Quality statement 1: Timely referral to early pregnancy assessment services
Quality statement
Women, trans men and non-binary people referred to early pregnancy assessment services are seen by the service at least within 24 hours of referral. [2014]
Rationale
Women, trans men and non-binary people with a suspected ectopic pregnancy or miscarriage should be referred to an early pregnancy assessment service for diagnosis and management based on an initial clinical assessment. They should always be seen within 24 hours of referral. However, depending on the clinical assessment, some people may need to be seen immediately to avoid adverse incidents, such as the rupture of a fallopian tube in an ectopic pregnancy. In addition, some people should be referred directly to an accident and emergency department, for example if they are haemodynamically unstable. It is important that appropriate measures are put in place to ensure safety.
Quality measures
The following measure can be used to assess the quality of care or service provision specified in the statement. It is an example of how the statement can be measured, and can be adapted and used flexibly.
Process
Proportion of women, trans men and non-binary people referred to early pregnancy assessment services who are seen by the service at least within 24 hours of referral.
Numerator – the number in the denominator who are seen in early pregnancy assessment services at least within 24 hours of referral.
Denominator – the number of women, trans men and non-binary people referred to early pregnancy assessment.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.
What the quality statement means for different audiences
Service providers (secondary care services) ensure that a system is in place to enable women, trans men and non-binary people referred to early pregnancy assessment services to be seen by the service at least within 24 hours of referral.
Healthcare professionals (such as consultant obstetricians, gynaecologists and ultra sonographers) see women, trans men and non-binary people in an early pregnancy assessment service at least within 24 hours of referral.
Commissioners ensure that early pregnancy assessment services are able to see women, trans men and non-binary people at least within 24 hours of referral. They may also work with NHS England and NHS Improvement regional teams to raise awareness and ensure that clear protocols and referral pathways are in place.
Women, trans men and non-binary people who are referred to a hospital early pregnancy assessment service are seen within 24 hours of referral. They may be referred by a healthcare professional (for example, their GP, midwife or nurse, or an emergency department doctor) or, if they have had an ectopic pregnancy in the past, or 3 or more miscarriages, they should be able to book an appointment themselves.
Source guidance
Ectopic pregnancy and miscarriage: diagnosis and initial management. NICE guideline NG126 (2019, updated 2026), recommendation 1.3.4
Definitions of terms used in this quality statement
Early pregnancy assessment services
An early pregnancy assessment service can be located in a dedicated early pregnancy assessment unit or within a hospital gynaecology ward. All early pregnancy assessment services should:
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be a dedicated service provided by healthcare professionals competent to diagnose and care for women, trans men and non-binary people with pain and/or bleeding in early pregnancy and
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offer transvaginal ultrasound and assessment of serum human chorionic gonadotrophin (hCG) levels and
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be staffed by healthcare professionals with training in sensitive communication and breaking bad news.
[Adapted from NICE's guideline on ectopic pregnancy and miscarriage, recommendation 1.3.2 and expert opinion]
Referral
Women, trans men and non-binary people can be referred by a healthcare professional (such as a GP, emergency department doctor, midwife or nurse) who has made a clinical decision about whether they should be seen immediately or within 24 hours of the referral.
Women, trans men and non-binary people who have had recurrent miscarriage (the loss of 3 or more pregnancies before 24 weeks of gestation) or a previous ectopic pregnancy can self-refer to an early pregnancy assessment service. [NICE's guideline on ectopic pregnancy and miscarriage, recommendations 1.3.3 and 1.4.7, 1.4.9, 1.4.11 and expert opinion]
Equality and diversity considerations
Appropriate care may depend on the ability of a woman, trans man and non-binary person to access services quickly, which may be difficult for some groups, such as recent migrants, asylum seekers, refugees, or those who have difficulty reading or speaking English. It is important to ensure that services are easily accessible to women, trans men and non-binary people from these groups.