Early Pregnancy Assessment Service (EPAS)
WNHS at KEMH has a specialised service to review patients with problems in the first trimester of pregnancy, including pain and bleeding which may represent suspected miscarriage or ectopic pregnancy.
If there is an Early Pregnancy Assessment Service (EPAS) at the patient’s local maternity hospital, please refer locally in the first instance.
EPAS clinics are available at Joondalup Hospital, Fiona Stanley Hospital, Rockingham General Hospital, Armadale Hospital and Midland Hospital.
The dedicated EPAS at WNHS at KEMH provides a senior clinician-led service with ultrasound support to those within WNHS KEMH catchment area or those requiring tertiary level antenatal care.
Clinical inclusion
Gestation cut-off for EPAS is 13+6 weeks’ gestation.
Women in the first trimester who have had a positive pregnancy test and one or more of the following:
- Vaginal bleeding
- abdominal / pelvic pain
- previous ectopic pregnancy
- previous tubal surgery
- Intrauterine Contraceptive Device in situ with unsited pregnancy
- Suspected or confirmed miscarriage seeking management advice
- Retained products of conception after pregnancy loss <20 weeks’ gestation (post-natal retained products to be referred to Emergency Centre of local maternity service)
- Monitoring of pregnancies of unknown location
Clinical exclusion
- Gestation greater than 14 weeks – refer to the emergency centre at local maternity service or WNHS at KEMH
- Post natal retained products of conception – refer to the emergency centre at local maternity service or WNHS at KEMH
- Intrauterine contraceptive device in situ with documented intrauterine early pregnancy on ultrasound – refer to emergency centre at local maternity service or WNHS at KEMH
- Fetal anomaly detected on ultrasound – please contact maternal fetal medicine fellow to discuss via WNHS at KEMH switchboard (08) 6458 2222
- If the patient is haemodynamically unstable, has severe pain or heavy vaginal bleeding please call ambulance as needed and direct to nearest emergency department for urgent care.
Please note: EPAS does not refer onwards for antenatal care, first trimester screening / NIPT, or referral to specialist clinics such as the Pre-term Birth Prevention Clinic or Maternal-Fetal Medicine.
If the woman requires these services, a further referral needs to be sent by GP to the local maternity service.
If a WNHS at KEMH patient direct referral to WNHS at KEMH Referral Co-ordinator. See WNHS KEMH Antenatal Referrals page for further details.
Referral for EPAS to include
- Detailed obstetric and gynaecological history as well as medical history
- Quantitative bHCG if available
- Copy of ultrasound reports from current pregnancy if available.
Urgent Referrals
Please ring and discuss urgent referrals with EPAS Clinical Nurse Midwife via WNHS Switchboard (08) 6458 2222 during EPAS clinic Monday to Friday 8am to 4.30pm.
Outside of these times if urgent, please contact the On Call Gynaecology team via switchboard (08) 6458 2222.
Referral Process
Patients are referred to the service via a telephone call made by referring doctor – this is due to the time critical nature of these appointments and is a different process to other WNHS clinics.
Do not send referral letter to WA Health Central Referral Service as it can take several days for the referral to be received.
Urgent and non-urgent queries can be directed to EPAS Clinical Nurse Midwife via switchboard during the clinic times Monday to Friday 8am to 4.30pm.
Contact Information
For urgent and non-urgent EPAS queries during clinic hours contact KEMH switchboard (08) 6458 2222.
For urgent queries regarding pregnancy less than 20 weeks’ gestation:
Tel: (08) 6458 2222 ask for On Call Gynaecology team.
For urgent queries regarding pregnancy over 20 weeks’ gestation:
Tel: (08) 6458 2222 ask for Senior Obstetric Registrar On Call.
Useful links
Consumers resources
Bleeding and/or pain in early pregnancy (PDF)
Health professional resources
Pregnancy: First Trimester Complications (PDF)
RACGP: Early pregnancy bleeding (external site)
A journal article to assist GP management.