Early pregnancy assessment; a role for the gynaecology nurse-practitioner

Recent improvements in the investigation of bleeding and pain in early pregnancy has led to simplified clinical guidelines. These in turn have created the opportunity for nurse-led early pregnancy assessment. We arranged for a gynaecology nurse-practitioner with experience to undergo additional training in early pregnancy care. She then took over the daily running of the Early pregnancy assessment centre (EPAC). A review of 200 consecutive cases showed that the nurse followed the guidelines extremely closely in terms of categorisation of patients, referral to the medical team for further investigation and selection of women who required anti-Rh(D) immunoglobulin. In addition, in the first 6 months of the clinic no cases of ectopic pregnancy were overlooked by the nurse-practitioner. Sixty-one per cent of the women attending the clinic did not need to see a doctor.