NHS should offer early pregnancy services seven days a week

8040902-article-female-gpEarly pregnancy assessment services should be made available seven days a week to ensure that women receive a timely diagnosis of ectopic pregnancy and are offered care and support during a miscarriage, says NICE.

The majority of pregnancies progress successfully but around one in five will result in a miscarriage, while ectopic pregnancies occur in 11 per 1,000 pregnancies.

About two-thirds of deaths caused by ectopic pregnancy are associated with substandard care, due to missed or late diagnosis.

This latest guidance aims to address this by recommending that regional services be organised so that an early pregnancy assessment service is available seven days a week for women who experience complications in their first trimester.

The dedicated service should offer diagnosis and care for women with pain and/or bleeding in early pregnancy.

The service should be provided by healthcare professionals who are able to offer ultrasound and assessment of serum human chorionic gonadotrophin (hCG) levels.

A 24-hour helpline offering advice and support for women with early pregnancy complications should be set up as part of the seven-day service.

Professor Mary Ann Lumsden, Professor of Gynaecology and Medical Education at Glasgow University, and chair of the group responsible for the guidelines, said: “There are around 200 early pregnancy assessment clinics around the UK but the level of service is very variable. Some centres do have units that already work seven days a week, others a five-day service and some three mornings a week.

“If you only have a service that is, say, five days a week then if a woman starts having a problem on Friday she may have to wait until Monday morning to be seen in an expert service or have to go via the emergency services.

“The provision of a seven-day early pregnancy assessment services will go a long way towards promoting good, timely diagnoses of ectopic pregnancies and miscarriage and will help to ensure all women in England and Wales receive excellent care.

“There may be some cost involved in setting up a seven-day specialist service but, in the long term, it is likely to be cheaper and is certainly better for the woman to have scan facilities and staff with the expertise to assess a woman than it is to treat her in theatre or on a hospital ward after she has collapsed from an ectopic pregnancy or excessive bleeding.”

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE, added: “It's vital that women and their families receive good, consistent, timely and effective care and support that addresses their needs and enables them to make informed decisions.

“We know that not every woman is receiving this level of treatment at the moment but this guideline will address that inconsistency and ensure all women receive excellent care, no matter where they live.”

Elsewhere, the guideline includes advice for GPs on the signs and symptoms of ectopic pregnancy which can often be general and non-specific. These can include pain and/or bleeding (although not always), pelvic or breast tenderness, dizziness or gut upset.

All GPs should have access to pregnancy tests and should think about offering a test during a clinical assessment of women of reproductive age.

The guideline also makes recommendations on when GPs should refer women to a specialist assessment service.

Dr Nicola Davies, a GP who helped to develop the guideline, said: “It can be difficult for GPs to diagnose an ectopic pregnancy, particularly when some symptoms are very general and women may not even be aware they are pregnant.

“I have seen two cases where an ectopic pregnancy was diagnosed but the women in question had no idea they were pregnant.

“By producing a list of potential signs and symptoms and also recommending that healthcare professionals should have access to pregnancy tests for women of reproductive age, the guideline promotes earlier diagnosis of ectopic pregnancy. This will mean that women receive appropriate care sooner and avoid serious complications.”

Listen to Professor Lumsden and Dr Davies discuss the guideline in more detail.

12 December 2012

This page was last updated: 12 December 2012

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Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.