Early pregnancy is often a worrying time and is especially difficult if you are experiencing problems. We at the early pregnancy clinic are here to help and support you in any way we can.
The Early Pregnancy Clinic (EPC) is a nurse-led clinic supported by the on-call medical team- including a lead consultant gynaecologist. We manage early pregnancy problems such as vaginal bleeding and abdominal pain and see women from about 6 weeks up until their booking appointment.
We also see women with a history of ectopic pregnancy, molar pregnancy and recurrent miscarriage (3 or more consecutive losses).
Our clinic runs 7 mornings a week strictly by appointment and referrals are accepted from GPs, the Emergency Department, midwives and other health care professionals. However, we also have a telephone answer machine service which can be used for self-referrals (028) 9598 8085. You can call this number and leave your details and a nurse will be in contact with you as soon as possible. Nursing staff are with patients every morning and so will usually answer these calls after lunch when the clinic is finished. You will be triaged over the phone and a decision will be made as to whether an appointment is required. The majority of women will not require a scan or an appointment and are supported with advice as to how best to manage things at home.
Whilst we endeavour to provide a service which meets the needs of the majority of women needing help in the early stages of their pregnancy it is important to recognise that, in early pregnancy, a scan will not affect the outcome of the pregnancy. Unfortunately once a miscarriage begins there is nothing we can do to stop it.
If your symptoms are in need of more urgent attention (bleeding that is very heavy e.g. saturating pads every 30 mins for more than 3-4 hours, flooding, gushing, dizziness/fainting or pain that is unmanageable with simple painkillers) please attend the Emergency Department.
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The Early Pregnancy Scan - what to expect
We recognise that attending the Early Pregnancy Clinic may be a frightening time because you are experiencing a problem in your early pregnancy.
This information aims to explain what to expect and how best to prepare yourself for the appointment.
You will be seen by one of the early pregnancy nurses. At a first appointment we ask to see you on your own initially. We will ask questions about your medical history and general health, then questions specific to the problem you are experiencing in this pregnancy.
The nurse will then carry out an ultrasound scan, at which time whoever is accompanying you may be present. Ultrasound is widely used and safe in early pregnancy. It does not cause miscarriage.
At the Early Pregnancy Clinic we carry out internal scans, also known as transvaginal scans. This is a specially designed scanner which is inserted into the vagina. This type of scan allows us to see your pregnancy and surrounding environment better so we can best asses any problems you are experiencing.
This type of scan is best carried out when the bladder is empty so please do this prior to attending the clinic.
After your scan the nurse will be able to explain the findings of the scan and any further tests or appointments that you may need.
In some cases this might involve: A blood test
A further appointment
A second opinion from a second nurse or a doctor
Admission to hospital
Further information can be found at:
https://www.rcog.org.uk/en/patients/patient-leaflets/early-miscarriage/
https://www.aepu.org.uk/useful-links/
Support groups:
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Miscarriage
We that recognise that reading this information is very difficult as it means that you are either worried you are having a miscarriage or have had a miscarriage confirmed. Miscarriages affect everyone differently and there is no right way to ‘feel’. It can be very distressing and you may need a great deal of support afterwards. Our team will give you advice and information as well as written leaflets. Other useful information can be found at:
www.miscarriageassociation.org.uk
www.nhs.uk/conditions/miscarriages
This information aims to help you better understand what a miscarriage is and help you prepare for the options, treatment and care. It is important to know that once a miscarriage has started, there is nothing that can be done to stop it and that even if you come to the Clinic and have a scan we cannot change the outcome of your pregnancy. We understand that this can be hard to accept.
An early miscarriage is the loss of your baby in the first three months of pregnancy. Most women experience vaginal bleeding but sometimes there may be no symptoms (known as a delayed or silent miscarriage). If this is the case the miscarriage may be diagnosed by an ultrasound scan. Diagnosis is based on the guidelines outlined by the National Institute of Clinical Excellence (www.nice.org.uk) and the Royal College of Obstetrics and Gynaecologists (www.rcog.org.uk).
If a miscarriage is suspected and nothing remains in the womb (confirmed by scan) we will do a blood test to confirm this. We recommend a pregnancy test is carried out two weeks later. We realise this may be difficult to do, however, it is important for you and us to know that the pregnancy hormones are settling.
