The Early Pregnancy Unit at Liverpool Women’s University Hospital provides a predominantly nurse led outpatient care to women with problems or concerns in early pregnancy (6-12 weeks). The service is also supported by a Consultant Lead who undertakes sessions in the service and provides medical guidance when required.
The service manages early pregnancy problems such as:
- Minimal/light vaginal bleeding
- Mild lower abdominalpain.
We also see women for reassurance who have had the following:
- Previous ectopic pregnancy
- Previous molar pregnancy
- Two consecutive miscarriages in the preceding pregnancies.
As part of your assessment, you will be offered an ultrasound scan (USS) for women between 6-12 weeks of pregnancy with a positive pregnancy test.
USS is undertaken to confirm the location and viability of a pregnancy. The USS will be performed by a nurse practitioner, sonographer, or a consultant doctor.
At this early stage of pregnancy, the USS performed are undertaken vaginally as this provides the most accurate information at this early stage of pregnancy.
More information
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Self-referral by telephone assessment on 0151 702 4140
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Appointments are only provided following a telephone assessment.
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If you have attended out of hours for an assessment in the Gynaecology Emergency Department and you meet the criteria for EPAU following their assessment an appointment will be made by the team appointment times are from 8am – 3pm Monday - Friday, you will be offered the next available appointment time.
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We aim to offer an ultrasound scan within 72 hours of referral.
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When the hospital enters into in period of escalation USS that are arranged for reassurance purposes only may be deferred to a later date.
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Please note only one adult will be allowed into the scan room. You are welcome to bring your partner or a friend/relative.
Can I bring someone with me to my appointment?
You are welcome to bring your partner or a support person. This is diagnostic process, and distractions need to be minimal. The rooms are small and require two staff as well as yourself and accompanying adult.
There will be other women in the department and on occasion we may have women who are upset.
We politely advise you to make alternative arrangements for children as you will be having a scan that will make it difficult to manage a young child.
We understand this is not always possible, if you are unable to arrange childcare, please inform the nurse at the time of your assessment. Every effort will be made to provide a suitable appointment time that will allow you to arrange care.
What will happen at my appointment?
On arrival to the Unit, you will be greeted by a member of the team who will confirm your details for the appointment. You will then be called into one of our scan rooms where a nurse practitioner will ask you your medical and pregnancy history.
The appointment will take around 30 minutes, it may take longer depending on the scan findings.
We will endeavour to obtain as much information as we can from your hospital notes. Sometimes however, we can obtain a better understanding by asking you directly.
You will be offered a transvaginal ultrasound scan and verbal consent to proceed will be required. The Ultrasound Scan (USS) will be an internal scan which provides the best images of your pregnancy when you are less than 12 weeks pregnant. It is important as it lets us see pregnancies earlier that we would through a scan completed on the stomach. Please be reassured It is completely safe and does not cause miscarriage.
What happens during the USS?
Before the USS you will be asked to go to the toilet and empty your bladder. You will then be asked to undress from the waist down and lie on the examination bed, you will be asked to remove your lower body clothing and to wear a provided gown to cover your bottom half to provide some dignity.
A condom like cover and sterile lubricating gel are placed over the vaginal probe before it is gently inserted into the vagina. The vaginal probe should not cause any discomfort when used. This can contain latex. We have latex free probe covers and will ask you about any latex sensitivity before we prepare the scan machine.
The Nurse Practitioner who performs the USS may can take a few moments before telling you the results of your scan, here they will be taking measurements and ensuring they are obtaining the best images to provide you with the correct information. If there are no concerns regarding your pregnancy the practitioner will be able print you a photograph and show you your baby.
On some occasions the Nurse practitioner may request an additional review of your scan, this may involve a doctor or another practitioner to review the findings or a re-attendance to further monitor the findings.
It is understandable that this could cause you some worry, however, please be reassured this is to ensure you receive the best possible care and we will explain the details of this to you. (See section below on what happens after the scan) Once dressed the nurse sonographer will go through any questions you may have.
Please be aware that the team do try to keep the clinic running on time but if a patient before you who may have unfortunately received upsetting news this can impact on waiting times.
What to do if my condition changes?
If you experience new or increased bleeding and or pain, please attend the Gynaecology Emergency Department (GED) located on the ground floor for further assessment.
Or you experience any of the following Symptoms ESPECIAILLY if you have not had a USS to confirm the site of your pregnancy.
- Pain: primarily or initially one-sided pain not relieved by paracetamol and codeine
- Shoulder tip pain or Diarrhea and/or vomiting
- Bleeding: soaked sanitary towel every 30-60 mins
- New dizziness on standing.
Do you need to drink plenty of fluids before your scan?
No, for an internal scan you need an empty bladder, you will be asked to use the toilet before your scan.
Can an internal scan still be done if the patient is bleeding?
Yes, we can still scan you if you are bleeding, we are used to scanning ladies who are bleeding in early pregnancy, please do not worry about this.
What will happen after the scan?
The following are likely outcomes.
- We see a pregnancy with a heartbeat, and we can discharge you
- We see an early pregnancy before the heartbeat stage, and we offer to re scan you in one to two weeks to ensure that the pregnancy is progressing okay.
There are a number of reasons why we may not see a pregnancy on your first visit.
- It is too early in the pregnancy to see the baby on ultrasound scan
- The pregnancy is not growing as it should
- Some women who visit the EPAU will be diagnosed with a miscarriage or ectopic pregnancy, and they will need further treatment and possibly an admission to hospital
- We may not see a pregnancy on the scan, either inside or outside of the womb. If your pregnancy test is still positive, we will advise we do a blood test to monitor your pregnancy hormone also known as bHCG Level. In this case the reasons for this will be explained further at your appointment.
Can I be seen in the EPAU again?
Yes – we can see you in EPAU up to and including week 12 of your pregnancy, please contact us again and a further a further assessment will be undertaken and if required an appointment will be made.
However, if you experience any of the following, please attend the Gynaecology Emergency Department for examination and assessment. :
- New or increasing pain
- Increased levels of Bleeding – soaked sanitary towel every 30 -60 mins
- Shoulder tip pain
- Diarrhoea and/or vomiting
- New dizziness on standing.
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Liverpool Women’s University Hospital
Address: Liverpool Women’s University Hospital
Crown Street
Liverpool
L8 7SS
The EPAU is located on the second-floor next to the Hewitt Fertility Centre entrance - following the corridor to the left of reception take the first set of stairs or lifts to the second floor, exit to the right and follow the corridor to the entrance door and you will see an intercom to access the EPAU a member of the team will admit you to the unit. The main reception team will direct you if you require assistance.