All Services

Gynaecology & Early Pregnancy Assessment Unit (GEPAU)

Contact number:   01772 524415

• 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.

  If you have a pregancy or baby loss over 16 week gestation please follow this link to the maternity bereavment page.

   

   

• 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

  Funeral Options Following Pregnancy Loss

  Home Termination of Pregnancy

  Miscarriage - why me?

  Molar pregnancy and gestational trophoblastic disease

  Unplanned Pregnancy - Your Options

• 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

  • We are sorry you’ve had a miscarriage (Urdu)

  • We are sorry you’ve had a miscarriage (Punjabi)

  • We are sorry you’ve had a miscarriage (Polish)

  • We are sorry you’ve had a miscarriage (Turkish)

  • We are sorry you’ve had a miscarriage (Gujarati)

  • We are sorry you’ve had a miscarriage (Bangla)

  • We are sorry you’ve had a miscarriage (Arabic)

  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

  • Why me?

    Miscarriages happen for lots of different reasons. Sometimes the cause is known but often it isn’t. Some women benefit from treatment but others don’t need it. This leaflet looks at the possible causes of miscarriage and the tests and treatment that might help you.

  • Management of miscarriage

    This leaflet is for anyone who is having to make difficult choices at an already distressing time, or perhaps trying to find out more about what has happened already.

  • Thinking about another pregnancy

    Miscarriage can be a very unhappy and frightening experience. Even some time later you may still be coping with feelings of shock and great sadness. You may also be feeling anxious about the future – especially about trying again.

  • Recurrent miscarriage

    A single miscarriage can be very distressing; and it can be devastating if the next pregnancy fails too ... and then the next. This leaflet looks at the known and possible causes of recurrent miscarriage and the tests and treatments that might help you.

  • Miscarriage and the workplace

    This leaflet contains information and support for employees, employers, managers, HR and colleagues, regarding miscarriage, ectopic or molar pregnancy.

  • Your feelings after miscarriage

    Every miscarriage is different; and there is no right way to feel about it. This leaflet looks at how your loss might affect you, your partner and other people in your life. It also suggests ways to help you through.

  • Partners Too

    Pregnancy loss - miscarriage, ectopic pregnancy or molar pregnancy - can be very distressing. The physical experience can be traumatic. But you have also experienced a loss. We hope that this leaflet will help you understand and cope with your own feelings about your loss as well as your partner’s.

  • Men and miscarriage

    Miscarriage can be a very distressing experience for a couple, even they feel it in different ways. We hope that this leaflet will help you to understand and cope with your own feelings about your miscarriage as well as your partner’s. N.B. The leaflet 'Partners Too' is for partners of any gender.

  • Pregnancy loss and infertility

    This leaflet is for everyone who has experienced infertility and miscarriage or ectopic pregnancy. We hope you will find something here which will help you.

  • Pregnancy after loss

    For many people who have experienced miscarriage, ectopic or molar pregnancy, finding out they are pregnant again can bring with it a mixture of hope and anxiety. We hope this leaflet will help people through.

  • Looking after your mental health during and after pregnancy loss

    We all need to look after our mental health. But experiencing pregnancy loss may mean you need to take even greater care of yourself for a while. This leaflet aims to help you through.

  • Supporting someone you know

    It can be difficult to know how best to support someone who has a miscarriage, ectopic pregnancy or molar pregnancy. This leaflet aims to help you know what to say and do to offer comfort and support when you may be needed most.

  • Talking to children about miscarriage

    This leaflet aims to help you to handle miscarriage with children. We have written it mostly for parents, but we hope it will also be useful if you are a relative or friend, or if you work with children.

  • When the trying stops

    For some women and their partners, there comes a time when they begin to think about stopping their attempts to have a baby.

  • Blighted Ovum

    This leaflet explains what a blighted ovum is – and the different medical terms that might be used when it is diagnosed.

  • Ectopic pregnancy

    Ectopic pregnancy can be a very distressing and frightening experience. This leaflet aims to explain what ectopic pregnancy is, to provide you with information and to answer some of the most common questions about both facts and feelings. We hope this will help at what can be a very difficult time.

  • Molar pregnancy

    We have written this leaflet for women and their partners who have been affected by a molar pregnancy (also called a hydatidiform mole).

  • Second trimester loss: late miscarriage

    Most miscarriages happen in the first 12 or 13 weeks of pregnancy. It is much less usual to miscarry after 13 weeks and if this has happened to you, you may have been very shocked. We do hope that this leaflet helps a little at what might be a very difficult time.

  • Antiphospholipid syndrome and pregnancy loss

    We have written this leaflet for women and their partners, who have had recurrent miscarriages and have also been diagnosed with antiphospholipid syndrome.

  • Your miscarriage

    Miscarriage can be a very distressing experience. Apart from the emotional upset, you have to cope with the physical trauma of the miscarriage. And you have to face the loss of all the pregnancy meant to you as your body returns to normal. This leaflet has been designed to help you.

  • Miscarriage: The facts and your feelings

    A leaflet for young people, to help you understand your feelings and the facts about miscarriage.

  • Targeted advertising & how to stop it

    Information about how to stop or reduce targeted advertising or emailings after pregnancy loss.

  • Contact card

    A pocket-sized card carrying details on how to access the Miscarriage Association's services including the helpline, email and website.