If some or all of the pregnancy is still inside the womb, we will talk to you about the best options for you. You may choose to wait and let nature take its course (Expectant management of miscarriage), use tablets (Medical management of miscarriage) or have a minor operation (Surgical management of miscarriage and Manual vacuum aspiration). Regardless of the option you choose we recommend (based on NICE guidelines) that you wait a week and have a repeat scan carried out. This allows a second nurse to confirm your news. Furthermore, research has shown you and your partner are in a better position to deal with intervention (if required) after having some time to think about what you want to do.
Sadly early miscarriages are very common. One in five women will have a miscarriage, and very often we do not find any reason as to why the miscarriage has happened.
You are not at any higher risk of another miscarriage if you have had one or two early miscarriages. Most miscarriages occur as a one-off event and there is a good chance that you will go on to have a successful pregnancy in the future.
You can try for a baby as soon as you and your partner feel physically and emotionally ready. For some women and their partners the effects of a miscarriage can be devastating. Some come to terms with things within weeks and others it may take longer. Family and friends may be able to help. Talk to your GP if you feel you are not coping.
Further info:
https://www.rcog.org.uk/en/patients/patient-leaflets/early-miscarriage/
https://www.aepu.org.uk/useful-links/
Support groups:
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Expectant management of miscarriage
This information aims to explain what ‘letting nature take its course’ or ‘expectant management’ means. This is successful in about half of all women who choose this option.
It is important for you to know that every person and every miscarriage is different. This information is what ‘most women’ experience, but you may have a different story.
It may take some time for the bleeding to start. It normally begins with light bleeding and/or brown staining. For some women this light bleeding/staining may stop and start for a week or two. If this persists for more than two weeks we may recommend other options.
When the bleeding starts to get heavier, you may experience cramping in your lower tummy.
We will advise you take pain relief and the nurse can recommend which is best and how to take it safely.
Heavy bleeding is expected as are cramps and it is normal for you to saturate large sanitary towels for a couple of hours. If you faint or experience flooding/ gushing coupled with dizziness for prolonged periods of time please attend the Emergency Department (A&E) of your local hospital where you will be assessed by the on call team. In occasional cases you may need admission to hospital.
Depending on what stage your pregnancy is at, you may see recognisable tissue within the blood that you pass. This tends to be whitish in appearance and more fluid in structure. This can be quite distressing. You can bring the tissue to us at the Early Pregnancy Clinic and the nurse can explain the options available. It is also ok not to see anything or wish to take any further action.
After passing the tissue the bleeding normally settles down quite quickly. In most cases it settles to light bleeding and then staining. The bleeding should stop completely with 5-10 days. If this had not happened please contact us. We will recommend a pregnancy test two weeks after the bleeding has stopped. We realise this may be difficult to do however, it is important for you and us to know that the pregnancy hormones are settling.
At the early pregnancy unit we are aware this may be a frightening time but we want you to know you are not going home unsupported. Our clinic is open 7 days a week and we have a phone line (028 9598 8085) through which you can leave a message and we will endeavour to return your call as soon as possible.
Further info:
https://www.rcog.org.uk/en/patients/patient-leaflets/early-miscarriage/
https://www.aepu.org.uk/useful-links/
Support groups:
https://www.miscarriageassociation.org.uk/
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Medical management of miscarriage
We understand that reading this information can be very difficult, as you have been given the very sad news that your pregnancy is not progressing. Our hope is to explain the process of medical management of your miscarriage and the benefits, risks and what you can expect.
What is medical management?
Sometimes the symptoms of a miscarriage are not immediately obvious. You may have had a scan that showed that the pregnancy stopped developing some time ago. Alternatively, your scan may show that a miscarriage has started but some of the pregnancy remains inside the womb. Instead of waiting for the miscarriage to happen naturally (Expectant management of miscarriage), medical management uses a medication called misoprostol to speed up the process. It is a safe procedure carried out in the early pregnancy unit by one of our nurses. Misoprostol works by preparing your cervix and helping your womb contract to speed up the process of miscarriage.
What are the benefits?
- You are more in control of your treatment and get to manage the process at home.
- If successful, medical management avoids surgery and general anaesthetic.
- The risk of infection is low.
- Medical management is successful in about 80-90% of cases.
What are the risks?
- Bleeding can be heavy and you will pass clots. Although rare, if bleeding is too heavy and you become anaemic, you may require a blood transfusion.
- The process of miscarriage can be painful. Most women have strong period-like pain and cramps and can find the process very painful, especially as the pregnancy is expelled.
