1. Home
  2. Regular

Upper abdomen ultrasound

Regular Off Off

This information is for patients who have been referred by their GP for an upper abdomen ultrasound (scan). 

You must telephone the NBT Imaging department within 4 weeks of your GP referral. We will arrange an appointment at a convenient time for you at Southmead Hospital or one of our community sites. 

Our phonelines are open:

Monday - Friday

8:30am - 4pm

Telephone: 

0117 414 8994

You should have a pen and paper ready to write down the date, time, and location of your appointment. 

If for any reason you need to change your appointment, please contact us on the number above. 

Before your abdomen scan

Please do not eat for at least 5 hours before your scan. 

You may drink clear fluids only, for example water. 

You may take your normal medication. 

If you are diabetic please contact us on 0117 4148994 as soon as possible and we can give you advice. 

If for medical reasons you need assistance with transport to and from your appointment, please contact us on 0117 4148994.

When you arrive 

If you are coming to Southmead Hospital, please follow the check-in process outlined in your appointment letter. 

If your appointment is at another community site, please book in at the Imaging or X-ray reception desk. 

The examination will be performed by a sonographer or radiologist. Each scan takes around 15-20 minutes. 

Once the scan is complete you may leave. A report will be sent to your GP, this is usually within 10 days. 

After the scan you may eat and drink normally. 

© North Bristol NHS Trust. This edition published February 2024. Review due February 2027. NBT003667.

Pelvic ultrasound

Regular Off Off

This information is for patients who have been referred by their GP for a pelvic ultrasound (scan). 

You must telephone the NBT Imaging department within 4 weeks of your GP referral. We will arrange an appointment at a convenient time for you at Southmead Hospital or one of our community sites. 

Our phonelines are open:

Monday - Friday

8:30am - 4pm

Telephone: 

0117 414 8994

You should have a pen and paper ready to write down the date, time, and location of your appointment. 

If for any reason you need to change your appointment, please contact us on the number above. 

Before your pelvic scan

You will need a full bladder for this examination. 

Please drink two pints of water or squash at least one hour before your appointment time and do not pass water (pee). 

Your appointment may also include an internal examination. This will be explained in detail by the staff performing the examination. 

If for medical reasons you need assistance with transport to and from your appointment, please contact us on 0117 4148994.

When you arrive 

If you are coming to Southmead Hospital, please follow the check-in process outlined in your appointment letter. 

If your appointment is at another community site, please book in at the Imaging or X-ray reception desk. 

The examination will be performed by a sonographer or radiologist. Each scan takes around 15-20 minutes. 

Once the scan is complete you may leave. A report will be sent to your GP, this is usually within 10 days. 

© North Bristol NHS Trust. This edition published February 2024. Review due February 2027. NBT003668.

Birth/pregnancy spacing

Regular Off Off

What is birth spacing or pregnancy spacing?

Pregnancy spacing is an essential part of family planning. The time between giving birth and getting pregnant again is called birth spacing, or pregnancy spacing.

This page has information about the importance of pregnancy spacing and will help you understand the factors you should consider before you conceive again. 

Following a pregnancy, a woman's body needs to rest. Pregnancy spacing is an essential part of family planning. 

Why is family planning important?

Being parents already, family planning takes on new meaning. Having another child can change your family's lives. Some questions you may want to think about:

  • Are you ready to take care of a newborn again?
  • How will your other child/children react to sharing your attention with a new baby?

While you and your partner might have preferences about how close in age you'd like your children to be, some research shows that how you space your pregnancies can affect the mother and baby’s health and development?  

Research shows that getting pregnant less than 12 months after a birth is associated with health risks for women of all ages. 

For most women, its best to wait at least 18 months between giving birth & getting pregnant again. 

This gives your body time to fully recover from your last pregnancy before it’s ready for your next.

What are the risks of spacing pregnancies close together? 

Research suggests beginning a pregnancy within 6 months of a previous birth, increases the risk for certain health problems for the mother and baby. 

These include the risk of: 

  • Premature birth.
  • Low birth weight.
  • Stillbirth.
  • Placenta partially or completely peeling away from the inner wall of the uterus before delivery (placental abruption).
  • Congenital disorders.
  • Mental health disorders.
  • Maternal anaemia (anaemia for mother).

