12 - Organisation of the early pregnancy unit

Summary

Introduction

Early pregnancy complications are one of the most common reasons for women of reproductive age seeking medical help. Many pregnancies are complicated by pain and/or bleeding, which often causes concern because of a perceived risk of miscarriage or ectopic pregnancy. Around 40% of biochemical and clinical pregnancies may result in miscarriage and bleeding complicates around 21% of clinically detected pregnancies. There are many other symptoms which may also cause concern to pregnant women, such as hyperemesis, loss of pregnancy symptoms and gastrointestinal problems.

In the past, a woman with early pregnancy complications would first have to seek advice from her general practitioner or self refer to the accident and emergency (A&E) department in a local hospital. In A&E, early pregnancy problems would often be treated as a low priority and it was not unusual for women to spend many hours waiting to be treated. A&E departments have limited access to diagnostic and laboratory services and many women in the past had been admitted for inpatient investigations.

A significant change has occurred in the management approach to early pregnancy complications. In the past, surgery was considered necessary for both the diagnosis and treatment of early pregnancy complications. It has now been recognised that the majority of miscarriages and a significant proportion of ectopic pregnancies could be managed conservatively. Conservative management, however, requires sophisticated diagnostic facilities and a robust follow-up structure, which is not available in emergency departments.