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.
- Refer using the EPAC Form for referrals to both St Michaels Hospital or NBT
- Information on Remedy about local Early Pregnancy Clinics
- NICE Clinical Knowledge Summaries guidance about the about the management of suspected miscarriage
- NICE Clinical Knowledge Summaries guidance about the management of suspected ectopic pregnancy.
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 hydratidiform 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 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 EPC at that hospital.
- Details of clinic locations are provided on the EPC referral form.
- Clinics at Southmead are open 8:30-11:00 Monday-Friday. Fax 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.
- Clinics at St Michaels are open 8:30-16:30 Monday-Friday. Please email the referral form to firstname.lastname@example.org (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. Alternatively, you can give the referral form to the patient and advise them to ring 0117 342 5171 between 8.30-4.30pm (weekdays) to book their appointment.
- EPAC is based at Ashcombe Clinic, which is open for advice and support 9am-5pm Monday-Friday. The service is only accessible via referral. Women can contact EPAC directly for advice on 01934 647 082.
- Scanning clinics at Weston General are open 9:30-11:15.
- To access the clinic at Weston, call the Maternity Unit on 01934 647 082. They will take details and a midwife will contact the patient on the next working day. The lead midwife can be contacted by the patient for advice Monday-Friday 9:00-17:00, on 01934 647 288.
- If 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 Gynaecology SHO (via WGH switchboard).