- The tablets do not work for everybody. They fail to work in 10-20% of women. The doctor or nurse looking after you will help advise you about your likelihood of success.
- If the treatment does not completely empty the womb, there is a risk that hospital admission or surgery (Surgical management of miscarriage) may be required.
- Bleeding can continue for up to 3 weeks after the treatment and some women may need several follow-up scans to monitor progress.
Giving your consent.
If you decide to go ahead with the treatment you will be asked to sign a consent form. This states that you agree to the treatment and understand what it involves.
What happens during medical management?
The treatment involves the administration of 4 tablets (Misoprostol) orally or vaginally. Pain and bleeding usually occur within 2-4 hours. Heavy bleeding with clots is to be expected and it is not unusual to soak four to six pads in the first hour. Most women experience strong cramps and abdominal pains until the pregnancy tissue has passed, which may take 3-4 hours then they will ease off quite quickly.
Some women find that it may take a few hours for bleeding to begin, even if they are experiencing pain. If bleeding has not started within 48 hours of taking the Misoprostol a second dose of the tablets may be required.
Pain medication such as paracetamol, ibuprofen, or codeine can be taken as needed.
Are there any side effects of the medication?
- Nausea and vomiting may occur but should resolve within 2-6 hours.
- Diarrhoea may occur but should improve within a day.
- A skin rash may occur.
- Dizziness may occur.
When should I contact a health professional?
- If you have very heavy bleeding that does not seem to be getting less.
- If you are in significant pain even after taking pain medication.
- Raised temperature, flu –like symptoms, vaginal discharge that looks or smells bad.
- Continuous bleeding for more than 2 weeks.
If you feel faint or any of the above symptoms you must attend your nearest emergency department.
General advice
- Use sanitary pads not tampons to lessen the chance of infection.
- Don’t have intercourse until the bleeding has stopped, this allows the cervix to close and reduces the risk of infection.
- Wait for at least one period before trying for a new pregnancy.
- Continue taking folic acid and vitamin D if you are going to try to get pregnant in the near future.
- Do a pregnancy test to confirm a negative result 2 weeks after your bleeding has stopped.
How you might feel after medical management?
It is normal to feel tired after a miscarriage, both due to physical symptoms and the emotional impact of the miscarriage. Miscarriage can cause a range of emotions for you and your partner. These may include anger, guilt, frustration, despair and feelings of loss and extreme sadness.
There are various support services from The Miscarriage Association available online including information leaflets, online forums and telephone advice.
Further info:
https://www.rcog.org.uk/en/patients/patient-leaflets/early-miscarriage/
https://www.aepu.org.uk/useful-links/
Support groups:
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Surgical management of miscarriage
Surgical management is one of 3 ways that a missed or incomplete miscarriage can be managed.
It involves having a procedure to remove the pregnancy from the womb with a suction device. This can be done under or a general anaesthetic, or with local anaesthetic (see Manual Vacuum aspiration (MVA)). This usually happens a few days after a miscarriage has been diagnosed but may need to be done sooner if you are bleeding heavily or have signs of infection.
If the surgery is done under general anaesthetic you will be admitted to hospital for this –usually the day surgery unit. If you chose to have it done under local anaesthetic (MVA) it will be performed in the early pregnancy clinic by one of the doctors.
Before the surgery you may be given tablets to take or vaginal pessaries to soften the neck of the womb (cervix). Your cervix will be gently opened using fine probes called dilators and the suction device is introduced into the womb to remove any remaining pregnancy tissue.
If you are Rhesus negative blood type you might need an Anti D injection depending on the stage of your pregnancy.
Are there any risks with the surgery?
The surgery is safe but there are small risks with the procedure
- Bleeding heavily.
- Infection
- Damage to the womb or cervix.
- Adhesions inside the womb (scar tissue).
The risk of infection is the same with medical management of miscarriage (tablets) or surgical management.
Is the surgery always successful?
- Yes in 95% of cases.
How long will I be in hospital for?
- You should be able to go home the same day.
What should I expect afterwards?
- You will be sleepy after the anaesthetic and shouldn’t drive home.
- You will have bleeding like a heavy period for about 2 days and it should stop gradually over the next 2 weeks.
- A few cramps for which you can take paracetamol.
- You can shower or bath as normal.
- You should stay mobile and drink plenty of water after your operation.
Based on Tommy’s Pregnancy information 2020
https://www.rcog.org.uk/en/patients/patient-leaflets/early-miscarriage/
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Manual Vacuum Aspiration
What is Manual Vacuum Aspiration (MVA)?
