The emergence of early pregnancy units into clinical practice demands educational support and the development of clear guidelines. For the inquisitive trainee, the array of information portals, both paper and electronic, can be bewildering leading to initial confusion about where to start.

This book provides a useful vade mecum that allows a ready and accurate reference source as well as encouraging more complex reading and critical analysis for those that aspire to improved practice. This compendium represents an excellent primer while providing a solid foundation from where to start.

It makes another useful addition to a burgeoning series.

Introduction

Early pregnancy problems account for a major part of all gynaecological emergencies. Other less common gynaecological emergencies are acute pain, severe vaginal bleeding and collapse, which are covered in detail in other chapters.

All women with early pregnancy and acute gynaecological problems should receive prompt referral to a dedicated early pregnancy unit that provides efficient, evidence-based care with access to appropriate information and counselling. The National Service Framework recommends that all women should have access to an early pregnancy unit, which should be easily available (www.earlypregnancy.org.uk). Ideally, these services should also be directly accessible to GPs.

A report of the National Confidential Enquiry into Patient Outcome and Death in 2007 stated that when a patient with an acute healthcare problem arrives in hospital, he or she requires prompt clinical assessment, appropriate investigations and institution of a clear management plan. There should be an early decision regarding the need to involve all relevant specialties and other required services followed by a timely review by an appropriately trained senior clinician. This should be undertaken in an environment that is best suited to meet the patient's clinical needs. Although there is conflicting opinion on the optimal location for the assessment of emergency admissions, it has been recommended that women presenting with early pregnancy complications should undergo initial assessment in dedicated emergency assessment units. The rationale for the use of emergency assessment units is that they can reduce both the emergency department's workload and hospital length of stay.

Acute gynaecological problems are among the most common reasons for women of reproductive age to seek medical help. Early pregnancy complications account for the majority of gynaecological emergencies. In the UK, emergency gynaecological care used to be provided mainly by junior doctors working in casualty departments. However, it became clear that this model of care was not well suited to meeting the needs and increasing expectations of women. Developments in diagnostic ultrasound, which occurred in parallel, have led to wide acceptance of ultrasound as an essential tool for the assessment of developing pregnancy from a very early stage until delivery. Routine ultrasound scanning to assess fetal health and wellbeing has now been introduced in most developed countries.

To meet demands for more accessible, patient-centred care, early pregnancy assessment units were developed in the UK. This model of care has proved to be very successful and has been adopted by most acute hospitals. Early pregnancy units usually provide an integrated ultrasound scanning service to facilitate diagnostic work-up and to formulate appropriate management plans. Easier access to health professionals with an interest in early pregnancy care and greater availability of ultrasound scanning have resulted in increased attendance at early pregnancy units, with many women wishing to confirm that their pregnancy is normal rather than seeking help for serious medical complications. Improved diagnosis of miscarriage and ectopic pregnancy has prompted the development and implementation of more conservative management strategies.