Standards of care provided by Early Pregnancy Assessment Units (EPAU): A UK-wide survey

Abstract

Standards of services provided by the EPAUs across the UK vary from one unit to another. The aim of this purposive sampling self-administered survey was to assess these standards against a benchmark set by the Royal College of Obstetricians and Gynaecologists (RCOG). These standards were set out in a report by a RCOG working party (2008). Out of 181 units contacted in this survey, 140 units responded. We looked at the setup of the EPAU, services offered, accessibility and protocols for management of miscarriage and ectopic pregnancy. The survey shows that there is a considerable variation in the management protocols and the quality of services offered by the EPAUs in the UK. Many units do not meet the standards set by the RCOG.

Clinical practice guidelines for recurrent miscarriage in high-income countries: a systematic review

“…Although CPG are promising and effective tools for improving the quality of care, many are not implemented fully in practice after dissemination; this is also the case for recurrent miscarriage (Franssen et al, 2007;Poddar et al, 2011;Van den Boogaard et al, 2011;Parry, 2018;Manning et al, 2020) and pregnancy loss (Le Gouic et al, 2017;Ijaz et al, 2019) and reproductive CPG more broadly (Gameiro et al, 2019). Barriers to recurrent miscarriage CPG implementation occur at four levels: the CPG; professionals; patients; and organizations (Van Den Boogaard et al, 2011).…”

Variations in the organisation of and outcomes from Early Pregnancy Assessment Units: the VESPA mixed-methods study

“…A total of 2422 (36.7%) women attended units for follow-up visits. Of those who had a follow-up visit, the median number of follow-up visits was 1 (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. The overall ratio of new visits to all follow-up visits was 6606 to 3512 (1.88).…”

“…3,[8][9][10][11][12][13][14][15][16][17][18][19][20] The majority of the studies (n = 10) 3,[8][9][10][11][12][13][14][15][16] were conducted in the UK. Of the studies included, two were cross-sectional studies, 8,9 four were observational studies 3,[17][18][19] that compared outcomes before and after the establishment of an EPAU, and the remaining studies were descriptive. [10][11][12][13][14][15][16]20 The quality of the evidence was described as low or very low.…”

“…7 Evidence from the cross-sectional studies shows that in approximately half of the EPAUs ultrasound scans are performed by sonographers only, whereas in less than one-quarter of EPAUs the scanning is done by medical, nursing or midwifery staff. [7][8][9] Professionals from different disciplines perform ultrasound scanning in the rest of the EPAUs. Regarding access to services, all EPAUs accept patients referred from other health-care professionals, whereas only 51% of EPAUs accept self-referrals and the majority of units (70%) provide a weekday service only.…”

“…Regarding access to services, all EPAUs accept patients referred from other health-care professionals, whereas only 51% of EPAUs accept self-referrals and the majority of units (70%) provide a weekday service only. [7][8][9] There is a paucity of data regarding the best indicators for clinical and service outcomes, and women's views and experience of care were included in only two studies. 14,16 Given the considerable variation between different EPAUs in the levels of access to their services and the levels of care they provide, the best configuration of EPAUs for optimal balance between cost-effectiveness, clinical effectiveness, service-and patient-centred outcomes remains unknown.…”