Closely spaced pregnancies might not give a mother enough time to recover from pregnancy before moving on to the next pregnancy. For example, pregnancy and breastfeeding can deplete your stores of nutrients, particularly folate. If you become pregnant before replacing those stores, it could affect you or your baby's health.  
Inflammation of the genital tract that develops during pregnancy and doesn't completely heal before the next pregnancy could also play a role.

What are the risks of spacing pregnancies far apart?

Some research also suggests that long intervals between pregnancies pose concerns for mothers and babies, such as an increased risk of pre-eclampsia in people with no history of the condition.

It's not clear why long pregnancy intervals might cause health problems. It's possible that pregnancy improves uterine capacity to promote foetal growth and support, but that over time these beneficial physiological changes disappear.

What’s the best interval between pregnancies?

To reduce the risk of pregnancy complications and other health problems, research suggests waiting 18 to 24 months, but less than five years after a live birth before attempting your next pregnancy. 

Balancing concerns about infertility, people older than 35 might consider waiting 12 months before becoming pregnant again. Choosing when to have another baby is a personal decision. When planning your next pregnancy, you and your partner might consider various factors in addition to the health risks and benefits. Until you decide about when to have another child, using a reliable method of contraception. 

If you have previously had a caesarean section, births that occurs 18 months or less apart, you have a higher risk of uterine rupture (this is an emergency, when the scar on the uterus opens prior to delivery). 

Health professionals will always support you in your choice, which will be about what is right for you and your pregnancy.

What else do I need to know about pregnancy spacing?

There is no perfect time to have another baby. Even with careful planning, you can't always control when conception happens. 

Discussing reliable contraception options until you are ready to conceive and understanding the possible risks associated with the timing of your pregnancies can help you make an informed decision about when to grow your family.

© North Bristol NHS Trust. This edition published March 2024. Review due March 2027. NBT003676.

Intrauterine device "coil" at caesarean section

Regular Off Off

Intrauterine contraception, known as a coil or IUD, is one of the most effective ways of preventing or delaying a further pregnancy.

It is possible to have this fitted at the time of a caesarean birth. It is inserted through the opening in the womb, after the placenta (afterbirth) has been removed.

Caesarean childbirth and coil fitting 

There are many benefits to having your contraceptive coil fitted at the time of your caesarean:

  • It is very safe.
  • It provides contraception immediately.
  • It is painless - you will already have an anaesthetic for the operation.
  • Either the hormone (LNG-IUD) or hormone free, copper coil (Copper-IUD) can be fitted.
  • Both coils are safe to use while breastfeeding.

About the contraceptive coil

No contraceptive method is 100% effective, but the coil has a very low risk of failure (less than one pregnancy per 100 women over a year).

When a coil is fitted at the time of a caesarean there is a one in 1000 risk of injury to the womb (perforation) at the time of insertion and a one in 20 risk of the device falling out of the uterus afterwards.

There is a small chance of infection (one in 100) in the first few weeks following insertion, this is the same risk as if the coil was fitted later.

Types of contraceptive coil: 

Hormonal LNG-IUD

This coil contains a small amount of a hormone (progesterone) that is released directly into the womb. Progesterone causes mucus in the cervix to thicken so sperm cannot get through, and the womb lining to thin so that an egg cannot implant. Only a trace of the hormone enters the blood stream.

Because the hormone causes the womb lining to thin, period pain and bleeding will reduce, although it can take up to 3-6 months for your bleeding pattern to settle or stop totally.

Copper IUD

This coil does not contain hormones. The copper in the device prevents sperm from reaching an egg and implanting in the uterus.

Because there are no hormones in this coil your period cycle will not be affected, although sometimes your periods may be heavier.

Advice after your coil fitting: 

What to expect

You will need to have a follow up appointment in the hospital after your coil fit for a scan and possibly a thread trim. 

The scan is to confirm the coil remains correctly sited within the uterus once is has returned to its pre-pregnancy size. We would recommend using additional contraception until this follow up appointment has taken place.

When the coil is inserted at the time of a caesarean, there is a higher chance that the threads will not be seen in the vagina at the check-up visit. This does not affect how the coil works and most can be removed easily when required.

