Lancashire Teaching Hospitals Services

Reasons you may attend the unit

Whilst most pregnancies will progress without complications, some women experience problems within the early stages of pregnancy and require additional monitoring, treatment and care. Some of the most common reasons why women are referred to the early pregnancy assessment unit are:

Vaginal bleeding and / or central lower abdominal pain with a positive pregnancy test
Previous ectopic pregnancy
Previous molar pregnancy
Severe Vomiting in pregnancy

You may be advised to attend the department immediately, given an appointment for another time or advised to remain at home with some safety-netting advice. You may also be directed to another provider such as your GP.

How to find us

Our Early Pregnancy Unit is on the first floor of the Sharoe Green Unit located within the Gynaecology Assessment Unit. The unit provides a dedicated service to women experiencing a problem in early pregnancy (up to 16 weeks gestation), such as pain, bleeding or severe vomiting.

Sharoe Green Unit: Royal Preston Hospital

How to find us by car

From M6 motorway, exit junction 32.

Turn left off slip road onto A6 Garstang Road heading towards Preston, at the second set of traffic lights turn left into Sharoe Green Lane. Pass the main entrance of the hospital (on your right) and continue past Booths Supermarket (on your left) and at the second mini roundabout turn right in the hospital grounds, continue on this road to the second car park (G). The Sharoe Green unit is on the right. (Car parking is £3 per visit)

From Preston Town Centre

Follow the A6 signposted Garstang and Lancaster; turn right at traffic lights signposted to hospital into Sharoe Green Lane. Pass the main entrance of the hospital (on your right) and continue past Booths Supermarket (on your left) and at the second mini roundabout turn right in the hospital grounds, continue on this road to the second car park (G). The Sharoe Green unit is on the right. (Car parking is £3 per visit)

Bus Services

Operates from the main bus station

No’s 7, 19, 22, 23 and 123 all go to the hospital

Taxi Services

Local taxis offer a service to and from the hospitals. Free phones are available at both hospital sites to make taxi bookings.

What to expect when you arrive

On attending the early pregnancy assessment Unit you will be seen by one of our nurses who will perform some initial observations and take a history of your symptoms. You may then have an ultrasound scan depending on your clinical situation. You may then need to wait to see one of our doctors. As this is an emergency facility, with several clinics running at the same time, there can sometimes be a short wait to see the doctor. All of our patients are seen in order of clinical priority. Your nurse will be able to advise you if there may be a wait.

The Doctor may perform an assessment and any necessary examinations or tests, e.g., a vaginal examination, external and internal ultrasound scans and/or blood tests.

The nurse or doctor will then:

Decide if it is safe to go home or require admission and or arrange a follow-up appointment.
Unless you ask us not to, we will send your GP information about the care we have given you.
Provide signposting advice for what do if your symptoms persist or worsen.

What else do I need to know

It is essential that you telephone and speak to a member of the nursing team before attending the unit. This is because women with an early pregnancy complication may not necessarily need to attend in-person or may be more suited for an assessment by the GP in different location or within the maternity service.

The Early Pregnancy Unit provides emergency treatment and if you are invited to attend the unit for an appointment, women are seen in order of clinical priority, which means that you may be in the department for longer than anticipated.

It is also important to understand that the department is shared with the Gynaecology Assessment Unit and currently we do not have separate waiting areas. Several different types of clinics will be running simultaneously, and we apologise if this affects your overall experience of care.

Experiencing early pregnancy complications is often a worrying time. We recognise that you may wish to bring someone with you for your appointment. Unfortunately, we have a limited waiting area so we ask that you only bring one adult support partner with you, and we would not advise that you bring children with you.

Please do not contact the Early Pregnancy Unit to arrange an appointment with the midwife.

You can do this by clicking here:

Test results

If you have had additional tests during your assessment, we may ask you to contact us to advise you of the results and arrange any necessary treatment plans.

When you go home

Prior to discharge the nurse or doctor will provide you with signposting advice for what do if your symptoms persist or worsen. If you go home and feel unwell when you feel your symptoms have become worse, please contact the department for clinical assessment or advice at any time.

