Early Pregnancy Assessment Service - Royal North Shore Hospital

If you are having heavy vaginal bleeding or have severe lower abdominal pain please present to your nearest emergency department or phone 000 for an ambulance.

The Early Pregnancy Assessment Service (EPAS) is a clinic for women experiencing vaginal bleeding and / or lower abdominal pain under 20 weeks of pregnancy. EPAS is a Nurse/Midwife led clinic supported by the medical team including a staff specialist, sonographers pathology and support services.

The care provided in EPAS will meet the clinical, emotional and social needs of the individual woman.

Some women may require more than one visit before a diagnosis can be made. If medical or surgical management is recommended, this can be arranged in the clinic and scheduled for a subsequent date.

EPAS provides coordinated assessment, diagnostic, and management planning for threatened or diagnosed pregnancy loss. We also manage and treat women who have an ectopic or a molar pregnancy and require follow up.

For women experiencing a miscarriage or pregnancy loss

We acknowledge the emotional hardship you and your loved ones face during this time, however it is important to understand that you are not alone and there are support services available to help you and your partner navigate this emotional process.

• All previous blood and ultrasound results
• List of current medications and drug allergies 
• Your referral letter from your GP/Specialist 
• Your Medicare/DVA Card 

All woman must be assessed by their general practitioner (GP) prior to obtaining an appointment in EPAS.

We provide treatment for women who are experiencing:

• Pain or bleeding who are clinically stable up to 20 weeks pregnancy
• Women with a non-viable pregnancy on ultrasound scan
• Women with gestational trophoblastic disease (molar pregnancy)
• Women requiring methotrexate treatment of ectopic pregnancy
• Ectopic pregnancy or a pregnancy of unknown location
• Women requiring βhCG tracking of pregnancy of unknown location, molar pregnancy, ectopic or post methotrexate.

A named referral from your GP is necessary addressed to Dr Alastair Morris. Referral guidelines for GP's are located in the links below:

• Early Pregnancy Assessment Service Referral Form (PDF)
• Referral guidelines for general practitioners and medical staff (PDF)

Please fax referral to (02) 9463 1005. Include copies of all relevant blood tests and ultrasound results.

Women should receive a call from EPAS within two business days from receipt of referral to discuss ongoing care and schedule the appointment

Non-eligible:

• Women with other early pregnancy problems e.g. hyperemesis, diabetes, hyper/hypo-thyroid
• Women who are greater than 20 weeks pregnant should be reviewed in the Birthing Unit
• Any woman less than 20 weeks pregnant whose condition worsens (i.e. increased pain and/or bleeding) should be reviewed in an emergency department.

What to expect at your appointment

• Be prepared to stay up three to four hours
• Do not fast for this appointment
• A support person is welcome to attend with you, however, it is preferred not to bring children to this appointment
• A blood test may be taken as this is an important investigation for certain management. Some women require weekly blood tests, and these results will be followed up by our staff.
• An ultrasound may be required as it is an integral diagnostic tool when determining the cause of bleeding and pain in early pregnancy. A full bladder is NOT required prior to an ultrasound at this service.
• It is common for a trans-vaginal ultrasound to be performed, which is the most accurate way to assess early pregnancy. This procedure may be uncomfortable but not painful. A full bladder is not required for the ultrasound.
• When the results from investigations are available, the EPAS nurse midwife or doctor will explain them to you. They will discuss the options for further management if required. Please do not hesitate to ask questions or request further explanation. Our clinicians are aware of your anxiety and concern.
• Surgery can be arranged from EPAS however it is not likely to be on the same day as your initial appointment
• Social work services are offered to all women

Follow up

• Some women may need several appointments at EPAS.
• Some women can have follow up at your GP depending on your results. With your consent a letter will be provided to your local GP regarding your EPAS presentation, investigation and management.

Our Team

For Patients

• Healthdirect Australia - A 24-hour government health information and advice line.
  • Phone: 1800 022 222
• Pregnancy, Birth & Baby Helpline - You can ring the helpline any time of the day or night, 7 days a week
  • Phone: 1800 88 24 36
• Patient information on miscarriage management options (PDF)
• EPAS patient information brochure (PDF)
• Thinking of having a baby
• Early Pregnancy - When things go wrong (PDF)
• Prevention of Haemolytic Disease of the Newborn - Important Information for Rh (D) Negative Women (PDF)

Support group resources

• The Pink Elephants Support Network
• Gidget House: Perinatal Psychological and Emotional Support
• Bears of Hope
• Open doors counselling and education services
• Pillars of Strength
• Pregnancy Loss Australia
• Grieflink
• SANDS
• Red Nose Grief and Loss: Bereavement Support
• Recognition of Early Pregnancy Loss

For GPs

• EPAS policy (PDF)
• Maternity - Rh (D) Immunoglobulin (Anti D) guideline (PDF)
• FAQs - Use of Rh (D) Immunoglobulin (PDF)