MVA is an alternative to going to theatre for surgical management of a miscarriage if you wish to avoid a general anaesthetic and the delays associated with this. It is performed in an outpatient setting under local anaesthetic and you will be awake throughout. The advantages over surgical management under general anaesthetic are that you will experience less drowsiness and nausea from the anaesthetic, have a planned appointment time, a shorter hospital stay, and you can eat and drink normally before and after the procedure. The success rate and risks are the same as for having the procedure performed in theatre (Surgical management of miscarriage).
Alternatively you may wish to choose to wait for the tissue to pass naturally (Expectant management of miscarriage), take tablets to help you miscarry (Medical management of miscarriage), or have the procedure under general anaesthetic. The early pregnancy staff will be able to help you with this decision.
What does a MVA involve?
The procedure will be explained to you by the doctor or specialist nurse and you will have to sign a consent form. A blood test will be taken to check your blood group and your pulse, blood pressure and temperature taken. You may have another vaginal scan to confirm that pregnancy tissue is still present. A medication called misoprostol will be prescribed for you to take 2-3hrs before the procedure and a time given for you to come back. Misoprostol helps to soften the cervix (neck of the womb) and makes it safer to insert the suction tube into the womb. It can cause nausea, vomiting, diarrhoea, abdominal pain, headache, hot flushes and an unpleasant taste in the mouth. You will be asked to take painkillers such as paracetamol, ibuprofen or codeine approximately 1hr before the procedure.
The procedure itself takes only a few minutes but you will be on the couch for a bit longer (around 15-20 minutes). A doctor or specialist nurse will insert a speculum (similar to that used in a smear test) and apply local anaesthetic. The cervix may be opened a little and a plastic tube connected to a gentle suction device will then be inserted in to the womb to remove the pregnancy tissue. You may feel some discomfort similar to crampy period pain. You can request that the procedure is stopped at any time. The doctor or nurse may use an abdominal or vaginal scan at different times during the procedure. We can provide Nitrous oxide (known as gas and air) to help with pain relief. Some patients prefer to listen to music or use their phone as a distraction. You may need a further scan to ensure the womb is empty at the end of the MVA.
What happens after the MVA?
We will recheck your blood pressure and pulse and ensure that your bleeding is satisfactory. If your blood group is rhesus negative we will offer an injection of anti-D. We would ask that you stay for a short while after the procedure to ensure you are well enough for discharge and that you have passed urine. We would recommend that someone escorts you home.
You can expect some bleeding after the MVA which will usually settles within 7 days but can continue for up to 14 days. Crampy abdominal pain can occur at home but will usually be controlled with simple over-the-counter painkillers.
We recommend that you avoid sexual intercourse and don’t use tampons until your bleeding has stopped to reduce the risk of infection. You may return to work when you feel able.
If you experience any fever, dizziness, offensive vaginal discharge, very heavy bleeding or severe abdominal pain please contact your GP or the early pregnancy unit on (028) 9598 8085.
If you feel very unwell or any of these symptoms become severe, please attend A&E. Do not go directly to the clinic as there may not be a doctor or nurse there to look after you.
Further info:
https://www.aepu.org.uk/useful-links/
Support groups:
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Pregnancy of unknown location (PUL)
What is a pregnancy of unknown location?
This is a condition in which you have a positive pregnancy test but we have been unable to see your pregnancy on a vaginal (internal) scan. PUL can be a confusing diagnosis and there are three possibilities as to what could be happening:
- Your pregnancy may be very early and is too small to be seen on scan. It is normal not to see a pregnancy on scan until around 6 weeks. This is especially common if you have an irregular cycle or you have attended before 6 weeks.
- You may have already miscarried. This is more likely if you have attended the clinic with bleeding. The pregnancy hormone levels can be raised for a few weeks following a miscarriage which will make a pregnancy test remain positive.
- You may have an ectopic pregnancy. This is when a pregnancy is located outside the womb, usually in one of the fallopian tubes.
What will happen now?
We will need to take some blood tests including your pregnancy hormone levels (called beta hcg). We will need to repeat the hcg test 48hours after the initial test to see how much the pregnancy hormone level increases or decreases over this time. You will usually be able to go home and will be given a time to come up for the second test. A scan may be performed at this second appointment. It is very important that you return to the clinic for this second test.
When will I know what is happening?
