Your referral to the Early Pregnancy Assessment Unit

The EPAU is an area in the hospital that manages problems in early pregnancy.

The most common problems are vaginal bleeding and abdominal pain. You may have one, or both of these symptoms.

The staff in EPAU will do a full assessment of the problems you are having. This will include reviewing your symptoms, and sometimes involves blood tests or an ultrasound scan. You will probably have to repeat your medical history and the reason for attending EPAU.

We understand that this can be very distressing but it is very important to ensure you receive the best possible care.

Some common causes of bleeding and pain in early pregnancy are:

• Bleeding from the implantation site - as the pregnancy attaches itself into the endometrium (lining of the womb) it may cause some blood vessels of the uterus (womb) to bleed. This is also called a ‘threatened miscarriage’.
• Miscarriage - is a loss of pregnancy which can cause vaginal bleeding and may include lower abdominal (tummy) pain or cramping.
• Ectopic pregnancy - a pregnancy outside of the uterus (womb), usually in a fallopian tube that carries the egg to the womb from the ovaries. Symptoms include vaginal bleeding, abdominal pain, rectal (back passage) pain and diarrhoea.
• A haematoma - this is a small area of bleeding, like a bruise, next to the pregnancy sac. A haematoma may be reabsorbed by the body or come away naturally as vaginal blood loss.
• Trauma to the cervix (neck of the uterus) - During pregnancy, tissues become rich in blood supply and soften. Because of this, any slight trauma to the cervix can cause bleeding. This may occur after sexual intercourse.
• Infection in the vagina - Common infections like thrush or other infections may cause bleeding from the vagina in small amounts described as ‘spotting’.
• Constipation - This is a common cause of pain in early pregnancy. The bowel becomes lazy because of the effect of the pregnancy hormones, and you may find that you go to the toilet to open your bowels (have a poo) less frequently. This causes a build-up of poo in the bowel, which leads to abdominal (tummy) pain.
• Urine infection - This is common in pregnancy and can cause pain and bleeding.

We can organise for you to be seen within two or three days at the EPAU. Your appointment should be given to you before you leave the Urgent and Emergency Care Centre.

Following your attendance in UECC you may have been advised to contact EPAU for further assessment or advice. In some cases this assessment and advice will be over the telephone.

If you have been advised that you will receive a call from the EPAU and no one contacts you within 48 hours, please phone EPAU on 01709 427072 to make sure an appointment has been made. Sometimes the appointment will be telephone advice only.

While waiting for your appointment, it is usually best to try and live as normally as possible. It is normal to feel anxious during this time, but there are many reasons why pain and/or bleeding can occur in early pregnancy as described above.

If you feel that you need to rest, you can, but try to keep as active as you feel able to. There is not always specific treatment to stop your bleeding and unfortunately, miscarriage cannot be prevented.

Taking pain relief such as Paracetamol for any back or abdominal pain you might have, is perfectly safe. It is important to wear sanitary pads only and not tampons if you are experiencing vaginal bleeding.

Early Pregnancy  Assessment Unit (EPAU)

01709 427072
Monday to Friday, 8am to 4pm (closed Bank Holidays)

01709 427072
01709 424349

Gynaecology Inpatient Ward

01709 424349