Guidance and information on how to refer to EPAC
There are EPAC clinics at St Michaels Hospital, Southmead Hospital and Weston General Hospital. EPAC is an emergency clinic for women with suspected miscarriage or ectopic pregnancy.
Do not refer to EPAC women with known dates less than 6 weeks pregnant with bleeding and no pain – if less than 6 weeks pregnant then CKS guidance 2018 advises the woman to repeat a urine pregnancy test after 7–10 days and to return if the test is still positive, or if her symptoms continue or worsen.
Further information about the EPAC clinics at UHB, NBT and Weston and how to refer, is available via Remedy:
EPAC Referral Criteria
Patients must have:
- Positive pregnancy test and > 6 weeks or < 18 weeks pregnant with bleeding +/- pain
- Positive pregnancy test and < 6 weeks with significant pain +/- bleeding if considering ectopic (but see below information also)
- Previous hydatidiform mole or ectopic pregnancy
After assessing the patient, the referral form can be faxed directly to the relevant Early Pregnancy Clinic. If the patient is already booked for their antenatal care, you must refer the patient to the Early Pregnancy Clinic at that hospital. If the patient is not yet booked, please refer to the hospital which the patient thinks they will book for.
Cases that require discussion with on-call Gynaecology
- Severe pain and/or bleeding
- Haemodynamic instability
- Patients who you feel cannot wait for EPAC assessment
- Patients not meeting the clinic referral criteria
- Postnatal women
- Women with problems following medical or surgical TOP
Early Pregnancy Assessment Clinics
- If the patient is already ‘booked’ for antenatal care at one of the Bristol hospitals, please ensure that you refer to the patient to the EPAC at that hospital.
- UHB and NBT use the same EPAC referral form.
- North Bristol Trust EPAC
- Details of clinic locations are provided on the EPAC referral form.
- Clinics at Southmead are open 8:30-11:00 Monday-Friday.
- Fax the form and/ or give the completed referral form to the patient to take with them to the clinic. Advise patients to attend between the clinic opening times. Patients are seen in order of arrival unless clinical need dictates otherwise.
- St Michael’s Hospital (UHB) EPAC
- Clinics at St Michaels are open 8:30-16:30 Monday-Friday.
- Please email the referral form to email@example.com (faxed referral forms are no longer accepted). Advise the patient that the clinic will contact them on the next working day to arrange an appointment time.
- Weekend scanning appointments are only available for patients who would otherwise require admission.
- EPAC is based at Ashcombe Clinic, which is open for advice and support 8.30am-4.30pm Monday-Friday. This is a midwife-led clinic, with consultant Gynaecologist support.
- To refer you can either
- Complete the Weston EPAC referral form and email it to firstname.lastname@example.org.
- Or ring the direct line for healthcare professionals (01934 647 217). Out of hours, please ring 01934 647 288 and leave a message including the woman’s details – this will be actioned the next working day.
- Once the referral has been received, the patient will be contacted in working hours.
- They will see patients up to 19+6/40, and who meet one or more of the following criteria:
- Vaginal bleeding and/ or pain
- Women who are at increased risk ectopic pregnancy (i.e. history of ectopic pregnancy/tubal surgery/pelvic inflammatory disease/infertility/assisted conception/IUCD in situ)
- Previous miscarriage – scan at 8 weeks if can be accommodated.
- Maternal medication – scan for viability if indicated
- Urgent dating scan (fundus palpable)
- Unable to hear foetal heart at appropriate gestation
- Reduced foetal movements
- ? spontaneous rupture of membranes
- Postpartum with abnormal PV bleeding
- Post termination of pregnancy with abnormal PV bleeding
Patients who you feel cannot wait to be reviewed in Early Pregnancy Clinic
- If following assessment, you feel that the patient cannot wait to see EPC the next working day, please ring the on-call Gynaecology SHO.
- In Bristol, the acute Gynaecology take alternates weekly between St Michaels and Southmead Hospitals. To confirm which hospital is on-call, check with the Shift Manager or the hospital switchboard.
- In Weston, please telephone the Maternity Unit (01934 647 082) or the on-call SHO (via WGH switchboard).