1 Early pregnancy – models of healthcare

Introduction Early pregnancy problems form a major part of all gynecological emergencies. In the past, patients were admitted to the emergency receiving ward and waited for a considerable length of time before undergoing ultrasound scan and clinical assessment. With the appearance of early pregnancy assessment units (EPU), an increasing number of women are being assessed and managed as outpatient or office attenders. The advent of high-resolution transvaginal ultrasound coupled with the improved access to hCG measurements has allowed the development of models of care and improved delivery of care. Within the UK the growth of EPU numbers has increased to the extent that over 200 active units are registered with the Association of Early Pregnancy Units (AEPU). The AEPU has set out, since it’s inception in 2001, to improve the standards of early pregnancy care and to provide a clearer pathway for the patient’s journey (earlypregnancy.org.uk). In recent years ultrasound diagnosis and improved understanding of problems related to early pregnancy have led to the introduction of medical and expectant management of miscarriage and selected cases of ectopic pregnancy. Randomized controlled trials have provided evidence-based practice (rcog.org.uk/guidelines). Patient choice has emerged as a powerful selector for treatment. The mission statement from the Association of Early Pregnancy Units has the patient at the center of all activity and the multidisciplinary care structure reflects the multitasking approach of care providers.