Early Pregnancy Assessment Unit (EPAU)
The Early Pregnancy Assessment Unit (EPAU) is for patients in the early stages of pregnancy up to 16 weeks.
About the EPAU
The Early Pregnancy Assessment Unit (EPAU) is a nurse-led service which provides specialist care for women who have, or who have had the following:
- Vaginal bleeding and/or pain in early pregnancy up to 16 weeks
- A loss of liquor before 16 weeks (watery vaginal loss)
- A positive pregnancy test and a scan result showing a pregnancy of unknown location with pain, bleeding or other relevant symptoms
- A previous ectopic pregnancy (at six weeks gestation they can be referred for a scan)
- Recurrent miscarriages
- A previous molar pregnancy, not less than 8 weeks gestation.
Locations and contact details
University Hospital Lewisham
- Gynaecology Outpatient Department,Ground floor, Green Zone, Lewisham High Road, SE13
- Reception: 020 8333 3000 ext. 8710 or 8729
Queen Elizabeth Hospital
- Gynaecology Outpatients Department, Stadium Road, Greenwich, London SE18 4QH
- Reception: 020 8836 4897
- Switchboard: 020 8836 6000
How do I get a referral?
You can self-refer to the EPAU by filling out our EPAU self-referral form.
You can also be referred by a clinician (doctor, midwife or advanced clinical practitioner) who will complete an electronic referral, or by your GP who will email us directly.
Once your referral has been received, please await a telephone call from the EPAU. You will have a telephone assessment with a specialist EPAU nurse, and they will advise whether you need to attend a booked appointment for a face-to-face assessment and/or scan. Women are often contacted on the same day, or the next working day if the referral is received after 3pm. It is likely that the caller ID will show as a private number or withheld number.
If you are experiencing heavy bleeding and/or severe pain, or feeling dizzy, please go straight to the Emergency Department. Do not wait to be called by the EPAU team.
When you attend the Emergency Department, you will be assessed by a doctor to see whether you need to stay in hospital and receive care as an inpatient, or whether you can be discharged and referred to to the EPAU as an outpatient. If it is decided that you need outpatient care, the Emergency Department will send an electronic referral to the EPAU nurse, and you will be contacted either the same day or the next working day.
Your appointment at the EPAU
Preparing for your appointment
Due to the current Covid-19 restrictions, we ask that you do not bring children to your appointment. However, at the time of your scan, you can be accompanied by your partner. They will be asked to sign a declaration form and wait for you outside the department until you are called in for your scan.
In line with our Trust’s policy a chaperone is available for all intimate examinations. If a family member or friend has accompanied you, the clinician will still request that a member of staff acts as chaperone for an intimate examination.
During your appointment
On arrival you will be booked in by our dedicated admin clerk and directed to the EPAU waiting area with your referral form and a number. You will then have an ultrasound scan which is usually a transvaginal scan (internal scan), to assess your pregnancy. The sonography team will advise if you need to empty your bladder prior to the scan. Once the sonographer is ready to scan you, we will ask you to call your partner to accompany you into the scan. After your scan, you will be reviewed by one of the specialist nurses who will then discuss with you the likely cause of your symptoms, whether you need to have any more investigations, and your treatment options.
As our hospitals are teaching hospitals, medical or midwifery students may be present during your appointment. If you do not wish to have them in the room during your appointment, please let the nurse or doctor know and students can be asked to step outside.
Treatments available for miscarriage include natural management, medical management, day surgical management under local anaesthetic (MVA) and surgical management treatment under general anaesthetic. Treatments available for ectopic pregnancies include laparoscopic surgery, medical treatment with methotrexate, or expectant management.
After your appointment
You will be given a copy of your ultrasound report. We will also send an electronic copy to your GP.
How can I refer a patient to the EPAU?
We are now welcoming self referrals from women, however, we will still accept referrals from the existing pathway. GPs wishing to make a referral should complete the Early Pregnancy Unit (EPAU) referral form below and send it to the correct email address.
- EPAU at University Hospital Lewisham: firstname.lastname@example.org
- EPAU at Queen Elizabeth Hospital: email@example.com
Is bleeding common in early pregnancy?
Yes, however bleeding does not necessarily mean there is a problem. An implantation bleed, when the pregnancy is settling into the womb lining, can be common at around 4-6 weeks. Unfortunately, bleeding can also be associated with an ectopic pregnancy (where the pregnancy grows outside the womb) or a miscarriage.
If you have had a previous miscarriage, we would you advise to contact the Early Pregnancy Assessment Unit if you experience bleeding.
What is the cause of abdominal pain in early pregnancy?
If you have abdominal pain in early pregnancy, we want to ensure that the pain is not caused by a miscarriage or an ectopic pregnancy. Abdominal pain can also be related to non pregnancy causes including muscular pain, pain related to fibroids, urinary tract infection and other surgical causes eg appendicitis.
What if my symptoms worsen while I am waiting for the Early Pregnancy Assessment Unit to contact me?
We would advise you attend your local emergency department unit if bleeding worsens whereby you are having to change your sanitary pad more frequently and feel unwell, or if you are experiencing severe abdominal pain which is not improving with simple pain relief eg paracetamol.