What to expect from an early pregnancy assessment

It is recommended that all women should have an early pregnancy assessment during the first trimester of their pregnancy, especially those who are experiencing bleeding and pain, or women who have previously had a miscarriage or ectopic pregnancy. We were fortunate enough to ask consultant obstetrician and Director of The Chelsea Birth Clinic, Mr Keith Duncan, to explain more about having an early pregnancy assessment and what you can expect.

What is an early pregnancy assessment?

An assessment of early pregnancy would normally involve your last period and various symptoms of pregnancy that you might have had, in particular, if there is any pain or bleeding. We would also note if there is a history of any previous pregnancies, whether successful, or if there has previously been a miscarriage or ectopic pregnancy, where a fertilised egg implants on the outside of the womb, usually in one of the fallopian tubes. The fallopian tubes connect the ovaries to the womb and if an egg is stuck it means that the baby will not develop and usually, needs to be removed by operation.

In modern times, we would then admit the woman into the early pregnancy unit if they are bleeding and following this, a pregnancy test can be taken and a transvaginal ultrasound is normally performed, which can ensure that the pregnancy is within the uterus.

We can also note the number of foetuses and check the fallopian tubes to ensure there is not an ectopic pregnancy. If there are any doubts about the viability of the pregnancy, or of the location, then quantitative hCG levels can be taken via a blood test, which measures the specific levels of the hormone human chorionic gonadotropin, to see how the pregnancy is progressing. If it is without uterine progression, we then know that further intervention may be required.

Who might need to have an early pregnancy assessment?

It is very useful for all pregnant women to have an early pregnancy assessment between six to eight weeks to exclude ectopic pregnancy, confirm dates and viability, and numbers of pregnancy. Those who have had previous miscarriage, ectopic or any pain or bleeding, should have an early pregnancy assessment. 

How long does the assessment take and can my partner come with me?

Assessment usually takes between 20-30 minutes and involves medical history-taking, scan and blood tests. As it is normally quite an anxious time, we would always advise having a partner or friend there with you in case there is bad news. It is always nice to see the fetal heart together, in particular, if you have had previous problems.

What kind of tests and scans are made?

The transvaginal scan looks at the pregnancy through the cervix, looking for and confirming that the pregnancy is in the uterine and not ectopic. If there are any questions or concerns about this, it can be followed up with a hCG blood test to check the progestogen levels, which can help give reassurance if the pregnancy is good. 

What happens afterwards?

Following the scan, an appropriate and individual management plan will be made. This normally requires further scanning in seven to ten days if there were any questions, and a further quantisation of hCG level, which should normally double over 48-hours.

If you would like Mr Duncan to be the specialist to support you throughout your high-risk pregnancy, or for him to aid you during water births, hypnobirthing or perform caesarean, visit his Top Doctor’s profile and make an appointment now for a consultation.