I think I can feel the threads, what to do?

When a coil is fitted at the time of caesarean section the threads are left long. Once your uterus has returned to its pre pregnancy size they are then trimmed.

You might be aware of the threads within the vagina or protruding just outside before your follow up appointment is due. If this is the case, please contact the one of the following emails below for any questions or queries. 

Try to avoid pulling on the threads yourself as the coil may be removed by accident.

I think my coil has come out, what to do?

Sometimes the coil can expel from the uterus. If you suspect this might have happened, it is important that you contact us as soon as you can and avoid any unprotected sex until this has been checked at your appointment.

When can I have sex again after having a coil inserted?

You can start having sex again whenever you feel ready although the timing of this will vary for each woman.

Post-partum contraception advice

If you are looking for further information or have any further questions or queries, please contact: 

Southmead Hospital if you give birth or due to give birth here: 

contraception@nbt.nhs.uk

St Michaels Hospital if you give birth or due to give birth here: 

stmikesLARC@ubhw.nhs.uk                

© North Bristol NHS Trust. This edition published March 2024. Review due March 2027. NBT003674. 

Post-birth contraception

Regular Off Off

Post-birth contraception

Contraceptive choices

Contraception may be the last thing on your mind when you are pregnant, but it is the best time to think about it if you want to delay or avoid another pregnancy.

Many unplanned pregnancies happen in the first few months after childbirth. You can get pregnant as early as three weeks after your baby is born.

Even if you are not interested in having sex after the birth, it is better to be prepared. Feelings can change, and it is possible to get pregnant quickly. Research has shown it is ideal to leave 12-24 months before getting pregnant again. This allows your body to recover and the healing process to begin. Giving your body and your next baby the best possible advantage

From 21 days after giving birth, you are no longer naturally protected from pregnancy, and should consider some form of contraception. Many methods of contraception can be started straight after birth. They are safe for you and your baby, even if you are breastfeeding. There is no need to wait for your periods to return or until your postnatal check-up before you use contraception.

Remember to talk with your midwife, obstetrician, or healthcare professional about your contraception options. They can help you choose the best method for your birth plan.

Contraceptive methods that can be started after childbirth

Progestogen-only contraception and a few others can be safely started at any time after having your baby, these include:

Contraceptive implant

You can have the contraceptive implant immediately after having your baby. It can be inserted in the hospital before you home.

The implant is a tiny, bendy rod, about the size of a matchstick that is inserted under the skin of your upper arm.

The implant steadily releases a hormone called progestogen into your bloodstream, which prevents the release of an egg each month (ovulation).

It also thickens the cervical mucus which makes it more difficult for sperm to move through the cervix and thins the lining of the womb, so a fertilised egg is less likely to implant itself.

It's more than 99% effective. Fewer than 1 woman in 1,000 who have the implant as contraception for 3 years will get pregnant.

Advantages 

  • Suitable if you are breastfeeding.
  • Can start immediately after birth. 
  • Lasts for 3 years. 
  • It can reduce your menstrual flow or stop your periods altogether. 
  • Does not contain oestrogen (safer for some people).
  • Removed at any time and fertility returns to normal quickly.
  • It may reduce period pain.

Disadvantages 

  • Possible irregular periods or no periods. 
  • Bruising, tenderness, swelling around implant after it is inserted.
  • You are not protected against sexually transmitted infections (STI’s) 
  • Migration of implant (it moves from its position). 
  • You may have some side effects such as breast-tenderness, acne, low mood, headaches. These should clear up after a period of use.

Hormonal Intrauterine Device (LNG-IUD) “Coil”

The hormonal IUD can be fitted either in the first 48 hours after delivery, or 4-6 weeks later. This will be discussed by your healthcare professional before you give birth and can be planned for the time of your delivery. It can also be inserted at the time of a planned caesarean section.

The hormonal intrauterine system (LNG-IUD) (sometimes known as a Mirena/Levosert/kyleena) is a little, t-shaped device that is placed in your uterus (womb).

It releases a small amount of hormone, called progestogen, which prevents sperm from getting through the cervix into the uterus and meeting up with an egg. It can last up to 5 years or more.

