The Early Pregnancy Unit (EPU) : A New Service

What is the EPU?
It is a dedicated outpatient early pregnancy assessment service aimed at the management of women with actual or threatened pregnancy loss.

What are the benefits of the EPU?
Traditionally, asymptomatic stable patients confirmed to be pregnant can be referred for routine care and Down Syndrome screening at the outpatient Antenatal Clinic (O&G Center) while patients with acute problems in early pregnancy requiring immediate attention such as abdominal pain and bleeding can be referred to the Emergency Department which is open 24 hours. At the Emergency Department, they will be reviewed by a gynaecologist who will arrange for further investigations such as an ultrasound scan or blood tests, or hospital admission, if required.

The EPU is ideal for patients who are stable but with first trimester pregnancy complications as it facilitates prompt access to a dedicated early pregnancy unit for patients on a non-urgent basis. It is a one-stop clinic to centralise and streamline assessment, diagnosis, management and counselling of these patients during the first 13 weeks of pregnancy.

Admission to hospital can be avoided in 40% of women, with a further 20% requiring shorter hospital stay. This is in line with the Royal College of O&G recommendation of providing patient centered care through a holistic approach.

What are the requirements for running an efficient EPU service?
To run an efficient service, we ensure that patients are seen in an appropriate setting with same day ultrasound service (Fig. 1) and immediate access to laboratory facilities to measure serial beta hCG levels.

Transvaginal scanning is required in majority of women referred to the EPU and is performed by accreditated sonographers who will document findings on standardised reports.

The EPU has also developed algorithms of care for the management of miscarriages and suspected ectopic pregnancies (Fig. 2) enabling hospital admission and treatment, including emergency surgery, to be instituted if indicated.

When to refer patients to the EPU
The EPU was set up in 1 July 2006 by the Department of Obstetrics & Gynaecology at SGH to facilitate referral of stable pregnant patients with first trimester complications such as bleeding or pain.

The EPU team comprises a gynaecologist, a sonographer and a nurse counsellor. Besides providing medical treatment, the team also provides counselling and support for those who experience a pregnancy loss and continuity of care for patients
with ectopic pregnancies who are managed medically as twice weekly blood tests to monitor the beta-hCG levels are performed in the EPU.

The availability of the EPU allows direct access to hospital resources for the management of first trimester complications. Unstable patients or those in whom the suspicion of an ectopic pregnancy is high and require immediate medical care should be referred to the Emergency Department.

What happens when patients are discharged from the EPU?
Once the first trimester complications, eg. ectopic pregnancy or miscarriage, are treated or the pregnancy is ongoing, the patients will be referred back to the General Practitioner, Obstetrician or polyclinic of their choice for subsequent antenatal follow-up.