Introduction: Miscarriage (pregnancy loss prior to the 20th week gestation) can affect up to 20% of all pregnancies. Current clinical practice streamlines early pregnancy assessment via an Early Pregnancy Assessment Service (EPAS). We conducted a retrospective study to assess the outcomes of this clinic.
Method: All women seen over a 1 year period (1/1/2018-31/12/2018) in the EPAS clinic at Liverpool Hospital were included in the study. Data was extracted from the electronic medical record and paper records of the clinic. Data collected included demographic data, background medical and pregnancy information, treatment undertaken, presentations to emergency department, units of blood administered and outcome of the EPAS assessment. Data was analyzed using SPSSv 26, and significance set at p<0.05.
Results: A total of 966 women were assessed at an average of 9(8-11) weeks gestation, were 32.2(28.9-37.9)yrs of age, with 40.7% of women born overseas and 25.7% from culturally and linguistically diverse (CALD) population. Women presenting for their third or more miscarriage accounted for 13.4% of EPAS presentations and occurred more likely in older women LR 1.07(1.04-1.1) and women that had undergone a previous cesarean section.
Of all EPAS presentations 63% miscarried, 30% were found to have a continuing viable pregnancy, 4.3% had an ectopic and 0.9% a molar pregnancy diagnosed. Of all miscarriages 55% (n=331) were managed conservatively, 17.4% (n=104) had a medical management and 25.3%(n=151) required surgical treatment. Medical management was successful in 72.3% of women, and conservative in 92.3% of episodes.
Conclusion: Treatment via EPAS is effective but requires significant time for assessment and follow up visits. Women with recurrent miscarriages may need improved referral for follow-up and assessment.