It is more than 99% effective. That means fewer than 1 out of 100 people who use an IUD will get pregnant each year.

Advantages 

  • Suitable for breastfeeding women.
  • Lasts at least 5 years.
  • It can reduce your menstrual flow or stop your periods. 
  • It can reduce heavy or painful periods.
  • Can be inserted before you leave hospital.
  • Does not contain oestrogen (safer for some people). 
  • Removed at any time and fertility returns to normal quickly.
  • It is not affected by other medications.

Disadvantages 

  • Possible irregular periods or no periods. 
  • Small risk of infection after insertion.
  • You are not protected against STIs. 
  • You may have some side effects such as breast-tenderness, acne, headaches, low-mood these should clear up after a short time.
  • There is a small risk your body may expel the IUD. 
  • Some women can develop small fluid-filled cysts on ovaries, this is uncommon, and these usually disappear without treatment.

Non-hormonal copper Intrauterine Device (copper IUD)

The copper IUD can be fitted either in the first 48 hours after delivery or 4-6 weeks later. This will be discussed by your midwife or doctor before you give birth and can be planned for the time of your delivery. It can also be inserted at the time of a planned caesarean section.

The copper IUD is a t-shaped device that is placed in your uterus (womb) which releases copper. It can last either 5 or 10 years based on the device fitted. 

The copper alters cervical mucus, which makes it more difficult for sperm to reach an egg and survive. It can also stop a fertilised egg from being able to implant itself. 

It is more than 99% effective. That means fewer than 1 out of 100 people who use a copper iUD will get pregnant each year.

Advantages:

  • Suitable for breastfeeding women
  • Lasts at least 5 or 10 years; once in place you do not need to think about contraception. 
  • It can reduce your menstrual flow or stop your periods. 
  • It can reduce heavy or painful periods.
  • Can be inserted before you leave hospital.
  • Does not contain oestrogen (safer for some people). 
  • Removed at any time fertility returns to normal quickly.
  • There are no hormonal side effects such as acne, headaches, or breast tenderness.
  • Not affected by medications 

Disadvantages:

  • Your periods could be heavier longer or more painful in the first 3-6 months after it is put in. 
  • Small risk of infection after insertion.
  • You are not protected against STIs. 
  • There is a small risk your body may expel the IUD

Contraceptive injection

You can use the contraceptive injection immediately after having your baby. It can be given in the hospital before going home.

The contraceptive injection contains a hormone called progestogen, which releases a hormone into your bloodstream to prevent a release of an egg each month (ovulation).

The injection is normally administered into your buttock.

It also thickens your cervical mucus, which makes it difficult for sperm to move through the cervix and thins the lining of the womb, so a fertilised egg is less likely to implant itself.

If used correctly, the contraceptive injection is 99% effective. This means than 1 woman in 100 who use the injection will become pregnant in a year.

Advantages:

  • Suitable for breastfeeding women
  • Each injection lasts for 13 weeks.
  • It can reduce your menstrual flow or stop your periods. 
  • It can reduce heavy or painful periods & help PMS symptoms for some women. 
  • Can be given before you leave hospital.
  • Does not contain oestrogen (safer for some people). 
  • It is not affected by other medication.
  • You do not need to remember to take a pill every day.

Disadvantages:

  • In real world use about 6 women in 100 become pregnant in a year because people forget to get their next injection (94% effective).
  • Your periods may change & become irregular, heavier, shorter, light or stop altogether.
  • It does not protect you against sexually transmitted infections (STI’s)
  • There can be a delay in 1 year before your periods return or you become pregnant.
  • Possible weight increase. 
  • Side effects like headaches, acne, hair loss, mood symptoms.

Progestogen Only Pill (POP)

If you have just had a baby, you can use the progestogen-only pills immediately if you wish. Your healthcare team can give you a supply of pills before leaving the hospital. 

This method suits women who want to take pills but cannot have oestrogen. The pills are taken every day and contain one hormone. 

There are two kinds of progestogen-only pill:

  • The traditional ones that thicken cervical mucus and stop sperm reaching the egg.
  • The newer ones that keep the ovaries from releasing an egg (ovulation).

