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Early Pregnancy Assessment Clinic

Checked: 23-09-2023 by Vicky Ryan Next Review: 23-09-2025

Service Overview

EPAC clinics across the system are currently experiencing high demand. Please only refer women to EPAC clinics who meet the referral criteria.

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.

Referral Criteria

Positive Pregnancy Test & less than 6+0 weeks of gestation where there is significant pain (with or without bleeding) and you suspect ectopic.
Positive Pregnancy Test, between 6+0 weeks and 19+6 with bleeding (with or without pain). i.e. suspected threatened miscarriage or ectopic.
Patients with previous ectopic or molar pregnancy should also be seen in EPAC when pregnancy is confirmed.

If dates are not known then also consider referral.

Exclusions

Use expectant management for women with pregnancy of less than 6 weeks gestation who are bleeding but not in pain and who have no risk factors, such as previous ectopic pregnancy. Advise the patient to repeat a urine pregnancy test after 7–10 days. Consider referral if the test is still positive or if symptoms continue or worsen.

See information about other scenarios not meeting criteria at the end of this page.

Referral

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

Refer using the EPAC proforma for referrals to St Michaels Hospital, Southmead or Weston (form is embedded in EMIS).

Please include clinical details and reason for referral in appropriate section of the referral form.
Please check patient telephone number provided is correct on the form
If a patient requires an interpreter, please include this information and the language required in the referral.

The EPC team will triage referrals and contact patient with an appointment date/time within 1-2 working days.

The clinics run Mon - Fri. For urgent or weekend referrals please contact the ‘on-take’ hospital team via switchboard. For women undergoing medical termination of pregnancy please refer back to provider.

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.

Southmead Hospital

Email referral form to: EPCReferral@nbt.nhs.uk Tel: 0117 4146777

Consultant lead: Dr Jane Mears

St Michael's Hospital

Email referral form to: earlypregnancyclinic@uhbw.nhs.uk Tel: 0117 3427790

Consultant Lead: Dr Abigail Oliver

St Michael's no longer accept referrals via ICE.

Weston General Hospital

Email referral form to: wghepac@uhbw.nhs.uk (note change of email address from 8.12.23).

Tel: 01934 647288

WGH no longer accepts self-referrals (since 1.10.23).

IF A PATIENT DOES NOT MEET THE ABOVE CRITERIA

IF A PATIENT DOES NOT MEET THE ABOVE CRITERIA:

Refer via the Gynaecology SHO on-call for:

postnatal women
women with problems following medical or surgical TOP
all women with severe pain and/or bleeding who require direct admission.

Scans for reassurance after previous miscarriage or for dating purpuses should not be sent via EPAC. Please refer to the Ultrasound Department at the hospital where they will be booked for their pregnancy:

St Michaels University Hospital - 0117 342 5347
Southmead - 0300 555 0103

Recurrent Miscarriage

Please refer to the Recurrent Miscarriage section of Remedy.

Resources

Miscarriage | Health topics A to Z | CKS | NICE

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.