- Problems in early pregnancy are very common especially bleeding and abdominal pain. There
is evidence that the ectopic pregnancy rate is rising throughout the U.K.
- Over the last ten years it has been established that dedicated early pregnancy units are
probably the best way to handle such patients. When first instituted many of these early pregnancy units
were mainly concerned with fast-tracking surgical evacuation of retained products of conception but this is
no longer true. In the last few years there has been considerable change in the clinical management of
patients with early pregnancy difficulties. At the same time the role of early pregnancy units has become
better defined.
- EPUs are no longer factories for evacuation of retained products of conception. Their aim
should be to reduce the need for inpatient care; reduce the need for emergency intervention; to facilitate
early diagnosis of ectopic pregnancies, and to provide support for those unfortunate enough to have suffered
a pregnancy loss.
- The best way to outline their function is perhaps to describe the expectation that any
individual patient should have from a visit to such a unit. The patient with an early pregnancy problem
should be seen by a staff member on arrival and offered an explanation of the procedures in the unit.
Ideally they should be interviewed and examined. Some of them will need ultrasound investigation, some will
require blood tests and some will need both. At all times they should be invited to participate fully in all
the management options and be handled sympathetically. At the end of their visit they should go away with
two presents. The first is a contact telephone number with the unit which they can feel free to use whenever
they feel they need to. The second is an invitation to complete an evaluation form, in order to feed back to
the unit their opinion of the way they were treated during their stay.
- Whenever possible the unit should be self-contained – this means that all the essential
functions of the unit are in one place. The unit should be staffed by dedicated individuals who have had
training in giving bad news. The staff should be subject to personal audit and peer review. The protocols
and function of the unit should be constantly monitored with clinical audit and user evaluation. All
equipment used should be subject to quality control, regular upgrading and maintenance. The above will
ensure that the unit is continually offering a quality service.
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- Many units run five days a week, some seven days a week. Many accept
referrals from a wide range of health care workers. Some accept direct patient referral. I believe that all
units should be members of the Association of Early Pregnancy Units. The unit should enjoy a patient and
staff support network – self-help and professional input to support both those patients and staff who are,
in the circumstances, frequently required to receive and give bad news
- The unit in Peterborough is situated in the gynaecology ward. The clinical practice
satisfies the majority of the guidelines illustrated above. There are a few differences which are dictated
by local circumstances.
- In Peterborough the unit comes under the aegis of the Woman & Child Directorate and is
under the overall care of the gynaecologists. The day to day running is organised by a
Consultant radiologist (currently Chairman of the Association of Early Pregnancy Units). The majority
of scans are carried out by Ultrasonographers and the unit is staffed by the gynaecology team. There is a
miscarriage counsellor to give support. A consultant with a special interest in infertility, looks after all
patients with recurrent miscarriages. Currently all the requirements of the unit are self-contained except
pathology. Surgery is carried out in a dedicated gynaecology theatre or emergency theatre.
- The Peterborough Unit is well known within the U.K. and the unit has frequent visitors from
other health care centres throughout the U.K.. We try to encourage colleagues to come and see us -that is
the only way to learn what to do and what not to do. The unit is always willing to give whatever advice we
can to anyone who needs our help.
- "Unless expressly stated otherwise, the contents of this page
represent only the view of the author and do not commit Peterborough Hospitals Trust (PHT) to any
course of action and are not intended to impose any legal obligation upon PHT".
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