If taken correctly, it can be more than 99% effective. This means that fewer than 1 in 100 women who use the progestogen-only pill as contraception will get pregnant in a year.

Advantages:

  • It is suitable for breastfeeding women.
  • You can start immediately after birth. 
  • It is safe for women who cannot have oestrogen.
  • It can reduce your menstrual flow or stop your periods altogether. 
  • You take the pill everyday; no break between packs.
  • You can take the POP even if over 35 & smoke.

Disadvantages: 

  • You must take the POP at the same time everyday.
  • If you are sick (vomit) or have severe diarrhoea, the POP may not work. 
  • You may have irregular bleeding. 
  • You are not protected against STIs.
  • Typical use of POP is 91% the way it is taken in real life by women. 
  • You may have some side effects such as breast-tenderness or spotty skin. These should clear up after a period of use.

Female sterilisation (tubal occlusion)

If you are sure your family is complete, sterilisation can be done at the time of caesarean section. You should think of this a permanent method.

If you are considering this option, you need to discuss as early as possible in your pregnancy with your healthcare team. So, they can assess whether this would be a suitable method for you and to become part of your birth plan. 

Female sterilisation is a procedure to permanently prevent pregnancy. The fallopian tubes are blocked or sealed to prevent eggs reaching the sperm and becoming fertilised. Eggs will still be released from the ovaries as normal, but they will be absorbed naturally into the woman's body.

It is more than 99% effective. That means fewer than 1 out of 200 people who have female sterilisation will get pregnant each year.

Advantages:

  • Suitable for breastfeeding women.
  • Permanent method if family complete.
  • Does not affect your hormone levels.

Disadvantages:

  • Sterilisation reversal is not available on NHS & can be difficult.  
  • Success rates vary, depending on factors like age and method that was used. 
  • Does not protect you from STIs.
  • Small risk of complications, infection, damage to other organs.
  • If pregnancy occurs after sterilisation, it is likely to be an ectopic pregnancy.

Lactational Amenorrhea Method (LAM)

Lactational Amenorrhea Method (LAM) involves breastfeeding when all the criteria are met below.

We are aware that some mothers may be concerned about starting contraception in the first 6 weeks after the birth of their baby and the aim of this information is to help you make the decision that is right for you.

Exclusive breastfeeding means that the baby is only having their mother’s own breastmilk, no supplements with formula milk, donor milk, or any water or solid foods.

When a mother is exclusively breastfeeding her baby and the baby is feeding frequently, the levels of the hormone prolactin will stay high enough to stop ovulation from happening.

If you are breast feeding your baby, the available evidence indicates that progestogen-only methods of contraception (Intra-uterine hormonal coil, Implant, Injection, and pill) have no adverse effects on lactation, infant growth, or development.

Women who breastfeed and experience a bleed in the first 6 months after childbirth have been shown to have a higher risk of pregnancy.

If used correctly, lactational amenorrhea method is 99% effective. This means that 2 women in 100 who use breast-feeding will become pregnant in a year. 

Therefore, for breastfeeding to be used as an effective contraceptive method it is recommended that all three of these criteria are met.

  • Exclusive breastfeeding day and night. 
  • No long intervals between feeds. This means no more than 4 hours during day or 6 hours at night.
  • No periods or bleeds.
  • Baby less than 6 months old.

If you breastfeed you should wait until 6 weeks after the birth of your baby before starting to use any method of combined hormonal contraception.

If breastfeeding reduces or other LAM criteria is no longer being fulfilled as above, please speak to your GP, or local sexual and reproductive healthcare services to move onto another contraceptive method of your choice. 

Condoms

A condom is a sheath-shaped barrier device used during sexual intercourse to reduce the probability of pregnancy or a sexually transmitted infection. 

There are two types of condoms:                                                    

Male condom

A male condom, also called an external condom is worn on the penis. Male condoms are a “barrier” method of contraception. They are designed to prevent pregnancy by stopping sperm from meeting an egg.

Make sure the penis does not touch your partners genital area before you have put on a condom – semen can come out of the penis before full ejaculation (you have come).

There are latex and non-latex condoms available.

Male Condoms are 98% effective at preventing pregnancy. This means that 2 out of 100 women using male condoms as contraception will become pregnant in a year.