Understanding what the results of an early ultrasound scan mean

There are several reasons why it may not be possible to interpret an early pregnancy ultrasound scan on your first visit. Some of the reasons may be related to:

It is too early in the pregnancy to see the baby on ultrasound scan.
The pregnancy is not growing as it should.
The pregnancy may be growing outside of the womb. (This is known as an ectopic pregnancy)

You may require more than one scan and a series of blood tests to confirm what is happening with the pregnancy. The frequency and timing of any tests or ultrasound scans will depend upon how far pregnant you are and what the initial scan shows.

Bleeding during early pregnancy

Bleeding during early pregnancy are relatively common symptoms and do not always mean there is a problem. Bleeding before 12 weeks can be associated with implantation of the pregnancy, changes to the blood flow to the cervix, infection, miscarriage or ectopic pregnancy.

Bleeding during pregnancy is a worrying sign for women at any stage of pregnancy and if you experience bleeding it is always better to seek advice from your GP, midwife or Early Pregnancy Unit.

The Tommy guide to bleeding in pregnancy is a useful resource that you can access here for more information.

Miscarriage

Experiencing a miscarriage can be an extremely difficult and distressing time for you and your family and the team will support you and your family throughout the process.

Further information can be found here

Sadly around 1 in 4 pregnancies are affected by miscarriage. Most miscarriages are unexplained, and it is difficult to determine a cause. Sometimes there can be underlying reasons such as when the pregnancy does not develop or because of other causes such as hormone or blood clotting problems.

Symptoms of miscarriage may include:

pain in your lower abdomen
a discharge or fluid from your vagina
Passing tissue or clots from your vagina
no longer experiencing the symptoms of pregnancy, (Nausea, vomiting, breast tenderness)

Understanding the terms used for miscarriage.

Complete miscarriage - This is when the scan shows that your womb is empty after a miscarriage. No further treatment is needed.

Incomplete miscarriage -This is when your scan shows that there is some tissue remaining in the womb.

Missed miscarriage -This is when your scan shows that the baby is not developing or has not developed and there is no heartbeat.

Management options following miscarriage.

Following a miscarriage there are several options available and the team will consider the safest, best most suitable option for you.

Your options will depend on your individual situation and what kind of miscarriage you have experienced. Before deciding, it is important that you consider all of the options, and it may be beneficial to read:

https://www.wihb.scot.nhs.uk/wp-content/uploads/2020/03/Management-of-miscarriage-1.pdf

Some women will have already miscarried when they attend the EPAU. A scan or a negative pregnancy test will confirm this.

Natural or expectant management

Some women prefer to wait for a miscarriage to happen naturally and for bleeding to start on its own. Your team may recommend this option to you if your miscarriage occurred before or around 8 weeks. It can take days or a few weeks for this to happen and once you start bleeding it is likely you will experience cramps, period pain and bleeding. The bleeding your experience is individual and can be a small amount (if the pregnancy sac reabsorbs) or may continue for 2-3 weeks. You may be asked to contact or visit the hospital, or you may be asked to do a pregnancy test 3 weeks after your miscarriage was confirmed.

If this test is positive you will need to return to the hospital to consider other options as this can mean that the miscarriage has not fully occurred. The hospital team will discuss the next steps for your care with you at this time.

Medical Management

Medical management describes a treatment for miscarriage with medication such as an oral pill or vaginal pessary. Most commonly you will be given a table to break down the lining of your womb. Sometimes the first dose is enough to cause a miscarriage. More commonly you will be asked to return for further treatment if required 2 days later. You may be asked to contact or visit the hospital, or you may be asked to do a pregnancy test 3 weeks after your miscarriage was confirmed.

Surgical management

This option involves an operation to remove the pregnancy tissue. At Lancashire Teaching Hospitals two options may be discussed with you.

