Primary Care Liaison Newsletter

EPAC info

Early Pregnancy Assessment Clinic, Mercy Hospital for Women

 The Early Pregnancy Assessment Clinic (EPAC) is a specialised service offering non-acute assessment of complications in the first trimester, point of care ultrasound if required, counselling and miscarriage management planning. This service is managed within the Emergency Department (ED).

Inclusion criteria:

  • Stable women who require assessment of first trimester complications such as pain/bleeding.
  • Women who require management planning for first trimester miscarriage.

Exclusion criteria:

  • Suspected ectopic pregnancy, refer to Emergency Department.
  • Women requiring emergency care.

See HealthPathways for further details.

Mercy Hospital for Women’s guidelines for miscarriage diagnosis flow chart can be a helpful tool to assist with determining when a repeat ultrasound should be ordered to establish viability. Many imaging companies will suggest repeating HCG levels and follow up scanning. Once an intrauterine pregnancy has been determined then a well-timed scan will provide appropriate care.

HCG in early pregnancy

  • Once an intrauterine pregnancy is seen, HCG levels are rarely a helpful test – ultrasound is the preferred test
  • Urinary pregnancy test: can detect HCG at 25 IU/L, 9 days post conception (day 23 of a 28 day cycle).
  • Quantitative serum HCG: will be positive 9-16 days post conception.
  • HCG levels cannot be used to determine gestational age. Ranges for HCG in early pregnancy vary greatly. They are very helpful to decide on timing of an ultrasound scan and for assessing resolution post expectant and medical management of an ectopic pregnancy.
  • HCG levels usually double about every 3 days, but are not a reliable marker of outcome. HCG levels in ectopic pregnancies may be lower than expected for the estimated gestation, may not demonstrate an acceptable increase and may fluctuate.

 

Terminology

Anembryonic pregnancy/ early fetal demise Non-viable pregnancy without fetal pole or yolk sac (previously “blighted ovum”)
Biochemical pregnancy Very early pregnancy with positive HCG but no pregnancy seen on ultrasound
Heterotopic Pregnancy An ectopic pregnancy that co-exists with an intrauterine pregnancy
Incomplete miscarriage Miscarriage where some POC remain in the uterus
Missed miscarriage Early pregnancy loss diagnosed on ultrasound without symptoms of pain or bleeding
PUL Pregnancy of unknown location (PUL) is an ultrasound description only and not a diagnosis
Recurrent miscarriage Loss of 3 or more consecutive early pregnancies (excluding ectopic pregnancy or termination of pregnancy)
Septic miscarriage Miscarriage with infection
Threatened miscarriage Bleeding in early pregnancy
Unsited pregnancy An intrauterine pregnancy has not yet been confirmed on ultrasound

Please remember to use where possible the terminology provided when referring a patient.

Additional resources

Please visit Mercy Hospital for Women’s Early Pregnancy Assessment Clinic website, Health Professionals page for additional resources for your patients regarding early pregnancy loss. This resource is available in a number of different languages.

Contact details

The Early Pregnancy Assessment Clinic can be contact on 8458 4439 Monday to Friday 8am to 4pm.

Referrals can be sent via HealthLink SmartForms, or alternatively faxed to 8458 4205.

See our Refer a patient website for more information.

For all outpatient referrals, please be aware there may be a delay of several days before your referral is directed to EPAC. Please phone EPAC midwife directly to discuss referrals prior to sending.

Last reviewed November 17, 2023.