Approximately 25% of pregnant women experience pelvic pain and / or bleeding in the first trimester.
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Purpose
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To standardise the initial assessment and triage process for women who have abdominal pain and / or bleeding in early pregnancy.
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Definition of terms
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EPAS - Early Pregnancy Assessment Service. This service runs Monday - Friday mornings in the Well Women's Clinic.
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Early pregnancy - all gestations up to 16 completed weeks. (Note: Women with pregnancy of gestation >16 completed weeks should be referred to the obstetric unit.)
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P.O.C - Products of Conception (avoid using the term "products of conception" with women and their families. From their perspective they have lost their baby.)
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Initial assessment (GP and Women's Departments including Urgent Care / Emergency)
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Women with pain and/or bleeding in early pregnancy may present to various care providers including:
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- their GP,
- the Women's Urgent Care / Emergency department, or
- other Women's departments and clinics - e.g. outpatients clinics, Choices etc.
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Upon presentation, women should be triaged as follows:
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Presentation to Urgent Care / Emergency
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| - Follow algorithm and refer accordingly.
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| | - Follow algorithm and refer accordingly.
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| | - Continue with Choices appointment as planned, including assessment, ultrasound and diagnosis.
| - Arrange follow-up with EPAS if required, or refer for management as appropriate.
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| Presentation to other Women's services
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| - If during EPAS operating hours, refer straight to EPAS.
- If outside EPAS operating hours, refer to ED.
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Algorithm : Initial assessment and triage of women with pain / bleeding in early pregnancy
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Refer also to the following Women's resources:
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Clinical Practice Guidelines (CPGs)
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References
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The content of this CPG is based on:
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- Royal College of Obstetricians and Gynaecologists - RCOG (2006) Greentop Guideline number 25: The Management of Early Pregnancy Loss, http://www.rcog.org.uk/index.asp?PageID=515
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- The Association of Early Pregnancy Units - AEPU (2004) Organisational, Clinical and Supportive Guidelines, http://www.earlypregnancy.org.uk/guidelines.asp
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Additional information has been drawn from:
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- Goodhope Hospital NHS Trust: EPAU operational policy and guidelines
- Sheffield NHS Foundation Trust: Guidance notes for the EPAU
- Sheffield NHS Foundation Trust: Guidelines for management of pregnant women under 20 weeks gestation who are seeking advice regarding pain or bleeding in pregnancy
- Cambridge University NHS Foundation Trust: Guidelines for the management of women presenting with bleeding and or pain in early pregnancy
- Cambridge University NHS Foundation Trust: Algorithm for the management of patients with bleeding and / or pain in early pregnancy
- Royal Prince Alfred Hospital (NSW): EPAS Service Brochure
- Gold Coast Health Services EPAC: Procedure - admissions to EPAC
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Evidence Table
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31 July 2007
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Royal Women's Hospital Clinical Practice Guidelines (CPGs) are intended to provide guidance to health care professionals, based on a thorough evaluation of research evidence, on the practical assessment and management of specific clinical issues or situations. The guidelines allow some flexibility on the part of the health care professional based on the needs of the specific patient for whom they are caring.
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