The value of the early pregnancy assessment clinic in the management of early pregnancy complications.

Abstract

OBJECTIVE: To determine the value of North York Hospital's Early Pregnancy Assessment Clinic (EPAC) in the management of early pregnancy complications and its effect on the number of emergency room (ER) visits. METHODS: The EPAC was opened in August 2005 at North York General Hospital. The number of patients being assessed, the sources of referral, the reasons for referral and the treatments provided in the clinic between January 2006 and December 2007 were reviewed. The number of patients attending the ER with the diagnoses of miscarriage, early pregnancy hemorrhage, and ectopic pregnancy one year prior to the opening of the EPAC (July 2004 to June 2005, year 0), during the first subsequent year (January to December 2006, year 1) and the second subsequent year (January to December 2007, year 2) were reviewed. RESULTS: Of the 1448 referrals to the EPAC during the two-year period, 38% were referred from the ER, 31% from family physicians, 24% from obstetricians, 2% from midwives, and 5% from other sources. The reasons for referral included confirmed missed miscarriage (450 patients, 31%), threatened miscarriage (471, 32.5%), complete miscarriage (182, 12.6%), ectopic pregnancy (111, 7.7%), incomplete miscarriage (59, 4.1%), hyperemesis gravidarum (23, 1.6%), and others (152, 10.5%). Through arrangements made by the clinic, 200 women underwent dilatation and curettage, and 133 were administered misoprostol to induce miscarriage. Fifty-seven patients with ectopic pregnancy received medical treatment with methotrexate, and 13 patients had surgery for ectopic pregnancy. There was no significant change in the total number of patients being assessed in the ER for early pregnancy hemorrhage, miscarriage, and ectopic pregnancy before and after the opening of the EPAC. However, there was a significant reduction in the number of repeat assessments in the ER for ectopic pregnancy, from 37% in year 0 (n = 24/65) to 24% in year 1 (n = 14/54) and 14.5% in year 2 (n = 9/62). There was also a trend towards a reduction in the number of repeat assessments in the ER for hemorrhage (year 0 = 32.4%; year 1 = 29.4%; year 2 = 27.5%), and miscarriage (year 0 = 19.5%; year 1 = 12.6%; year 2 = 16.9%). CONCLUSION: The EPAC is of significant value in the management of early pregnancy complications. It is particularly useful in the follow-up of patients with ectopic pregnancy and also helps to reduce the number of patients attending the ER for follow-up of other early pregnancy complications.