Early Pregnancy Unit

If you are experiencing pain and or vaginal bleeding you can ask for a referral by contacting your GP, NHS 111, midwife or a NHS healthcare professional who is providing you care. Referrals are reviewed Monday to Friday, once we receive your referral you will be contacted within 48 hours to arrange an appointment. In the event that we cannot reach you we will leave a voicemail message. 

The clinic is open Monday to Friday (excluding bank holidays) from 8am – 5pm. Out of hours advice can be obtained by calling our number 01183227181 this will be managed by the Inpatient Sonning Ward . 

When entering from Craven Road steps or ramp, take the lifts to the fifth floor and right out of the lifts. If coming from the main hospital pass the maternity ultrasound scanning department and go left at the double doors past the stairwell and then take the lift to the fifth floor. 

If you are concerned about pain or vaginal bleeding when the clinic is closed please contact your GP or NHS 111. If you experience any of the following symptoms go immediately to our or your nearest Emergency Department or call 999. 

• Heavy vaginal bleeding (soaking two or more sanitary pads per 30mins to an hour)
• Passing large clots or pregnancy tissue
• Sudden or severe abdominal or pelvic pain
• Pain in your shoulder tip
• Dizziness, fainting or collapse
• Fever, chills or generally feeling unwell. 

Our staff at the Emergency Department are all trained to treat you with respect and dignity but please be aware that other life threatening situations that need our immediate attention, may mean that you are waiting in the public waiting room for some time. Our staff in the Emergency Department do not have access to scan facilities but can help manage any pain and offer advice while we wait to admit you onto the wards if needed

Vaginal bleeding and/or cramping pain in the early stages of pregnancy are common and do not always mean that there is a problem. However, bleeding and/or pain can be a warning sign of a miscarriage or less commonly, of other complications of early pregnancy. Sadly, if the bleeding is because the pregnancy is miscarrying, it is very unlikely indeed that anything can be done to stop this. There are different types of miscarriage. 

A threatened miscarriage:

If you have had bleeding and/or pain but your ultrasound scan confirms that your pregnancy is progressing normally, this is known as a ‘threatened miscarriage’. Sometimes sadly these pregnancies do go on to have a miscarriage.

A missed miscarriage:

This can happen without any pain or bleeding, when your baby dies but you still feel pregnant and continue to have pregnancy symptoms. This type of miscarriage is often discovered during a routine ultrasound scan as part of antenatal care. It can come as a real shock, especially if you had no idea something was wrong.

An ectopic pregnancy:

When a pregnancy starts to grow outside the womb, it is called an ectopic pregnancy. In the UK, one in 90 pregnancies is ectopic. 

A pregnancy of unknown location (PUL):

When you have a positive pregnancy test and your pregnancy cannot be seen clearly on ultrasound scan, it is known as PUL. This can happen with very small early pregnancies, miscarriages that have occurred before the scan takes place or ectopic pregnancies too small to see. 

A molar pregnancy:

This is an uncommon condition where the placenta is abnormal and the pregnancy does not develop properly. It affects only one in 700 pregnancies. 

During a miscarriage you are likely to experience strong ‘period type’ pain and heavy bleeding, sometimes with clots. Bleeding can continue for around 3 weeks, in a complete miscarriage, this will then end once your uterus is empty. We call this ‘conservative management’. Sometimes it is necessary to, or you can choose to, have the miscarriage managed medically or surgically, in a number of ways. This can also be the case if your body retains some of the pregnancy and needs help to complete the miscarriage. The team caring for you can advise which option may be best suited to your individual circumstances but below are links to explain each option. We know these terms sound very medical and we are sorry if they don’t reflect the emotional importance of what you are experiencing. 

Conservative management    

Medical management of miscarriage

Surgical Management

Manual Vacuum Aspiration

ERPC

We would like to make you aware that we run a triage system much like the Emergency Department so we can prioritise those who are seriously unwell so you may have to wait after your appointment time if we have to deal with an emergency. We will keep you updated so you know how long you are likely to wait.

When you arrive at the unit you will be booked in by a receptionist who will confirm your details. We will require a urine sample so the receptionist will provide you with a sample container. There is a water fountain in waiting room 2, if you need to drink some water to help with providing a sample. We will be testing your urine for infection and the presence of the pregnancy hormone. You will initially be seen by one the nurse, who will ask you questions about why you have attended the clinic, assess your condition. You will have your observations recorded such as blood pressure and pulse. You will be asked to wait in the waiting room for an ultrasound scan.
 
The scan will be carried out by a sonographer or a specialist Doctor. The pregnancy ultrasound may include an abdominal ultrasound (external) and vaginal ultrasound (internal). Both scans are safe in pregnancy and will not cause harm to your pregnancy. 

If required, you will then have a further review which may include a blood test for pregnancy hormone (HCG) levels. You will be seen by a specialist nurse or doctor who will be able to answer any questions.  You may need more than one follow up appointment to get a final diagnosis. 

If you have been sadly informed about a miscarriage the team will have a discussion with you about management options available. This will be the same options as stated above on the section (Management of miscarriage options). 

The team caring for you will speak to you about your options, any follow up appointments that might be available. They’ll also discuss how you wish to have the pregnancy tissue or your baby’s remains to be managed. This sensitive topic is discussed in this leaflet. You can get a certificate to commemorate your baby, for free, from the government website.

A miscarriage can have emotional impact, not only on the person experiencing the miscarriage but their partner, and those they are close with. This can happen immediately after the miscarriage or weeks later. The most common emotions that are felt after a miscarriage are grief and bereavement. They can cause physical and emotional symptoms such as tiredness, loss of appetite, depression and difficulties in concentrating and sleeping. 

We have local charities who can support you, and national resources available to everyone (see Support below). Your GP can also refer you or you can self refere to Talking Therapies or for additional mental health support as needed.

If you are wanting to get pregnant again we suggest waiting till you feel emotionally and physically ready to have sex and ideally waiting till your periods have returned.

The Tommy’s website has more information about tests that look at your vitamin D levels, thyroid function, general fertility and fibroids or other pre-existing conditions. It also has a resource about the benefits of progesterone in early pregnancy.

Progesterone
Tests that are possible

If you have had three miscarriages in a row there are additional tests we can offer and you will be referred to our Recurrent miscarriage clinic. Once you are part of the clinic you may be offered reassurance scans in any future pregnancies. We are sorry that you have to experience something so devastating three times before these are available to you.

We wish to offer our sincerest condolences, and to help you through this difficult time. Our team recognise that this can be a painful and complex journey, and aim to provide emotional and practical support to families during this time. We know this can sometimes feel inadequate but there are local organisations that can also offer support and national resources with staffed helplines, peer support and community. 

Willows Support Group have in person and virtual support available and run Remembrance Services throughout the year. They help organise our Wave of Light which happens each October to remember our babies.

Tommy’s have a Miscarriage Support Tool and a Wellbeing After Miscarriage Programme. Both share experiences of how others have felt at this difficult time which may offer comfort and advice.

The Miscarriage Association have a lot of information you may find useful, including a resource for partners -  Partners Page and information about your rights when returning to work .

The Ectopic Pregnancy Trust focuses on early pregnancy loss through ectopic pregnancy. They are the leading charity focusing on ectopic pregnancy in providing such extensive general information and peer support for anyone that has been affected by for anyone experiencing the condition.