Female condom

A female condom, also called an internal condom is worn inside the vagina. Female condoms are “barrier” methods of contraception worn inside the vagina. They prevent pregnancy by stopping sperm meeting an egg.

A female condom can be put into the vagina before sex, but make sure the penis does not come into contact with the vagina before the condom has been put in. Semen can still come out of the penis even before full ejaculation (you have come). 

Female condoms are 95% effective. This means that 5 out of 100 women using female condoms as contraception will become pregnant in a year.

We know that women who use intrauterine methods (hormone LNG-IUD and copper IUD) and implants are four times less likely to have an unplanned pregnancy than women who use other methods.

If you are certain that you never want another pregnancy, then you may want to consider sterilisation. It is important you discuss this with your healthcare professional early in your pregnancy.

Emergency contraception

If you have unprotected sex in the first 3 weeks (21 days) after having your baby, you will not need emergency contraception.

If you have sex after the first 21 days without using reliable contraception, then you could get pregnant. Please discuss with your GP/pharmacist or sexual and reproductive healthcare clinic.

Contraceptive methods that have a delayed start after childbirth.

There are some restrictions on the use Combined Hormonal Contraception (CHC) by women in the weeks after childbirth due to increased risk of venous thromboembolism (VTE/blood clot) in this period, and if you are breastfeeding or developed certain medical conditions after childbirth you will need to wait at least 6 weeks before you can use:

  • Combined Oral Contraceptive pills (COC).
  • Combined contraceptive Vaginal Ring (CVR). 
  • Combined transdermal patches (patch).

Your clinician will assess your medical needs in relation to combined hormonal contraception.

You can usually start using the contraceptive diaphragm or cap 6 weeks after giving birth. If you previously used these before becoming pregnant, it is important you see your GP or contraception clinic after childbirth to make sure it fits correctly. This is because childbirth and other factors, such as gaining or losing weight can mean you need a different size. 

For women who are not breastfeeding and want to use Fertility Awareness Methods (FAM) meaning using your natural cycle as contraception: this can only be used from 4 weeks after childbirth as this is when ovarian function resumes and fertility signs and/or hormonal changes become clear.

Breastfeeding women should not use FAM as you are unlikely to have sufficient ovarian function to produce obvious fertility signs and/or hormonal changes during the first 6 months after childbirth.

© North Bristol NHS Trust. This edition published March 2024. Review due March 2027. NBT003673. 

Placenta Accreta Spectrum (PAS)

Regular Off Off

What is the placenta? 

  • The placenta (afterbirth) is an organ that develops along with the baby inside your uterus (womb) during pregnancy.
  • It attaches to the wall of your uterus and provides a connection between you and your baby.
  • Oxygen and nutrients pass from your blood through the placenta into your baby’s blood.
  • The placenta is often called the afterbirth because it will normally be delivered shortly after the baby is born.
  • Rarely, pregnancy may be complicated by a problem known as placenta accreta spectrum (PAS).

What is placenta praevia?

In some cases, the placenta attaches low down in the uterus and may cover part of or all of the cervix (the neck of the womb). In most cases, the placenta moves upwards and out of the way as the uterus grows during pregnancy. For some people, the placenta continues to lie in the lower part of the uterus as the pregnancy continues. This condition is known as low-lying placenta. If the placenta completely covers the cervix this is known as placenta praevia. If the placenta is very close (<20mm) or blocking the birth canal, you will need to have a caesarean birth.

illustration of placenta praevia, placenta accreta, and vasa praevia

What is Placenta Accreta Spectrum (PAS)?

  • PAS is a rare complication of pregnancy (between 1 in 300 and 1 in 2,000 pregnancies).
  • PAS covers a range of clinical conditions where the placenta is abnormally attached into the muscle of the uterus, making separation at the time of birth difficult.
  • PAS is more commonly found in women with placenta praevia and who have previously had a caesarean birth.
  • It can also occur if you have had other surgery to your uterus, such as removal of a fibroid (myomectomy) or uterine curettage.
  • It is more common if you are older (over 35 years old) or if you have had fertility treatment, especially in vitro fertilisation (IVF)

What are the different types of PAS? 

