Out of hours policy for first trimester scans (FOI)

​​​Request

What is the hospital out of hours policy for scanning women in their first trimester of pregnancy where there is a concern for miscarriage and in particular ectopic pregnancy? Please explain the rationale.

Response

Pregnant women presenting to the Emergency Department (ED) outside of Rayner Outpatients operating hours will be reviewed of their symptoms by the clinical team. 

If pregnant and clinically stable, they will be referred to the Early Pregnancy Assessment Unit (EPAU) for review and scan, usually within 24 hours. If attending over a weekend, scanning will be performed on the next Monday, with a safety net to attend ED if bleeding or pain increases. 

If the person attending is clinically unwell, they will be admitted and the on-call consultant will proceed to perform a scan and make a decision for treatment based on the results. Obstetrics and Gynaecology Consultants are competent in early pregnancy scanning and will provide out-of-hours scans if clinically indicated, as necessary. 

There is a clear pathway and escalation route to the appropriate care team (Gynaecology) at all times. This follows the Royal College of Obstetricians and Gynaecologists (RCOG) recommendations for diagnosis and management of ectopic pregnancy, which state “women should have access to all appropriate management options for their ectopic pregnancy. If local facilities do not provide all options, then clear referral pathways should exist to allow them to access appropriate care”. In Jersey, ED can refer to EPAU services for care.

Health and Community Services follow the RCOG National guidelines that suggest to see patients within 24 hours.