Option 1

MVA stands for Manual Vacuum Aspiration and may be carried out in a ward area, assessment unit or out-patient clinic. Medications may be given prior to the procedure to soften the cervix. Following this a local anaesthetic is used to enable dilatation of the cervix and removal of the pregnancy tissue. It usually takes about 10 minutes and pain relief will be offered. You will be advised to wait within the department for about 30 minutes after the procedure. This is to ensure that you are recovered well before going home.

Option 2

This is an operation under general anaesthetic to remove the pregnancy using a similar technique to MVA. Medication is sometimes required prior to this to soften the cervix. Ladies usually go home the same day. You may experience some cramping after, and this should settle after a few days. You may bleed for up to 3 weeks however this should gradually ease.

What to expect?

Following natural or medical management of miscarriage it is likely that you will experience cramping or contraction type pain. This is because the uterus is contracting to push out the pregnancy tissue. It is not uncommon to pass some clots or experience bleeding like a heavy period.

It is possible that you may see a pregnancy sac and a tiny baby especially if you were more than 10 weeks pregnant. Often the pregnancy passes whilst on the toilet and you can either flush the toilet or you may want to remove the pregnancy to have a closer look. There is no normal or right thing to do. We would encourage you to do what is right for you and your family. Sometimes families opt for a burial or cremation, and this can be arranged privately.

Follow Up

Remember -You may be asked to undertake a pregnancy test 3 weeks following your miscarriage. This is to confirm that your treatment or natural miscarriage has occurred. It is important that you contact the EPAU if your pregnancy test remains positive.

Ectopic pregnancy

An ectopic pregnancy is a pregnancy that develops outside of the womb, usually in the fallopian tube. It affects around 1 in 90 pregnancies and unfortunately, this type of pregnancy always results in pregnancy loss. This is because the fertilised egg develops outside the womb and to prevent dangerous complications for the mother, the egg must be removed. Medical treatment of ectopic pregnancy avoids the need for surgery. This is not always suitable, and some women may require an surgery .

Symptoms of an ectopic pregnancy tend to develop in the 6th week of pregnancy but can happen later. The main signs of ectopic pregnancy can include:

tummy pain low down which may be on one side.
vaginal bleeding or a brown, watery discharge.
pain in the tip of your shoulder.
discomfort when passing urine or opening your bowels.

Find further support with ectopic pregancy here

Molar pregnancy

A molar pregnancy is a rare complication of early pregnancy which affects around 1: 600 pregnancies a year. This condition occurs when the baby and placenta have not developed the way they should. Unfortunately, a molar pregnancy will not be able to continue. It may end on its own (a miscarriage) or if this does not happen, it's usually treated by a surgical procedure to remove the pregnancy.

There are often no symptoms of a molar pregnancy. It may only be diagnosed during a routine ultrasound scan at 8-14 weeks or during tests are done after a miscarriage. Some women with a molar pregnancy have

vaginal bleeding or a dark discharge from the vagina in early pregnancy (usually in the first trimester)
severe morning sickness
an unusually swollen tummy.

We don’t know exactly what causes a molar pregnancy, but there are some things that increase the risk. Again, try to remember that molar pregnancies are not caused by anything you (or the baby’s father) did or didn’t do.

For more information see the link at Tommy's

What do I do if I am vomiting in early pregnancy

Nausea and vomiting in early pregnancy can affect up to 80% of pregnant women.

It’s very common to feel nauseous or vomit during the initial stages of pregnancy, and in some cases, symptoms can last considerably longer than 12 weeks. Although it’s called morning sickness, it can happen at any time of the day and affect your ability to tolerate food and drink. Despite this being considered a normal part of pregnancy, symptoms vary from mild loss of appetite and feeling sick to extreme vomiting which affects your ability to function normally.