There are three main types of PAS defined according to the depth of placental invasion into the muscle of the uterus (myometrium). They have been classified by the International Federation of Gynaecology and Obstetrics (FIGO): 

  • Placenta accreta (FIGO 1): the placenta firmly attaches to the superficial layers of the myometrium.
  • Placenta increta (FIGO 2): the placenta is more deeply embedded into the myometrium.
  • Placenta percreta (FIGO 3): the placenta passes through the myometrium and attaches to the outer layer of the uterus (serosa), and sometimes becomes attached to adjacent organs such as the bladder.
illustration of normal placenta, placenta accreta, placenta increta and placenta percreta

Diagnosis of PAS

PAS can be seen on ultrasound imaging in approximately half of all cases, and in up to 80 - 90% of the time when ultrasound is done by PAS experts. Magnetic Resonance Imaging (MRI) may also be recommended in special cases. This does not involve radiation and is safe in pregnancy. 

Place of care - The South West PAS Network

Evidence shows that women have fewer complications when PAS is identified before birth and when cared for by an experienced team from diagnosis to delivery. The South West PAS Network is located in Southmead hospital, North Bristol NHS Trust. It coordinates, provides and standardises care for pregnant women with potential or confirmed FIGO 2 and 3 PAS disorder. The overriding aim of the network is to ensure equitable access, excellent experiences and the best possible outcomes for women and their families from all communities across the South West.

What should you expect from us? 

Antenatal care 

You may not experience any bleeding during the antenatal period and can be managed at home. 

Some do experience bleeding during the antenatal period. If this is heavy it may mean we need to deliver your baby early. 

If this is not heavy, but repeated, it may be necessary for you to be admitted to hospital for observation because of the risk of sudden heavy bleeding. This could be a prolonged hospital admission for observation. 

Once a decision has been made about timing of delivery, or should you be admitted with bleeding, you will be advised what to expect in terms of your baby’s prematurity, especially if a long stay in the Neonatal Unit is predicted. 

During your pregnancy you will be given the opportunity to have contact with our specialist midwife who supports our patients in the PAS service, as this can be a very stressful time. They will also be in contact with you after the birth of your baby to offer further support. 

Delivery planning 

You will be seen by a specialist consultant obstetrician and anaesthetist to plan the birth. Delivery is often planned earlier - between 34 to 36 weeks, to reduce the risk of heavy bleeding, should labour begin. The exact time of delivery depends upon your individual circumstances. Recovery time after delivery depends upon the type and extent of treatment you have for PAS. If PAS is suspected before your baby is born, your doctor will discuss your options and the extra care that you will need.

Delivery 

If you have PAS there is likely to be bleeding when an attempt is made to deliver your placenta after your baby has been born. The bleeding can be heavy and you may require a hysterectomy to stop the bleeding. 

There is a risk of injury to your bladder during the delivery of your placenta, this depends on your individual circumstances. 

Your team may discuss with you the option of a planned caesarean hysterectomy (removal of your uterus with the placenta still in place, straight after your baby is born) if PAS is confirmed at the time.

It may be possible to leave the placenta in place after birth, to allow it to absorb over several weeks or months. This type of treatment is often not successful and can be associated with very serious complications such as bleeding and infection. Some people will still go on to need a hysterectomy. 

Your healthcare team will discuss a specific plan of care with you depending on your individual situation.

We may plan for other specialists to be present for your delivery, to manage your risk of heavy bleeding (such as an interventional radiologist or a vascular surgeon), and to deal with any complications that may arise from where the placenta is located (such as a specialist bladder or bowel surgeon).

Your Birth Plan 

PAS can cause life-threatening bleeding at the time of birth, so we plan your care to manage this.

You will be seen by a consultant anaesthetist who will discuss the options available to you for anaesthesia and pain relief after the surgery.

We will discuss the need for blood transfusion and other treatments to replace the blood you may lose during the surgery. 

This may also affect how your blood clots so treatments may be needed to correct this. 

After surgery you may need admission to a Critical Care Unit to help your recovery, either on the labour ward or in the main Brunel building at Southmead hospital. You will also have involvement from specialist midwives and neonatology (baby doctors).

What should you do now?

