P6 - An Audit of the Early Pregnancy Assessment Service: A retrospective cohort Study

Abstract

The Early pregnancy Assessment Service (EPAS) was implemented in 2008 at the Liverpool Hospital, NSW. EPAS opens daily assessing and providing care for women presenting with pain and/or vaginal bleeding in early pregnancy. Women with hyperemesis, medical issues such as diabetes, blood pressure, etc or requiring termination of pregnancy are not seen in this service. 1. Length of time women spend in the EPAS aid in the management of staffing and service operations 2. Provide consistent management for outcomes of the current pregnancy. 3. The optimal management for a miscarriage will reflect the woman’s preferred choice, mental health, gestation age, and best practice 4. All women will have a follow up plan after presenting to the EPAS. 1. Women seen in EPAS over a 1 year period (1/1/2018-31/12/2018) 2. Data was extracted from the electronic medical record and paper records of the clinic. 3. Data collected included demographic, background medical and pregnancy histories, gestational age, vaginal bleeding present at initial visit, outcome of current pregnancy, management undertaken, days spent in EPAS, representations to the Emergency Dept. 4. Data was analyzed using SPSSv 26. A total of 966 women were assessed; majority at 9 (7-10) weeks; were 32.2 (28.9-37.9) years of age with 40.7 of women born overseas, and 25.7% from culturally and linguistically diverse (CALD) population. Women presenting for one or more miscarriage accounted for 39% of EPAS presentation, of those women; 18.7% had previous cesarean section; 18.3% had pre-existing co-morbidity; Women presented mostly at 10(7-12) weeks with vaginal bleeding. Over all EPAS presentation; 63% were miscarriage, 30% were found to have a viable pregnancy, 4.3% had an ectopic diagnosed, 0.9% had a molar pregnancy diagnosed. 331 pregnant women has managed by conservative treatment (38.9%), 130 women by medical management (15.3%), and 176 women managed by surgical method (20.7%). 86% of either conservative/medical management (461) being successful, 11.8% of either method failed. The study examined the Early Pregnancy Assessment Service (EPAS) clinic in 2018. Total 966 patients have visited through EPAS. Treatment via EPAS is effective but requires significant time for assessment and follow up visits depending on the gestation presented and management option chosen. Women would find this information helpful when making an informed decision for their preferred care pathway. This would result in higher patient satisfaction. Women with recurrent miscarriage may need improved referral for follow-up and assessment.