Early Pregnancy Assessment Unit (EPAU)

What is EPAU?

The Early pregnancy Assessment Unit (EPAU) provides nurse led outpatient care to women with problems or concerns in early pregnancy (6- 12 weeks). Ultrasound scans are undertaken to confirm the location and viability of a pregnancy following a referral.

The service is open Monday to Friday 8am - 4pm and accepts referrals from:

• Self-referral by telephone assessment on 0151 702 4140 

• The Gynaecology Emergency Department following the walk-in attendance of patients meeting the criteria.

The service manages early pregnancy problems such as:

• Minimum vaginal Bleeding
• Mild lower abdominal Pain

We also see ladies who have has the following:

• Previous Ectopic Pregnancy
• Previous Molar Pregnancy
• 2 x consecutive miscarriages in the preceding pregnancies

We can scan women between 6-12 weeks of pregnancy with a positive pregnancy test.  

Where is the EPAU located?

The EPAU is located on the second-floor next to the Hewitt Fertility Centre.

How do I get an EPAU Appointment?

• Assessment is by appointment ONLY.

• Self-referral by telephone assessment on 0151 702 4140

• Ultrasound scanning appointment times are from 8am – 3pm Monday - Friday, you will be offered the next available appointment time.

• We aim to offer an ultrasound scan within 72 hours of referral.

What to do if I need to be seen by EPAU during closed hours? 

If you have bleeding or in pain, please attend the Gynae Emergency Room located on the ground floor. 

Can I bring someone with me to my appointment?

Only one person will be allowed into the scan room. You are welcome to bring your partner or a friend/relative.

We advise you to make alternative arrangements for children however we do appreciate this is not always possible. If you are unable to arrange childcare, please be aware you are responsible for the safety of your children at all times.

What will happen at my appointment?

On arrival to the Unit, you will be greeted by a member of the team who will confirm your details for the appointment.  You will then be called into one of our scan rooms where a nurse sonographer will ask you your medical and pregnancy history.

The appointment should take around 30 minutes, it may take longer depending on the scan findings.

We appreciate this can be stressful and we will endeavour to obtain as much as we can from your hospital notes.  Sometimes however, we can obtain a better understanding by asking you directly.

You will be offered a transvaginal ultrasound scan.  This is an internal scan which provides the best images of your pregnancy when you are less than 12 weeks pregnant.  It is completely safe and does not cause miscarriage.  It is important as it lets us see pregnancies earlier that we would through a scan completed on the stomach.

The vaginal probe should not cause any discomfort when used. Before the scan you will be asked to go to the toilet and empty your bladder completely. You will then have to undress from the waist down and lie on a bed with a blanket covering your bottom half. A condom like cover and sterile lubricating gel are placed over the vaginal probe before it is gently inserted into the vagina. This can contain latex.  We have latex free probe covers and will ask you about any latex sensitivity before we prepare the scan machine.

The Nurse sonographer scanning you can take a few moments before telling you the results of your scan, this is to ensure they are obtaining the best images and providing you with the correct information. If there are no concerns regarding your pregnancy the sonographer will be able print you out a photograph and show you your baby on the screen.

On some occasions the Nurse sonographer may request an additional review of your scan, this may involve a doctor’s review or a re attendance to further monitor the findings, it is understandable that this could cause you some worry, however, please be reassured this is to ensure you receive the best possible care and we will explain the details of this to you. (See section below on what happens after the scan)

Once dressed the nurse sonographer will go through any questions you may have.

Please be aware that the team do try to keep the clinic running on time but if a patient before you may have unfortunately received upsetting news this can impact on waiting times.

Will the scan harm my baby?

A transvaginal scan will not harm your baby or cause you to miscarry.

Do you need to drink plenty of fluids before your scan?

No, for an internal scan we need an empty bladder, you will be asked to use the toilet before your scan.

Can an internal scan still be done if the patient is bleeding?

Yes, we can still scan you if you are bleeding, we are used to scanning ladies who are bleeding in early pregnancy, please do not worry about this.

What will happen after the scan?

 The following are likely outcomes.

• We see a pregnancy with a heartbeat, and we can discharge you.
• We see a very early pregnancy before the heartbeat stage, and we offer to re scan you in 1-2 weeks to ensure that the pregnancy is progressing ok.

However, there are a number of reasons why we may not see a pregnancy on your first visit.

• It is too early in the pregnancy to see the baby on ultrasound scan.
• The pregnancy is not growing as it should.
• Some women who visit the EPAU will be diagnosed with a miscarriage or ectopic pregnancy, and they will need further treatment and possibly an admission to hospital.
• We may not see a pregnancy on the scan, either inside or outside of the womb. If your pregnancy test is still positive, we will advise we do a blood test to monitor your pregnancy hormone also known as bHCG Level. The reasons of this will be explained further at your appointment.

Can I be seen in the EPAU again?

Yes – we can see you in EPAU up to and including week 12 of your pregnancy, please contact us again and a further appointment will be made.

However- If you experience any of the following:

• New or increasing pain
• Increased levels of Bleeding – soaked sanitary towel every 30 -60 mins.
• Shoulder tip pain
• Diarrhoea and/or vomiting.
• New dizziness on standing.

Please attend the Gynaecology Emergency Department for examination and assessment.

Useful links

• Miscarriage Association
• Ectopic Trust
• Molar Pregnancy
• GUM – The Royal Liverpool and Broadgreen University Hospital 
• Brook Advisory Service
• Action Line (BPAS)
• Honeysuckle Bereavement Team
• Axess Sexual Health - Axess Sexual Health