We may have an answer for you after the second appointment but occasionally women will need multiple appointments and blood tests to determine what is happening with their pregnancy. A specialist nurse or doctor will contact you by phone to tell you a likely diagnosis and what to do next, or you may be asked to return for further blood tests and scan.
If an early pregnancy is suspected then we will usually arrange a repeat scan in 1-2 weeks to allow time for the pregnancy to grow so that it can be seen on scan.
If a miscarriage is suspected we would normally advise you to do a home pregnancy test in 2-3 weeks which we would expect to be negative. If it is positive you should phone the early pregnancy clinic for advice. If sadly you have miscarried then we will ensure that you have information for support and advice.
If an ectopic pregnancy is suspected we will ask you to attend again for a senior doctor to review your case and discuss further management with you.
What should I look out for while I am waiting?
You should contact the early pregnancy clinic on (028) 9598 8085 if you experience any of the following:
- Vaginal bleeding – heavier than a normal period or passing large clots.
- Abdominal pain – any pain that keeps getting worse or does not go away with simple painkillers.
- Feeling faint or dizzy – especially on standing up.
- Pain in your shoulders.
- Pain in your vagina or back passage.
If you feel very unwell or any of these symptoms become severe, please attend A&E. Do not go directly to the clinic as there may not be a doctor or nurse there to look after you.
Further information:
https://www.rcog.org.uk/en/patients/patient-leaflets/ectopic-pregnancy/
https://www.rcog.org.uk/en/patients/patient-leaflets/early-miscarriage/
https://www.ectopic.org.uk/wp-content/uploads/EPT-Pregnancy-of-Unknown-Location-A5-leaflet.pdf
https://www.aepu.org.uk/useful-links/
Support groups:
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Ectopic Pregnancy
An ectopic pregnancy is when a fertilized egg implants itself outside of the womb, usually in one of the Fallopian tubes. In the UK, around 1 in every 90 pregnancies is ectopic. This is around 11,000 pregnancies a year.
Symptoms can include a combination of:
- a missed period and other signs of pregnancy .
- tummy pain low down on 1 side .
- vaginal bleeding or a brown watery discharge .
- pain in the tip of your shoulder .
- discomfort when going to the toilet.
In a few cases, an ectopic pregnancy can grow large enough to split open the Fallopian tube. This is known as a rupture.
Signs of a rupture include a combination of:
- a sharp, sudden and intense pain in your tummy .
- feeling very dizzy or fainting.
- feeling sick .
- looking very pale .
- shoulder tip pain.
- If you have any of these symptoms you should attend an Emergency Department.
There are 3 main treatments for an ectopic pregnancy:
- Expectant management – you’re carefully monitored with blood tests. Often early ectopic pregnancies will dissolve on their own. (Expectant management of ectopic pregnancy)
- Medication – an injection of a medicine called methotrexate is used to stop the pregnancy growing. (Medical management of ectopic pregnancy)
- Surgery – keyhole surgery (laparoscopy) is performed under general anaesthetic to remove the fertilized egg, usually along with the affected Fallopian tube. (Surgical management of ectopic pregnancy)
You will be told about the benefits and risks of each option. In many cases, a particular treatment will be recommended based on your symptoms and the results of the tests you have.
Some treatments may reduce your chances of being able to conceive naturally in the future, although most women will still be able to get pregnant.
Information based on :
https://www.nhs.uk/conditions/ectopic-pregnancy/
Further info:
https://www.rcog.org.uk/en/patients/patient-leaflets/ectopic-pregnancy/
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Expectant management of Ectopic Pregnancy
The term ‘expectant management’ of ectopic pregnancy means watching and waiting to see if your body will remove the ectopic pregnancy itself.
Expectant management is most effective in the earlier stages of pregnancy, usually when the pregnancy hormone ‘beta hCG’ level is below 1000 mlU/ml. In pregnancies with levels higher than this there is a higher risk that the ectopic pregnancy will cause a rupture of the fallopian tube if not treated. In these cases medical management of ectopic pregnancy or surgical management of ectopic pregnancy may be recommended by the doctor.
It is well known that many early ectopic pregnancies will resolve or go away on their own even if they are visible on scan. This management has been developed to avoid medical treatment and surgery. However, it does require careful monitoring and follow- up. This means that you will have to attend the hospital regularly for blood tests to monitor your hCG levels until the tests are negative which can take several weeks. Your hCG levels will be tested every 48 hours initially. Hormone levels can rise initially or stay static for a while which is OK as long as you have no pain and feel well.
