Early Pregnancy Assessment Unit

  • Seeing women and their partners when there is a problem during the first 16 weeks of pregnancy. They specialise in seeing women experiencing pain and bleeding in this early stage of pregnancy.

  • Address: Tunbridge Wells Hospital,

What we do

An Early Pregnancy Assessment Clinic (EPAC) is a staffed by a dedicated team of nurses, doctors and ultra-sonographers.  They specialise in seeing women experiencing pain and bleeding during the first 16 weeks of pregnancy.

The clinic at Tunbridge Wells Hospital runs to timed appointments. These appointments can be made by your GP, midwife or the Emergency Department.

Sometimes emergency patients need to be seen and you may have to wait for your scan or doctors review. We will let you know about any waiting times on the day.

Your appointment

When you arrive we will ask you to complete a triage and registration form. Please ask if you need help filling in the forms.  

A urine sample will be needed to check for urinary infections and we also will perform a pregnancy test before the ultra-sonographer or consultant gynaecologist scans you. You will not need a full bladder in less than 12 weeks of pregnancy unless requested in order to have your scan.

Your scan

We may need to do your scan internally using a small vaginal probe to allow the sonographer to make an accurate assessment of your pregnancy, and reach a diagnosis.

The sonographer needs to concentrate fully while doing the procedure, you can ask any questions at the end of your scan where they will explain what they have seen, and explain your diagnosis.

You may need to see a doctor following the scan, and sometimes there can be a short wait for this to happen.

You may not get answers to your questions after your scan, and we might ask you to come back for a further scan up to one week later. This is normal, and you should not be worried if this is scheduled for you.

If you have any questions or if anything is worrying you please speak to one of the nurses who will be happy to explain things to you.

Blood tests

We may need to take blood to check the hormone levels in your blood and in some cases your blood group. The nurse or doctor will speak to you about your scan findings and any other blood tests you have had.

When we take blood for hormones, called a Beta HCG, you will need a repeat test in 48 hours. We will call you on the day of the test after 8pm. Sometimes an emergency prevents the doctors from making contact with you and if this happens we will try to call the following day.

After your appointment

We understand this can be a stressful and anxious time and we will do our best to make you comfortable and at ease. You will also be given the clinic telephone number in case you have any concerns or questions once you arrive home.

Frequently asked questions

When should you attend the Early Pregnancy Assessment Clinic?

  • If you are in the first 16 weeks of your pregnancy and you are experiencing pain and or bleeding (this can be light spotting to heavier bleeding much more than a normal period bleed). You may see clots/brown discharge or other tissue.
  • If you have a referral from your GP or midwife.
  • If you are experiencing abdominal pain

What type of scan will I have?

In the early stages of pregnancy the uterus (womb) is still within your pelvis so an internal transvaginal scan (TVS) is needed. This is where an ultrasound probe is inserted vaginally.

If you do not wish to have an internal scan, we can offer an external scan called a transabdominal scan. However, in the early stages of pregnancy these scans may not provide as much information. You will be able to discuss this option with your ultra-sonographer.

The ultra-sonographer will explain the scan to you and if you need to see a nurse or a doctor you will be asked to take a seat in the waiting area.

It may not be possible to tell whether your pregnancy is continuing with the first scan, because of the early gestation.

We do not scan women under five weeks of pregnancy because the heart of the baby only starts to beat at six or seven weeks after your last period. The only way to we can tell the difference between a viable pregnancy and one that is failing is to repeat the scan in one or two weeks depending what we find on your first scan. The common findings can be separated into these categories.

  • Pregnancy of Unknown Location (PUL): Where we have been unable to locate the pregnancy with a scan and the hormone levels from blood tests are low. The main reasons behind a PUL:
    • The pregnancy is under 5 weeks; this can be due to irregular periods and long cycles and those who aren't sure of their last menstrual period.
    • The pregnancy may have been lost before the scan was performed.
    • You have experienced some vaginal bleeding which may not have been heavy as the pregnancy was very early.
    • The pregnancy hormones may be still present in your urine and can take up to 10 days to disappear after a pregnancy loss
    • Ectopic pregnancy. This can potentially be dangerous; you will be closely monitored to allow for early diagnosis to prevent internal bleeding.
  • Pregnancy of Unknown Viability (PUV): When a sac is identified in the womb correctly, but we cannot visualise a fetus with a heartbeat. If you are in very early pregnancy this can be a normal finding, as the fetus has not yet grown. Unfortunately if you are further along in your pregnancy this may mean that the pregnancy has failed.
    You will be rebooked for a follow up scan (in a minimum or seven days and a maximum of 14 days). If the pregnancy is failing it is possible you may spontaneously bleed and miscarry before the follow up appointment.
  • Ectopic pregnancy: If you discover you have an ectopic pregnancy (where the pregnancy grows outside the uterus, such as in the fallopian tube), you will need to be seen by a doctor and have a blood test.
    We may need to do a physical examination to rule out an ectopic pregnancy or look at your cervix. In this case there will be a chaperone with you.
  • Molar pregnancy: A rare condition where there is excessive placental development and little or no fetal development:
    • Partial molar is where two sperm fertilise an egg instead of one, and too much genetic material is produced for the fetus to develop.
    • Complete molar is where one or two sperm fertilise an egg which has no genetic material inside. This means there aren't enough chromosomes for the fetus to develop.
      If we suspect a molar pregnancy, a sample of tissue will be taken and sent for analysis. You will be under the care of a gynaecology consultant and we will monitor you closely.