Obstetrics & Gynaecology
Early Pregnancy Assessment Service
The EPAS is an appointment only outpatient service for women experiencing complications of pregnancy at <20 weeks gestation.
The EPAS is located in the Bendigo Community Health clinic:165-171 Hargreaves Street Bendigo Victoria 3550 Fax: 54414200
The EPAS is staffed Monday through Friday 0800 – 1600 with appointments available between 0900 – 1400.
When a referral is made to the EPAS, the referral will be triaged by the EPAS doctor and the woman will be contacted within one business day when an appropriately scheduled appointment and plan of care will be discussed and arranged. Please note the EPAS is unable to provide a walk in service and appointments are required.
Ultrasounds are not offered at the EPAS clinic and need to be done externally, ideally prior to the EPAS appointment.
Women requiring inpatient care will be managed via ED and the O&G department accordingly.
Suitability criteria for referral to EPAS:
- Women with vaginal bleeding and/or mild abdominal pain with a positive βhCG and who are <20 weeks gestation
- Women with a pregnancy or unknown location (PUL) who are asymptomatic
- Women with suspected Molar Pregnancy
- Women who have had an ultrasound (US) which confirms a miscarriage for discussion of management options
- Women who have had an US which confirms retained products of conception with a recent pregnancy of <20 weeks gestation who require further assessment and managemen
Women who are not eligible for EPAS assessment/management include:
- Women who are unwell and/or haemodynamically unstable Women seeking a ‘routine’ US (e.g. dating, previous history of miscarriage, nuchal translucency etc.)
- Women seeking ‘routine’ early pregnancy or antenatal care
- Women with gynaecological indications (e.g. ovarian cyst, Poly Cystic Ovarian Syndrome etc.)
- Women with non-pregnancy related conditions (e.g. back or musculoskeletal pain etc.)
- Women who are not pregnant Women whose pregnancy is >20 weeks gestation
Referral is by filling out the EPAS referral form and faxing this and the discharge summary to EPAS (03)54414200.
If ultrasound is indicated, provide the patient with the US request form.
Pregnant Patients at or after 20 weeks Gestation
All these patients should be assessed by the O&G team and the default position is that they should go directly to Maternity to be seen there. If the condition is deemed to be not pregnancy related after they have been seen, or if it is clearly non pregnancy related on arrival then the patient can be seen in ED however the O&G team must be contacted immediately when they arrive and so must the Maternity unit ANUM who will organise foetal doppler/CTG in ED promptly.
Remember that abdominal pain, urinary "incontinence" and back pain can all represent labor, that relatively minor trauma can result in placental abruption in late pregnancy, that headache, epigastric pain, ankle swelling or visual disturbance can all be pre-ecclampsia and that regardless of the presenting complaint you are treating two patients so two patients must be assessed.
SSOU is frequently appropriate for gynae problems. There is a "direct to SSOU" pathway for hyperemesis gravidarum. Bleeding in early pregnancy who are going to wait for an US or Gynae review should generally be nursed in SSOU. Pelvic pain in whom ectopic pregnancy has been ruled out and who need time for analgesia to take effect, ultrasound to be completed or O&G review can frequently be managed in SSOU. Most cases of RPOC and endometritis will be discharged on oral antibiotics after O&G review and brought back semi-electively for D&C so SSOU is a good option for them too.