Should you have bleeding, signs of labour such as contractions or the baby’s waters breaking, you should seek immediate medical assistance at your closest maternity unit.

References

Adapted from: 

The RCOG Patient Information Leaflet, Placenta Previa, Placenta Accreta and Vasa Previa (2018): 
Placenta praevia, placenta accreta and vasa praevia | RCOG 

The International society for Placenta Accreta Spectrum (IS-PAS) patient information leaflet (2020): 
IS-PAS – For Patients 

The ISUOG Placenta Accreta Spectrum patient information leaflet (2019):
Placenta Accreta Spectrum Disorder (isuog.org)
 

© North Bristol NHS Trust. This edition published May 2024. Review due May 2027. NBT003574. 

Pathology Visitor Policy

Regular Off Off

Welcome to Pathology Sciences

There are a number of hazards within our services. These are well managed but it is important that you follow instructions given by staff in the department/s who are responsible for your welfare.

To ensure that your visit to Pathology Sciences proceeds without incident, please take time to read these notes at the beginning of your visit.
The departments within Pathology are busy; your schedule may be subject to change, at short notice, due to the requirements of the services that we provide.

Our services are designed to comply with North Bristol NHS Trust Policies, MHRA, ISO 15189:2022, HTA and Screening Programme Standards and Guidelines.

Declaration

We ask all visitors and contractors to sign into and out of our visitor's book.
By signing the visitor's book, you confirm that you have read the information provided by us below and agree to abide by the instructions contained within. 
If you are here to provide a service, signing the visitor's book confirms you have the necessary competence and training to carry out the work.

Health, Safety and Security

  1. All visitors are subject to the Health and Safety at Work Act (1974) and other statutory provisions.
  2. In the event of a fire alarm sounding (continuous ring) please follow the exit routes to the nearest assembly point as directed by your host. Follow any instruction given by departmental Fire Wardens and Trust Fire Officers. You will be advised when it is safe to re-enter the building.
  3. Accident or ill-health: please inform your host who will seek first aid or other medical support as appropriate.
  4. If you have any particular health conditions that may affect you please inform your host in advance of your visit.
  5. Please do not touch items in laboratories unless informed that it is OK to do so, particularly chemicals, biological specimens or equipment.
  6. Please wear any personal protective equipment when advised to do so.
  7. Eating, drinking and the application of make-up is not permitted in laboratory areas.
  8. Wash your hands before leaving laboratory areas.
  9. Please keep personal belongings with you at all times or ask to host store items in secure areas on your behalf.

Confidentiality

Whilst on the premises you may come across patient or staff information. This must be treated as confidential and must not be passed on to others in any form once you have left.

Mobile Telephones

Switch off please, unless required for work!

Smoking

North Bristol NHS Trust operates a No Smoking policy on all of it’s premises.

Managment System

All Pathology disciplines operate management systems which include policies, procedures and objectives in order to safeguard patients, staff and visitors. We may ask that you familiarise yourself with some of these during the course of your visit.

Non-compliance with laboratory management systems, policies and procedures may result in an adverse incident causing harm to patients, personnel or services.

Finally...

If you have any concerns at all, please ask a member of staff.

Dr Rhiannon Hughes - Acute Internal Medicine and General Internal Medicine

Regular Off On A-Z of Consultants

GMC number: 7081854

Year & location of first qualification: 2010, Cardiff University

Specialty: Acute Internal Medicine, General Internal Medicine

Clinical interests: Medical Education and Simulation. Medical Leadership. 

Secretary: Sarah Thomas or Lisa Williams 

Secretary phone number: 0117 414 1140
Secretary email address: AMUsecretaries@nbt.nhs.uk
   
Dr Rhiannon Hughes has been a Consultant Physician at North Bristol NHS Trust since April 2022. Together with her colleagues, she provides care for patients referred from primary care or the emergency department in need of a specialist medical review. She also provides care for inpatients within the Acute Medical Unit. 

Dr Hughes holds a Postgraduate Diploma in Medical Education and has a special interest in the training and development of postgraduate doctors. She is an Advance Life Support instructor.

She is a member of the Royal College of Physicians and Society for Acute Medicine.

Related links

Hughes
Subscribe to Regular