•  This pathway is designed for patients within the treatment area of The Royal Sussex County Hospital in Brighton, and does not specifically apply to those patients being treated at The Princess Royal Hospital in Haywards Heath.

•  The aim of this pathway is allow patients with early pregnancy problems to be treated in the most appropriate environment i.e. The Early Pregnancy Assessment Clinic on Jowers Ward.

•  The EPAC clinic on Jowers offers where possible a next day service. We have the provision to see 10 new patients per day between 8.00 and 11.00, Monday to Friday.

•  For haemodynamically stable patients there is no need to send women to A&E on the day of review. If however you have concerns over the management of any women with early pregnancy problems please contact the on-call gynaecology registrar on bleep 8618.

•  We have limited capacity within the clinic and therefore are only able to see patients that satisfy the following clinical criteria:

  • Women with a positive pregnancy test and pain and/or bleeding
  • Women with a positive pregnancy test and a previous history of an ectopic pregnancy
  • Women with persistent bleeding following surgical management of a miscarriage (ERPC)

•  We do not have the facilities to accept patients without a prior pregnancy test and in addition we cannot see patients with the following clinical conditions:

  • Pain and bleeding with a negative pregnancy test
  • Women with an uncomplicated pregnancy requiring either reassurance or dating via ultrasound (need hyperlink)
  • Women with a history of recurrent miscarriage(need hyperlink)

Assessment of bleeding:

•  This should include asking about the degree of bleeding. Often this is easiest to judge for patients when put in context of a normal period for them.

•  Any bleeding that is heavier than a normal period probably warrants a same day assessment by the gynaecology team.

Assessment of pain:

•  It is not uncommon for women with early pregnancy bleeding to experience some diffuse lower abdominal pain.

•  If these women have marked general abdominal pain or localising unilateral pain then they require a same day assessment by the gynaecology team.

Risk factors

•  Where possible, these women should be asked about their previous history in relation to early pregnancy problems. Any women with the following risk factors warrants a same day assessment:

  • Previous ectopic pregnancy
  • Previous tubal surgery

Emergency Gynaecology Protocol..