What happens if it’s a viable pregnancy?
If the results are encouraging, then your patient will be asked to book into the most relevant clinic to continue their care, aiming for shared care with you as appropriate.
What happens if its an ectopic or a miscarriage?
Depending on the result, the patient will be counselled regarding their options. The counselling is provided by either the midwifery or the medical staff, with more senior members of staff being involved in more complicated diagnoses. The HSE Guidelines on management of early pregnancy loss can be accessed at http://www.hse.ie/eng/about/Who/clinical/natclinprog/obsandgynaeprogramme/guide9.pdf. Some small modifications have been made to fit in with our local practice.
The National Maternity Hospital Patient information leaflets are available on the following topics:
- General Management of Miscarriage
- Medical Management of Miscarriage
- Surgical Management of Miscarriage
- Attending the Hospital for Surgery: what you need to know.
We also work closely with the Chaplaincy Department and the Bereavement Midwives for women who require their support. Some women may require a referral to the Perinatal Mental Health team if they have difficulty coping with a pregnancy loss (http://www.nmh.ie/health-care-professionals/perinatal-mental-health-referrals.509.html)
What happens if it is not certain yet what is happening?
We follow the HSE Guidelines on “Ultrasound Diagnosis of Early Pregnancy Loss”, which we participated in writing. These are national guidelines which lay down strict criteria on when we can diagnose a miscarriage and can be accessed at http://www.hse.ie/eng/about/Who/clinical/natclinprog/obsandgynaeprogramme/guideultra.pdf. Some small modifications have been made to fit in with our local practice.
Sometimes when your patient comes for a scan we may suspect that the pregnancy may end in miscarriage they do not meet the criteria yet. If this happens we will ask her to return for another scan at a time where the diagnosis is more obvious (usually one to two weeks). We are very aware that this may be an anxious time for her and that she may link in with you. If you wish to have a copy of her ultrasound report or wish to discuss her care please feel free to contact us. We sometimes will need this time in order to see how the pregnancy evolves - we do not wish to make a misdiagnosis.
What if she have had an ultrasound elsewhere?
We often have patients referred to the EPAU who have had an ultrasound elsewhere and are then referred to this hospital for further care. We ask that your patient brings in a copy of her ultrasound report with her. In order to provide the best possible patient care we will wish to repeat the ultrasound to see if we agree with their findings, and occasionally we will need to repeat the ultrasound again at another time, as sometimes our findings do not meet the criteria set out in both our guidelines and the HSE National Guidelines.
Do I have to refer everyone to the hospital?
Depending on your clinical experience you may feel very comfortable in managing miscarriage in your own practice. If you think someone has had a complete miscarriage we would suggest advising the patient to check a pregnancy test in two weeks - it should be negative if she has had a miscarriage and if it is still positive you may need to reconsider your diagnosis. Please regard the EPAU as a resourse that you are welcome to access depending on your patients clinical requirements.
Patients with a previous history of ectopic pregnancy have a 10% chance of recurrance and should have an early pregnancy assessment at 7-8 weeks gestation. If you are concerned about the patient before this please feel free to refer her either as an emergency or as an elective referral, depending on your concerns.
What if my patient is well, but worried?
With limited resources we try to focus on women who are having problems in early pregnancy. If your patient cannot wait until then, an ultrasound can be arranged in Merrion Fetal Health which is a private ultrasound facility within the hospital (01 663 5060).
We welcome your feedback on your experience in accessing the EPAU. Please feel free to contact us if you have comments you wish to share. Our last assessment of patient satisfaction returned a 84% satisfaction rate, and we aim to continuously improve on this.
Tel: (01) 637 3217 or (01) 637 3218