Early pregnancy and urgent gynaecology

This service runs across two sites at Queen Charlotte’s & Chelsea Hospital and St Mary’s Hospital. Both provide consultant-led care for women who experience problems in early pregnancy. Women may also be referred to the units if they are pregnant and have a previous history of miscarriage or ectopic pregnancy, or if there is a suspected gynaecological problem that requires urgent clinical assessment.

The gynaecology emergency care unit (GEC) at St Mary’s Hospital provides an acute seven-day service. Outside of clinic opening hours, patients are triaged in A&E and can be offered gynaecological assessment and an appointment for an ultrasound if clinically needed. If necessary, patients can be admitted under the on-call gynaecology team 24 hours a day, seven days a week.

The early pregnancy and acute gynaecology unit (EPAGU) at Queen Charlotte’s & Chelsea Hospital is internationally recognised for expertise in early pregnancy and gynaecology ultrasound scanning. The unit has excellent links with the fetal medicine service, also based at Queen Charlotte’s.

Both units accept referrals from GPs, the urgent care centre, the antenatal clinic and A&E. We have links to excellent onsite gynaecological oncology and endometriosis services across sites.

We also run support groups for women and their partners who have experienced ectopic pregnancy or miscarriage. You can find more information about these on the patient information page.

Conditions we treat

The service provides specialist care for the following:

• Assessment of women with bleeding and/or pain in early pregnancy
• Diagnosis and subsequent management of miscarriage and ectopic pregnancy
• Recurrent miscarriage (defined as three or more consecutive miscarriages)
• Nausea and vomiting in pregnancy (hyperemesis)
• Suspected molar pregnancy
• Gynaecology: scans for suspected pelvic pathology requiring emergency review
• Bartholin’s cysts and abscess
• Suspected pelvic inflammatory disease
• Possible ovarian cyst accidents (ovarian cyst rupture or torsion)
• Significant heavy menstrual bleeding with anaemia requiring hospital admission

Treatments we offer

Where medically appropriate, we offer a range of management options for conditions in early pregnancy and acute gynaecology. 

• Expectant, medical and surgical management of miscarriage
• Management of ectopic pregnancy: medical, surgical and close monitoring with expectant management
• Inpatient and outpatient management of nausea and vomiting in pregnancy 
• Surgical management of molar pregnancy and liaison with the gestational trophoblastic unit at Charing Cross Hospital 
• Incision and drainage of Bartholin’s cysts and abscesses under local anaesthesia or general anaesthesia
• Ultrasound based assessment for suspected pelvic pathology. If required emergency surgery can be performed, or women may be monitored and appropriate follow up arrangements made.

Additional information

Elective placements

We are able to offer electives for medical students. For more information please contact Professor Tom Bourne, consultant gynaecologist by emailing t.bourne@ic.ac.uk at Queen Charlotte’s, or Dr Shahla Ahmed, consultant gynaecologist by emailing shahla.ahmed1@nhs.net at St Mary’s.

Clinical trials and research

The EPAGU at Queen Charlotte’s is well-known globally for its research output. As a result, we have been appointed by the Tommy’s charity as the Tommy’s National Centre for Miscarriage Research in collaboration with the University of Birmingham and the University of Warwick.

We are actively involved in studies developing diagnostic tests and in particular the use of ultrasound diagnostics. Our research lead, Professor Tom Bourne, is a founding member of the International Ovarian Tumor Analysis (IOTA) group and sits in the steering committee of several large international trials. There are strong links with the Institute of Reproductive and Developmental Biology (IRDB) at Imperial College London run by Professor Phillip Bennett, with projects ranging from the study of the microbiome to novel biomarkers in early pregnancy.

Many of our studies are currently recruiting and women attending the EPAGU will be invited to participate. Both units contribute to large multicentre research projects. The unit has strong international links, in particular with KU Leuven in Belgium. 

Patients maybe invited to participate in ongoing research across both units and your participation is voluntary. The data collected is anonymous in order to gain more insight and understanding of early pregnancy issues. If you wish to participate please let a member of the team know during your visit.

Further online resources

Tommy’s – Tommy's is a charity that funds research for pregnancy and babies.

Ectopic Pregnancy Trust

Miscarriage Association

Association of Early Pregnancy Units