Gynaecology - For Clinicians

Gynaecology provides a full outpatient and inpatient gynaecology service with special emphasis on one stop outpatient services, and tertiary skills in sub-fertility, urogynaecology, endometriosis and minimal access surgery.

Early Pregnancy Assessment Clinics (EPAC)

The Early Pregnancy Assessment Clinic (EPAC) is an emergency service available to all women referred by their GP or Health Professional. 

Guidelines for referral

Criteria:

• A positive pregnancy test is mandatory (either GP or home test)
• Early pregnancy more than 6+0 weeks and fewer than 18+0 weeks from LMP
• Early pregnancy bleeding and/or pain
  (If booked at a hospital, the patient should be referred to their hospital of booking)
• Previous ectopic or molar pregnancy (above 6 weeks gestation)
• If a woman has pain between 5 and 6 weeks gestation a referral will be accepted but the patient may not be appropriate for a scan. It is important to be aware of this.

The patient must attend with a written referral. This can be a letter, scan request or fax, detailing the following:

• Reason for attendance
• Obstetric and gynaecological history, including LMP and contraception
• Date of pregnancy test and blood group if known

On weekdays, within EPC hours there is no need to telephone as well. At the weekend or out of hours, please telephone the SHO on call.

Cases not suitable for EPAC:

• Unstable patients with severe bleeding and/or pain. Please refer to the on-call Gynae SHO for admission
• Negative pregnancy test. Please refer to the GP
• Postnatal patients. Please refer to the on-call Gynae SHO
• Post termination
• Reassurance scan after previous miscarriage
• Request for dating scan.
• Women above 18 weeks and below 20 weeks – Please contact the Gynae SHO

Pregnant women with viable pregnancies are discharged and if they have further problems would need to be re-referred to the clinic.

Management of miscarriage
EPAC at Southmead Hospital offers a choice of treatment following diagnosis of a miscarriage: Conservative management; medical management; surgical management under local anaesthetic ( MVA) and surgical management under a general anaesthetic.

Ectopic pregnancy
Treatment varies between conservative, medical and surgical management.

Current Anti D guidelines
Anti D 500 IU is recommended for all rhesus negative women with vaginal bleeding after 12 weeks of pregnancy. If bleeding continues intermittently, Anti D 500 IU is repeated after 6 weeks. If bleeding is heavy or there is significant pain, Anti D 500 IU is repeated after 2 weeks.

Other EPAC information
There are EPAC clinics at Southmead Hospital and St Michaels Hospital. Please advise your patient that these clinics are emergency clinics for women with suspected miscarriage or ectopic pregnancy. Your patient will be assessed, may have blood tests, but not always a scan. A 2-4 hour wait can be expected Please refer your patient to the nearest EPAC (independent of the on-take system).

On Saturday, Sunday and bank holidays, please refer to the on-take hospital. Referral is only via the on-call Gynae SHO and only for women who would otherwise require admission.