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Early Pregnancy Assessment Clinic (DRAFT)

Checked: 02-06-2025 by Jenny Henry Next Review: 29-05-2027

Service Overview

The Early Pregnancy Assessment Clinic (EPAC) is an emergency clinic for women with suspected miscarriage or ectopic pregnancy. Clinics run at Southmead, St Michaels and Weston General Hospitals, Monday to Friday. 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.

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

Women will be assessed and may have blood tests but not always a scan. There is no need to have a full bladder. Patients should be advised that a 2 - 4-hour wait can be expected.

Referral

Referral should be made using the EPAC form www.nbt.nhs.uk/epac-bristol-and-weston (available in EMIS for GP referrals)

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.

With effect from 2nd June 2025, NBT and UHBW have launched a self-referral option for EPAC clinics at Southmead, St Micheal’s and Weston General hospitals This service will make it easier and faster for people requiring early pregnancy services to book an appointment and remove the need for them to visit a GP, emergency department or other healthcare provider to initiate contact.

The criteria for self-referral are:

six weeks - 19 weeks and six days of pregnancy and experiencing bleeding and/or pain

previous ectopic pregnancy
previous molar pregnancy

Clinician referrals are still accepted for patients meeting the following 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.

For patients not meeting the 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 purposes 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.

Contacts

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

Weston General Hospital

Email referral form to: wghepac@uhbw.nhs.uk

Tel: 01934 647288

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.