Who can go for this type of management?
You need to be pain free with a level of hCG less than 1000 and willing to attend for several blood tests to have this type of management. This can sometimes take a few weeks.
What are the risks?
Occasionally an ectopic pregnancy can rupture despite low hCG levels. Report to your nearest emergency department if you develop severe pain or feel unwell.
What else do I need to know?
You should not do any heavy lifting or housework until the hCG levels are dropping consistently and should only undertake gentle exercise, such as walking, until the hCG is at non-pregnant level.
You should avoid sexual intercourse until your hCG is at non-pregnant level.
Most people take time of work initially and do not return to work once the hCG levels are falling consistently.
Further info:
https://www.rcog.org.uk/en/patients/patient-leaflets/ectopic-pregnancy/
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Medical management of Ectopic Pregnancy
The term ‘medical management’ of ectopic pregnancy means using a drug called methotrexate.
This drug stops the pregnancy developing any further and the pregnancy is gradually reabsorbed by the body leaving the fallopian tube intact.
Methotrexate is most effective in the earlier stages of pregnancy, usually when the pregnancy hormone ‘beta hCG’ level is below 5000 mlU/ml. In pregnancies with levels higher than this there is a higher risk that the ectopic pregnancy will cause a rupture of the fallopian tube despite treatment with methotrexate.
The treatment is given by means of an injection. The dose is calculated according to your height and weight. Before the injection, blood tests are done to check liver and kidney function and to ensure that you are not anaemic.
This method has been developed to avoid surgery. However, it does require careful monitoring and follow- up. This means that you will have to attend the hospital regularly for blood tests to monitor your hCG levels until the tests are negative which can take several weeks. Your hCG levels will be tested on the day that the medication is given, again on day 4, and on day 7 after the injection.
A few days after the injection, it is usual to begin to bleed and this bleeding can last between a few days and up to 6 weeks.
Every 3-7 days, beta hCG levels will continue to be monitored to ensure that they are falling appropriately. Most women only need one injection but in up to a quarter of cases a further injection may be required if beta hCG levels are not decreasing.
What are the risks?
Occasionally an ectopic pregnancy can rupture despite low hCG levels. Report to your nearest emergency department if you develop severe pain or feel unwell.
What are the side effects?
The most common side effects of Methotrexate are:
- Crampy abdominal pain and it usually occurs during the first 2 to 3 days of treatment. Please inform the early pregnancy staff if pain is severe.
- Fatigue- many people feel very tired during treatment.
- Vaginal bleeding or spotting.
- Nausea, vomiting, and indigestion.
- Light-headedness or dizziness, this can be a sign of rupture so please inform the early pregnancy clinic.
What can I do to help the treatment work?
It is important not to take any folic acid supplements as it can delay the effects of the medication.
You should not do any heavy lifting or housework until the hCG levels are dropping consistently and should only undertake gentle exercise, such as walking, until the hCG is at non-pregnant level.
You should avoid sexual intercourse until your hCG is at non-pregnant level.
Most people take time of work initially and do not return to work for at least two weeks while the treatment begins to work.
In the first week it is important to avoid painkillers which fall into the anti-inflammatory group such as ibuprofen. The preferred painkiller is paracetamol, and you should refrain from drinking alcohol until your hCG is at non-pregnant level.
Further info:
https://www.rcog.org.uk/en/patients/patient-leaflets/ectopic-pregnancy/
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Surgical management of Ectopic Pregnancy
An operation to remove an ectopic pregnancy will involve a general anaesthetic and admission to hospital. There are two types of surgery that may be performed:
- Laparoscopy (otherwise known as keyhole surgery). Your stay in hospital is shorter: 48-72 hours.
- Laparotomy (known as open surgery). This is done through a larger cut in your tummy and may be needed if internal bleeding is suspected. You will need to stay in hospital for 2-4 days and it will take approximately 6 weeks to recover.
The aim of surgery is to remove the ectopic pregnancy. The type of operation performed depends on your wishes, your fertility plans and the advice of your surgeon after the ultrasound.
What does a laparoscopy involve?
- Small cuts are made in your tummy – up to 4 in total.
- A telescope is inserted through a cut at your belly button
- Your Fallopian tubes and ovaries can be seen with this telescope in order to look for the ectopic pregnancy.