If your morning sickness manageable there are a number of things can do to manage your symptoms. This includes:

Getting plenty of rest (tiredness can make nausea worse)
avoid strong smelling foods.
Eat something like dry toast or a plain biscuit before you get out of bed.
Eat small, frequent meals, little and often.
Drink plenty of fluids, such as water (sipping them little and often may help prevent vomiting). Ice may also be helpful to keep your mouth hydrated.
Eat foods or drinks containing ginger – there's some evidence ginger may help reduce nausea and vomiting but this may not be helpful in all cases.
Try acupressure – there's some evidence that putting pressure on your wrist, using a special band or bracelet on your forearm, may help relieve the symptoms of nausea.
Get support from family and friends. The Pregnancy Sickness Support website, https://www.pregnancysicknesssupport.org.uk/ provides helpful resources, counselling and peer support for those who are significantly affected.

Women with nausea and vomiting in pregnancy should in the first instance contact their GP for an assessment of their symptoms, urine testing for presence of ketones and support. Following review by the GP you may be asked to attend the EPAU for further treatment and support. If your GP is closed, you can access your out of hours service or 111.

What is hyperemesis gravidarum (HG)?

Hyperemesis gravidarum (HG) is extreme sickness associated with early pregnancy. It affects approximately 3% of pregnancies and is very debilitating for sufferers. HG strongly limits everyday activities and vomiting and/or nausea are severe.

It is important that you observe your fluid and dietary in-take, and you should always seek medical advice if you are unable to keep any food or fluid down. It is easy to become dehydrated and sometimes Intravenous fluids and medication are required to support symptom management to try and stabilise your overall condition and maintain wellbeing.

As a guide if you are vomiting and

have very dark-coloured urine or have not passed urine in more than 8 hours.
are unable to keep food or fluids down for 24 hours.
feel severely weak or faint when standing up.
have tummy (abdominal) pain.
have a high temperature.
vomit blood.
have lost weight.

For more information please visit https://www.pregnancysicknesssupport.org.uk

You should contact your GP for more urgent advice. Unfortunately, we cannot accept self-referral to the Early Pregnancy Unit for vomiting in pregnancy unless you are currently under our care or have been diagnosed with hyperemesis in a previous pregnancy.

What to do if you think you need urgent advice and treatment?

You may require more urgent or emergency care if:

you are in significant pain despite taking simple pain killers such as Paracetamol.
experiencing moderate to severe vaginal bleeding.
you have pain in your shoulder.
you feel extremely unwell.

You can access more urgent care via NHS 111, 999 or help via your nearest A&E Department.

Caring for you

The experience of pregnancy loss can be extremely difficult to manage and can have an emotional effect on women, their partners, and their families. If you are struggling to cope and feel that you need further advice and support, there are several options. You are not alone. Tell your GP as they can help you access additional support including which may include support from a specialist mental health team.

Here is a list of websites with further support

Sands - https://www.Sands.org.uk/support-you

Miscarriage association – https://www.miscarriageassociation.org.uk

NHS Miscarriage - https://www.nhs.uk/conditions/miscarriage

Tommy’s - https://www.tommys.org/baby-loss-support/miscarriage-information-and-support/recurrent-miscarriage

Cradle – https://cradlecharity.org

Pre-pregnancy Health and Wellbeing

It may be beneficial to optimise your health and the health of your partner before conceiving and there are several things that you can do to prepare your body.

Get your vitamin D level checked – Particularly if you have dark skin or you are from African or south Asian origin. Evidence suggests that low vitamin D levels can increase the risk of having a miscarriage.
Ask you GP to consider checking your thyroid function. The thyroid gland helps to regulate hormone levels and in your body. Thyroid issues may cause miscarriage particularly if your results indicate levels outside of the normal range.
Your GP may want to consider fertility investigations and conditions such as Polycystic Ovaries or fibroids can affect your ability to conceive and carry a pregnancy.

Research has shown that there are many things that can be done when trying to conceive to ensure that you are in the best possible physical and emotional health which may increase the chance of a healthy pregnancy.

If your smoke try to cut down or stop.
Stop drinking alcohol.
Start taking Folic Acid and vitamin D if you in an at risk group.
Eat a healthy balanced diet.
Reduce the amount of caffeine in your diet.
Consider your BMI and weight and if required try to lose weight.
Have a smear test.
Take care of your emotional health

Your partner

When planning a pregnancy it is important that men are healthy too.

