Shaping better health
REMEDY : BNSSG referral pathways

Early Pregnancy Assessment Clinic (EPAC)

Checked: 15-02-2019 by hana.cavill Next Review: 11-10-2019

Service Overview

There are EPAC clinics at St Michaels Hospital, Southmead Hospital and Weston General Hospital.   EPAC is an emergency clinic for women with suspected miscarriage or ectopic pregnancy. 

For suspected miscarriage:

Refer if positive pregnancy test and between 6+0 and 18+0 weeks with bleeding (with or without pain).

Do not refer women if their known dates indicate that they are less than 6 weeks pregnant (with bleeding and no pain) – if less than 6 weeks pregnant then CKS guidance 2018 advises the woman to repeat a urine pregnancy test after 7–10 days and to return if the test is still positive or if her symptoms continue or worsen.

For suspected ectopic pregnancy:

Refer if positive pregnancy test with pain (6 week cut off does not apply) and ectopic pregnancy is suspected. Discuss with on call gynae team if severe pain or bleeding or patient is acutely unwell and emergency admission is required.

Patients with previous ectopic or molar pregnancy should also be seen in EPAC when pregnancy is confirmed.

To refer your patient, please follow the instructions on the referral form (see below)

For more information about the St Michaels Early Pregnancy Clinic please see patient leaflet 

Referral UHB & NBT

Refer using the EPAC proforma for referrals to both St Michaels Hospital or NBT. (please note that St Michaels no longer accepts faxed referrals - see instructions below)

Criteria:

  • Positive pregnancy test (either GP or home test) & less than 6+0 weeks where there is significant pain (with or without bleeding) and you suspect ectopic

  •  Positive pregnancy test, more than 6+0 weeks and less than 18 + 0 weeks from LMP with bleeding (with or without pain)

  • Previous ectopic or molar (hydatidiform mole) pregnancy

Process:

The patient must be referred, this is not an open access clinic. 

Southmead - To refer your patient, please provide your patient with this referral form (or fax it) and ask them to arrive between 08.00 and 11am. Scanning starts by 9am. Patients are seen in order of arrival unless clinical priority dictates otherwise.

St Michaels - please email the form to ubh-tr.earlypregnancyclinic@nhs.net with your patient’s up to date contact telephone number and they will be contacted with the offer of an appointment usually for the same day or the next day. Alternatively, please ask your patient to collect the referral form from you and ask them to phone 0117 342 5171 between 08.30 and 16.00 to book an appointment. Patients can also be referred on ICE (EPAC ICE Referral guide). Faxed forms are no longer accepted.

The clinics run Mon - Fri. At the weekend, please telephone the SHO on call.

N.B. Please tell your patient that this is an emergency clinic for women with suspected miscarriage or ectopic pregnancy. Women will be assessed, may have blood tests but not always a scan. A 2-4 hour wait can be expected. There is no need to have a full bladder, bladder can be filled on arrival to clinic.  

IF A PATIENT DOES NOT MEET THE ABOVE CRITERIA:

Refer via the Gynaecology SHO on-call:

a) postnatal women

b) women with problems following medical or surgical TOP

c) All women with severe pain and/or bleeding who require direct admission.

Reassurance scan after previous miscarriage or for dating. Please refer to the Ultrasound Department at St Michaels University Hospital (0117 342 5347) or if booking at Southmead  (0300 555 0103)

 

 

Referrals - WGH

EPAC is located in Ashcombe clinic on the second floor and is open from 09.00 - 17.00 for advice and support. Ultrasound scans are available between 09.30 and 11.15. The clinic is led by specialist midwives and supported by consultant gynaecologists who see women with early pregnancy complications up to 19weeks + 6 days.

This service is accessed via referral only. Referrals may be made from the Emergency department (ED), GP and midwives.

Referrals to EPAC can be made via; 

  • Health Professional direct line 01934 647217

  •  email  wnt-tr.waht-epacreferrals@nhs.net

  •  fax  01934 881013

Women can self refer via the patient line 01934 647288 who will then be triaged. An appointment will be given as required.

The referral form is available as an EMIS template. Once a referral has been received the woman will be contacted and given an appropriate appointment and/or advice within working hours.

 

Recurrent Miscarriage

Please refer to the Recurrent Miscarriage section of Remedy.