To have the best chance of a future pregnancy inside the womb and a lower chance of another ectopic pregnancy you will be advised to have the affected fallopian tube removed (salpingectomy).
If you only have one tube or the other tube looks unhealthy you may be advised to have a salpingotomy. This aims to remove the pregnancy without removing the tube. It carries a higher risk of ectopic pregnancy in the future. After salpingotomy you will need followed up with blood tests to check that all pregnancy tissue has been removed. The decision to perform a salpingotomy or salpingectomy can sometimes only be made during the operation.
What are the benefits of laparoscopic surgery?
- The operation is less painful.
- You will recover more quickly.
- Your scars will be multiple but small.
What are the risks?
- Overall risk of a serious complication is 2 in 1000.
- Damage to the bowel, bladder or major blood vessels (4 in 1000 risk).
- Infection or bruising around the wounds.
- Formation of a hernia at the wound site.
- Uterine perforation (small hole) (1in 100).
- Change of operation to open surgery (1 in 200).
The risks are higher if you are very overweight, very thin or have had previous abdominal surgery.
What about future pregnancies?
Your risk of developing another ectopic pregnancy will be slightly higher than in someone who has never had an ectopic pregnancy before. You should book in to have an early scan in your future pregnancies to ensure that the pregnancy is inside the womb.
Based on:
www.guysandstthomas.nhs.uk/leaflets
Further info:
https://www.rcog.org.uk/en/patients/patient-leaflets/ectopic-pregnancy/
https://www.aepu.org.uk/useful-links/
Support groups:
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Recurrent Pregnancy Loss
Experiencing a pregnancy loss (miscarriage) can be very distressing. If this occurs several times, the impact on you and your partner can be devastating.
What is recurrent pregnancy loss?(also known as recurrent miscarriage)
Recurrent pregnancy loss affects 1 in 100 (1%) couples trying to have a baby. Your healthcare professional may diagnose recurrent pregnancy loss after the loss of two or more pregnancies. You will normally be referred to a clinic following the loss of two or three pregnancy losses for further assessment. Tests will be organised before your appointment, via the early pregnancy service. This will depend on your age, how far along your pregnancy was and other factors such as any health problems you have or that run in your family.
What increases the risk of recurrent pregnancy loss?
Unfortunately, in over half of women who experience recurrent pregnancy loss no risk factors or cause may be found. Most couples are likely to have a successful pregnancy in the future, particularly if test results are normal. Some factors that may increase the risk of recurrent pregnancy loss are:
- Age – increasing age is the most significant risk factor for pregnancy loss. If the woman is aged over 40, more than 1 in 2 pregnancies end in a miscarriage. Miscarriages may also be more common if the father is older.
- Lifestyle factors – including being overweight, excessive alcohol or caffeine consumption, and smoking.
- Underlying medical conditions – pre-existing medical conditions, for example thyroid disorders, diabetes or conditions that affect your blood such as antiphospholipid syndrome (APS).
- Anatomical abnormalities – sometimes there may be a physical abnormality such as the shape of the womb or a problem with the cervix that increase the risk of pregnancy loss in second trimester (the middle three months of pregnancy).
- Genetics – In a small number of couples, one partner may have an inherited abnormality that can increase the risk of recurrent pregnancy loss.
- Unexplained recurrent pregnancy loss – This can be challenging and difficult to process. However, research has found that for most couples where no cause was found, a successful birth was more likely with supportive care in their next pregnancy. This usually involves increased support and contact with your clinical team.
What tests might be undertaken?
- Blood tests – to check for antiphospholipid syndrome, thyroid problems, genetics, vitamin D, hormone levels, rubella immunity among others.
- Anatomy assessment – This often involves an internal ultrasound to look at the shape of the womb. Your specialist may also suggest other assessments depending on your individual situation.
- Tests for male partners – your specialist may suggest some tests for your partner following your assessment.
- Genetic testing of pregnancy tissue – This is not always possible but may help to determine your chance of miscarrying again. This is usually only offered after 3 pregnancy losses.
There are several tests that are not usually recommended but you may have heard about online or from another source. You will not be offered these as there is no or very limited evidence that the tests help or will result in a treatment that will reduce the risk of pregnancy loss. Occasionally these tests may even be harmful. As research findings emerge about new treatment the information may change about certain tests and this should be discussed with your specialist.
