Pain and bleeding at <12weeks into pregnancy

Who can refer:

Appointments Only (Patient needs to phone the department to be triaged and given an appointment, they should not present in person) 

• Self-referral
• GP 
• Practice Nurse 
• Health Visitor 
• Midwife 

Who to refer:

• Any pregnant lady with severe pain or who look unwell should be seen as emergency via A and E/O and G reg bleep ( 6017 ).

• All pregnant patients at less than 12 weeks' gestation with pain or bleeding (including those with suspected ectopic pregnancy). 
• Reassurance USS is available for patients who have had: 
• Previous ectopic pregnancy- USS at 6-7 weeks unless symptomatic earlier than that.
• Previous molar pregnancy.
• 2 or more previous miscarriages - USS at 6-7 weeks unless symptomatic earlier than that.

We are unable to offer reassurance USS to patients who have had one previous miscarriage at this time. 

Who not to refer:

Patients with hyperemesis should be referred to obstetric triage by bleep 6016. 

How to refer:

We operate an appointment system. Please do not send patients up without having spoken to a member of the nursing staff. Please advise patients that they may not be seen face to face at initial contact but will be triaged and followed up appropriately. 

PAU: 01896 826735

Out of hours: Contact Gynaecology registrar on call through appropriate switchboards 6017 (GP referral or A&E )

You will be asked to provide the following info when contacting PAU (they will then not require a referral letter from you): 

• LMP 
• Date of first positive test 
• Menstrual cycle length  
• Full medical and surgical history (any risk factors for ectopic pregnancy)   
    

Following telephone discussion, we often request that a baseline hCG be taken by the practice treatment room nurse and PAU will then chase the result and call the patient with a management plan.  
  
We may ask patients to have follow up hCG taken in their surgery by the treatment room nurse and PAU will chase the result and call the patient with a management plan