Start taking Folic Acid and vitamin D if you in an at risk group.
Eat a healthy balanced diet.
Reduce the amount of caffeine in your diet.
Reduce or stop smoking because smoking can cause infertility.
Reduce or stop drinking alcohol as this can affect the quality of sperm.
Keep testicles cool and wear lose fitting underwear. (A reduced temperature is better of sperm)

Over 16 weeks?

Maternity Assessment Suite

If you are over 16 weeks pregant and have cancerns either yourself or your pregancy, please contact maternity triage on 01772 52 4495

When is it safe to try for another baby?

Following a miscarriage, you can try for another pregnancy as soon as you feel emotionally and physically ready. Making a decision to try again is personal and sometimes couples want to try start away and this helps them to come to terms with the pregnancy loss. Others need time to grieve for the pregnancy and prefer to wait. The Tommy’s toolkit might help you to get personalised support and advice on when to try and confirm the likelihood of a further miscarriage.

https://www.miscarriagetool.tommys.org/

There is some evidence that suggests that getting pregnant in the first 6 months following a miscarriage can lower your risk or a repeat miscarriage in the next pregnancy.

Occasionally you may be advised to wait before conceiving (such as following a molar pregnancy) and the team will advise you on whether this advice applies to you.

Useful Numbers

Other Useful Contact Numbers (Maternity)

Royal Preston Hospital

If you are under 16 weeks pregnant and experiencing any problems with bleeding and abdominal pain then please call our Gynaecology Assessment Unit on: 01772 524415

Sharoe Green Reception Desk: 01772 524235 (the desk is open Monday - Friday from 8am until 8pm. if you are calling out of hours, please contact the relevant department)

Ultrasound dating scan booking line Monday - Friday 9am - 4pm (please call the day AFTER your booking appointment): 01772 524426

Ultrasound (appointment enquiries / cancelling / reschedulling only): 01772 524416

Triage / Maternity Assessment Suite: 01772 524495

Maternity Ward A: 01772 524959

Maternity Ward B: 01772 524830

Chorley Antenatal Clinic: 01257 245123
Preston Antenatal Clinic: 01772 524272

Preston Birth Centre: 01772 528223

Chorley Continuity Team: 01257 245889
Midwifery Teams: 01257 245193 (Please contact only for queries regarding community midwife appointments or visits)

Neonatal Unit: 01772 524242

For any other queries please contact the main hospital number on 01772 716565

Domestic Abuse Helpline numbers:

Preston: 01772 435865
Chorley: 01772 201601
24-hour National Domestic Abuse Helpline (Freephone): 0808 2000 247
Victim Support: 01772 201142

Leaflets

Home Termination of Pregnancy

Manual Vacuum Aspiration

Miscarriage - why me?

Molar pregnancy and gestational trophoblastic disease

Pregnancy - your options

Your Options Following Your Pregnancy Loss

Accessible and Other Language Leaflets

The Miscarriage Association lealfets provide detailed information and advice following preganancy loss.

The following links are leaflets from the Miscarriage Association website https://www.miscarriageassociation.org.uk

Other language leaflets

Accessible leaflets

Miscarriage Information Booklet, illustrated

This illustrated leaflet has been written with the support of people with learning disabilities. It is clear and easy to read and could be useful for anyone with reading difficulties. Please note that the pictures are very graphic.
Your miscarriage (For D/deaf people)

A leaflet for a range of D/deaf people. We use clear plain English on the left hand page. There is more detail on the right hand page.
Your miscarriage (Illustrated)

This leaflet, published in 2011, has been written and illustrated to make the information easier to understand. It is available as a pdf only. See also the Miscarriage Information Booklet, published in 2018.

Miscarriage Association Leaflets

The Miscarriage Association lealfets provide detailed information and advice following preganancy loss.

The following links are leaflets from the Miscarriage Association website https://www.miscarriageassociation.org.uk

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Gynaecology & Early Pregnancy Assessment Unit (GEPAU)

Early Pregnancy Assessment