Treatments for recurrent pregnancy loss
Recurrent pregnancy loss is a growing clinical and research area. Currently there is very limited evidence to support specific treatments. It is important to note that if a cause or risk factor is identified, this does not necessarily mean there is an available treatment to reduce your risk of a further pregnancy loss
A healthy diet and exercise which contribute to a healthy weight, avoiding smoking and limiting alcohol are all advised.
All women with recurrent pregnancy loss will be offered:
- Progesterone – recent evidence has suggested that this hormone may be beneficial if given early in pregnancy.
- Supportive care in the next pregnancy, including additional reassurance ultrasound assessment.
In some individual circumstances possible treatment that may be offered include:
- Heparin and aspirin if you are diagnosed with antiphospholipid syndrome.
- Medication to correct your thyroid hormone levels if you are diagnosed with a thyroid gland problem.
- If you are diagnosed with a weakness in the cervix (opening of the womb) you may be offered additional monitoring or treatment in future pregnancies.
- Referral for genetic counselling – You may be referred to a specialist if either you or your partner has a chromosome abnormality who will discuss with you what your chances are for future pregnancies and will explain what your choices are. This is known as genetic counselling.
- Surgery to the womb – if an abnormality is found in your uterus.
- Referral to another centre in the UK for additional advice may be recommended for a small number of couples.
For further information and support, please visit:
https://www.publichealth.hscni.net/publications/recurrent-pregnancy-loss
https://www.rcog.org.uk/en/patients/patient-leaflets/recurrent-and-late-miscarriage/
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Molar Pregnancy
Molar pregnancy (also called hydatidiform mole) is where a fetus doesn’t form properly in the womb and a collection of abnormal cells grow instead.
A complete mole is when there is no fetus and just the abnormal cells.
A partial mole is when a fetus starts to form as well as the abnormal cells. This fetus cannot develop into a healthy baby because it has a complete set of extra chromosomes.
Symptoms of a molar pregnancy
Sometimes there are no signs. Some women will have irregular bleeding or severe morning sickness. The tummy may be unusually swollen. These symptoms are fairly common in pregnancy and aren’t necessarily a sign that anything is wrong with your baby. Sadly a molar pregnancy will not result in a baby.
Treatment for a molar pregnancy
If a scan shows you have a molar pregnancy, a procedure to remove it will be recommended. This will normally be done by suction removal, where a thin tube is passed into your womb through your vagina. This can be done under local anaesthetic with gas and air (Manual Vacuum Aspiration) or under a general anaesthetic (Surgical management of miscarriage) depending on your preference. Medication may be used to soften the neck of your womb prior to the procedure. Most women are able to go home after the procedure. The tissue removed at the procedure will need to be examined in a laboratory to confirm the diagnosis.
Follow up
Women who have had a molar pregnancy are registered with a specialist centre for follow up. All women with molar pregnancies in Northern Ireland are referred to Charing Cross Hospital in London for monitoring. You don’t have to attend the hospital but they will ask you to post blood or urine samples to them to test. Follow-up involves measuring the pregnancy hormone HCG either in blood or urine samples. Follow up can last for up to 6 months depending on how quickly the hormone levels return to normal. If the levels are falling no further treatment is necessary. If the levels are not returning to normal further treatment may be necessary.
Trying for another pregnancy
Having a molar pregnancy doesn’t affect your chances of getting pregnant again and the risk of having another molar pregnancy is small (about 1 in 80). It is best not to try for a baby until all the follow up is complete. Your doctor will discuss and advise on the use of contraception if required.
It can take time to recover emotionally from a molar pregnancy. Talking with family and friends about how you feel may be helpful. There are counselling services available and support groups such as the Molar Pregnancy Support Group.
Charing Cross website: www.hmole-chorio.org.uk
https://www.rcog.org.uk/en/patients/patient-leaflets/gestational-trophoblastic-disease-gtd/
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Referrals Source
Referrals are accepted from:
- GPs
- The Emergency Department
- Midwives
- Other health care professionals.
We also have a telephone answer machine service which can be used for self-referrals (028) 9598 8085.
You can call this number and leave your details and a nurse will be in contact with you as soon as possible. Nursing staff are with patients every morning and so will usually answer these calls after lunch when the clinic is finished. You will be triaged over the phone and a decision will be made as to whether an appointment is required. The majority of women will not require a scan or an appointment and are supported with advice as to how best manage things at home.
Contact Details
Early Pregnancy Unit
Ward 4E
Acute Services Block
Ulster Hospital Dundonald
Upper Newtownards Road
Belfast
BT16 1RH
(028) 9598 8085