and the sonographer will go through any questions that you may have. 

The sonographer will complete a report and may request an additional review based on your scan. This may involve a doctor review or re-attendance to further monitor the findings. It is understandable that this could cause you some worry, however, please be reassured that this is to ensure you receive the best possible care and will explain the details of this to you. Depending on how busy the unit is, there may be a delay in waiting for a doctor review, but we will endeavour to keep you updated on waiting times during your appointment. 

Please note, there will always be a chaperone with you during your ultrasound scan and any further examinations. 

 

Can I bring someone with me to my appointment?

You can bring one person with you to your appointment. You are welcome to bring your partner or a friend / relative to support you during your appointment. We ask that you make alternative arrangements for children as a visit to our EPAU can be stressful, and waiting times can be longer than anticipated. Staff working in the unit are not able to care for children within the department. The sonographer may not perform an ultrasound scan at your appointment if a child is present. 

 

What will happen after the scan?

The following are likely outcomes:

• We see a correctly sited pregnancy with a heartbeat, and we can discharge you to your routine antenatal care.
• We see a very early pregnancy before a heartbeat is seen, and we may offer to rescan you in 7-10 days to ensure that the pregnancy is progressing as it should.

There are, however, several reasons why we may not see a pregnancy on your first visit to the EPAU.  These reasons can include:

• It is too early in the pregnancy to see the baby on the ultrasound scan.
• The pregnancy is not growing as it should.
• Some women who visit the EPAU will be diagnosed with a miscarriage or ectopic pregnancy, and they will need further treatment and possibly an admission to the Gynaecology Ward.
• We may not see a pregnancy on the scan, either inside or outside of the womb. If your pregnancy test is still positive, we will advise that we obtain a blood test to monitor your pregnancy hormone (human chorionic gonadotropin) also known as bHCG level.  The reasons for this will be explained further at your appointment. 

We understand that some patients have a needle phobia.  Desensitisation means gradually getting used to things that scare you.  It helps you to feel less afraid over time.  Please feel free to watch our Needle Phobia video which is designed to help put you at ease before medical procedures involving injections and needles.

 

Gynaecology Assessment Unit

If you experience any of the following:

• New or increasing abdominal pain.
• Increased levels of bleeding.
• Shoulder tip pain.
• Diarrhoea and/or vomiting.
• New dizziness on standing.

Please contact the Gynaecology Assessment Unit for advice.  Depending on your symptoms, we may suggest you attend for an examination and assessment. 

If you experience and severe pain or heavy vaginal bleeding where you are soaking through a sanitary pad every 30 minutes, please attend the Emergency Department. 

Useful contact numbers

• Early Pregnancy Assessment Unit 0151 604 7450
• Gynaecology Assessment Unit 0151 604 7450
• Antenatal booking 0151 604 7501 option 1
• Gynaecology Ward 54 0151 604 7132
• Fetal Medicine Unit 0151 604 7024
• Community Midwives 0151 604 7682
• British Pregnancy Advisory Service 03457 304030

Useful links

• BPAS - British Pregnancy Advisory Service

• The Miscarriage Association - The Miscarriage Association:Pregnancy Loss Information & Support
• The Ectopic Pregnancy Trust - The Ectopic Pregnancy Trust - Support For You And Your Loved Ones
• Cradle Charity - Home | Cradle Charity
• Sands - Sands | Saving babies' lives. Supporting bereaved families.
• Tommy’s - Saving babies' lives - Charity for Babies | Tommy's
• Molar Pregnancy - a rare complication that can happen in pregnancy