Background
Early pregnancy care has undergone radical changes over the years. The wide use of ultrasonography and the introduction of early pregnancy units (EPU) has brought about a shift from the inpatient admission of women with early pregnancy problems to general gynaecological wards, to outpatient management in specialist clinics. Early pregnancy assessment units have been established to facilitate the streamlining of patient care and to provide an effective service for the management of early pregnancy disorders. Women who are found to have normal pregnancies are given reassurance, whilst those diagnosed with complications such as an ectopic pregnancy or miscarriage are given counselling and are managed as appropriate.
(2;13;39)
The earliest reported established Early Pregnancy Assessment Unit was in 1991 in the United Kingdom. It demonstrated an improvement in the quality of care, whilst reducing the number of admissions and average length of stay with significant cost
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savings.(13) For example, the administration of intravenous fluids and anti-emetics in an outpatient clinic setting has reduced the need for women having to be hospitalised for supportive treatment. Moreover, EPU, which are often lead by nurse specialists offer a setting for psychological support and follow up.
Early pregnancy care has been revolutionised by the incorporation of ultrasound examination allowing women with ectopic pregnancy and other early pregnancy disorders to be assessed and followed up without the need for immediate intervention or admission. (40) Scanning can be performed by trained gynaecologists, sonographers and specialist nurses, and the setting also provides supervised training opportunities for trainees and nurses.
There is currently a lack of accurate information on the number and distribution of EPUs in the UK. The structure of the units varies from one unit to another and across regions. An overview of the EPUs registered with the Association of Early Pregnancy Units (AEPU) shows regional variations, with large numbers in the South East but comparatively few in the North Eastern areas. It is, therefore, not clear if access to EPU services is adequate across the regions, and what impact this may have on clinical outcomes. The information on the distribution of EPUs may facilitate service planning and policy, and may improve outcomes by identifying regions that require investment. Due to constant changes in practice and emerging evidence, a national network of early pregnancy units could facilitate the rapid dissemination and uptake of guidelines and recommendations, including those developed through UKEPSS studies.
37 Building the network
I used multiple methods to identify and invite EPUs to join the UKEPSS network.
These included:
Approaching units on the AEPU registry
Direct communication with all NHS hospitals in the UK
Contact via Early Pregnancy Clinical Studies Group (EPCSG), Miscarriage Association (MA) and Early Pregnancy Trust (EPT).
Announcement at the national AEPU conferences (2012, 2013, 2014) Self-registration through UKEPSS website
Contact through obstetric units (on the UK Obstetric Surveillance System [UKOSS] network)
Eighty six UK Early Pregnancy Units (EPUs) have registered with UKEPSS (Figure 1). Each EPU is represented within the UKEPSS network by a nominated clinician, nurse and a sonographer, and there are currently 133 early pregnancy practitioners registered and active in the participation with UKEPSS. The UKEPSS Network collected details of EPUs in the UK with names of lead clinicians, nurses and
sonographers. This information can be used nationally by service planners and policy makers, for instance, the Department of Health to gather data on geographical
spread of early pregnancy services. One of the anticipated outputs of the UKEPSS network is the rapid dissemination of guidelines and uptake of evidence, which can have the potential to improve care and outcomes for patients. Details of the network are made available on the UKEPSS website (http://www.birmingham.ac.uk/ukepss)
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for use by clinicians, researchers and patients. It is anticipated that the UKEPSS Network will be an enduring legacy and a platform for future research beyond the PhD programme.
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London and Southeast
Barts Health NHS Foundation Trust Buckinghamshire Healthcare NHS Trust
Brighton and Sussex University Hospitals NHS Trust Chelsea and Westminster Hospital
Colchester General Hospital
Conquest Hospital, East Sussex Healthcare Darant Valley Hosiptal, Dartford, Kent Epsom General Hospital Surrey Royal Hampshire County Hospital EPU Heatherwood Hospital EPU
Homerton Hospital EPAU, London
King's College Hospital NHS Foundation Trust Kettering General Hospital
Newham General Hospital
North Middlesex University Hospital Queen Charlotte's and Chelsea Hospital Royal Berkshire Hospital
St Peters Hospital, Chertsey University College Hospital, London West Middlesex University Hospital EPAU Whittington Hospital
Wexham Park Hospital, Slough East Midlands and East Anglia Bedford Hospital
EastDarant Valley Hospital Luton & Dunstable Hospital
Milton Keynes General Hospital Trust EPU Nottingham University Hospitals NHS Trust EPAU
Nurture Fertility, Nottingham University Hospitals NHS Trust Rosie Hospital, Cambridge University Hospitals FT
Royal Berkshire Hospital Royal Derby Hospital GAU Peterborough City Hospital EPU
Southwest
Derriford Hospital Plymouth Dorset County Hospital
Musgrove Park Hospital Taunton St Michael’s University Hospital Princess Anne Hospital, Southampton Poole Hospital EPU
Royal Devon & Exeter Hospital Centre For Womens Health Salisbury NHS Foundation Trust EPU
North West
Blackpool Teaching Hospitals NHS Trust Blackpool Victoria Hospital EPAU Central Manchester University Hospitals Countess of Chester NHS Foundation Trust East Lancashire Hospitals Trust, Burnley General EPAU/GAU
ELHT EPAU/Lancashire Womens Hospital Liverpool Women's NHS Foundation Trust Maternity Unit, Cumberland Infirmary North Cumbria University Hospitals NHS Trust Pennine Acute Hospitals NHS Trust
Preston Lancashire Teaching Hospitals NHS Foundation Trust
Southport & Ormskirk NHS Trust
St Helens & Knowsley Hospital/Whiston Hospital Whiston
St Mary's Hospital, Manchester Southport & Ormskirk NHS Trust
West Cumberland Hospital, Whitehaven, Cumbria Whiston Hospital
Wrightington, Wigan and Leigh Foundation NHS Trust
North and North East
Bradford Teaching Hospitals NHS Trust
Calderdale & Huddersfield NHS Foundation Trust Harrogate District Hospital EPAU
LIFE Newcastle Hospitals NHS Foundation Trust Newcastle upon Tyne Hospitals NHS Trust North Tyneside General Hospital
QE Gateshead Health Foundation Trust St James University Hospital EPU Sunderland Royal Hospital
University Hospital of North Durham York Hospital EPAU
Northern Ireland Belfast Health and Social Care Trust Ulster Hospital, Dundonald
Wales
Princess Of Wales Hospital
Scotland
Aberdeen Maternity Hospital Early Pregnancy Services Ayrshire Maternity Unit, University Hospital Crosshouse Dr Gray's Hospital (Elgin), NHS Grampian
Forth Valley Royal Hospital Ninewells Hospital Dundee
Pregnancy Support Centre, Edinburgh
The MRC Centre for Reproductive Health, University of Edinburgh
Figure 1.
UK EARLY PREGNANCY SURVEILLANCE SERVICE NETWORK
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