An Early Pregnancy Unit in the United States: An Effective Method for Evaluating First-Trimester Pregnancy Complications.

Abstract

In the United Kingdom, early pregnancy assessment clinics have existed since the early 1990s and have become the reference standard for evaluating and treating women with first-trimester pregnancy complications. These units have now been established in many countries and have been found to be effective and efficient, saving money and unnecessary emergency department visits and hospital admissions. To our knowledge, no such model has been described in the United States. A PubMed search using a combination of "early pregnancy unit," "early pregnancy assessment clinic," and "United States," "U.S.," and "America" on May 14, 2017, yielded no results. Denver Health, a safety net hospital in Denver, Colorado, has established the first known early pregnancy unit in the United States. Patients with positive urine pregnancy test results who are in their first trimester by best estimation, have not had a prior ultrasound examination, and present to their primary care providers with pain, bleeding, history of an ectopic pregnancy, history of a tubal ligation, or conception with an intrauterine device in place are eligible to be evaluated in the early pregnancy unit. This article describes our clinical setup, methods, and findings in the first 2 years of the unit's inception with the intention of serving as a model for the establishment of more early pregnancy units throughout the United States.