To ask the Minister of Health whether different Health and Social Care Trusts have different protocols in response to women who experience bleeding while in their first trimester of pregnancy.

All HSC Trusts offer early pregnancy services for women who experience bleeding following a positive pregnancy test.

Please see below the Trusts protocols in response to women who experience bleeding while in their first trimester of pregnancy:

Belfast HSCT Trust

The Belfast Trust have a policy on the Management of Bleeding in Pregnancy in place. The Trust also follows National Institute for Health and Care Excellence (NICE) guidance NG 126 on Ectopic pregnancy and miscarriage: diagnosis and initial management NG126.

Referrals to the Early Pregnancy Unit (EPU) are accepted from Emergency Department/ GP/ Maternity Assessment Unit / Antenatal Clinic / Self-referral from women.

Access to EPU is available within a few days of referral but is also available on a same day basis consistent with clinical need. Specific arrangements are in place to support women with a history of ectopic or a scan confirmed ectopic pregnancy. EPU services also operate ongoing review every two to three weeks for women with ongoing bleeding in early pregnancy.

Women in the very early stages of pregnancy e.g. 4/5 weeks who report bleeding may be asked to repeat a pregnancy test in one week. Should the test remain positive and there remain concerns re bleeding they will then be offered review in EPU.

South Eastern HSC Trust

South Eastern Trust provide early pregnancy services for women who experience bleeding following a positive pregnancy test. Women can self-refer or be referred by their general practitioner.

Northern HSC Trust

The Northern Trust operates early pregnancy clinics (EPC) on both Antrim and Causeway sites seven days a week. The EPC is a nurse-led service offering ultrasound assessment and blood testing. The EPC accepts self-referrals, referrals from gynaecology, midwifery care, GP’s and ED. Initial assessment is primarily via telephone triage

Antrim EPC is available 9am – 5pm Monday to Friday and 9am to 3pm on Saturday and Sunday. Causeway EPC runs 9am – 1pm Monday to Sunday.

Out of hours or if women’s history indicates they may become unstable, such as heavy bleeding, severe abdominal pain, dizziness or vasovagal episode, they should attend the closest emergency department (ED) for assessment. Depending on presentation of symptoms and quantification of bleeding different pathways may be followed;

Scant – light bleeding: women are advised to observe with worsening symptoms advice given. A log of the call will ensure woman is allocated appointment if bleeding persists or worsens.

Light – moderate bleeding: woman is allocated an appointment in EPC – if they have not had a scan in this pregnancy already, it is ideal that the woman is seen within 24 hours

Heavy bleeding: same day assessment is required. If clinical triage indicates, women are diverted to ED and then assessed by Gynae / EPC team at a later point in the assessment when stabilised.

The above information is in relation to PV bleeding in the first trimester with no associated symptoms such as abdominal pain etc. Clinical judgement is used in all the above circumstances, depending on history, presentation and assessment. Safety net advice is given to all patients regarding worsening symptoms. Patients who have uncomplicated PV bleeding who are less than 6 weeks pregnant are advised to do a home pregnancy test in 2 weeks. If positive an appointment is allocated or if reassessment of symptoms dictates this.

Southern HSC Trust

The Southern Trust operates an Early Pregnancy Problem Clinic where women can be referred or self-refer when experiencing bleeding in the first trimester. The opening hours of this clinic are currently 09.00-19.00 Monday to Friday and they are aiming to open on a Saturday in the near future. Outside of these hours women can attend the Emergency Department where they will be triaged and will await further assessment by the Gynae team.

Western HSC Trust

Women experiencing bleeding in the first trimester of pregnancy are referred by their GP/ED to Early Pregnancy Assessment Unit for management. Each case is managed individually depending on clinical scenario.