Early Pregnancy for the On‐Call Gynaecologist

ABSTRACT Key Content Early pregnancy presentations form a large part of unscheduled hospital attendance, with miscarriage affecting one in four pregnancies. The self‐sufficiency of many Early Pregnancy Assessment Units (EPAUs) can reduce exposure for obstetrics and gynaecology doctors to counselling patients and formulating ongoing management plans. Interpreting scan findings and their significance can be difficult when this is not part of a daily workload. Patients are often anxious and providing support whilst navigating diagnostic uncertainty can be challenging. This article reviews the up‐to‐date evidence for managing early pregnancy problems that the on‐call doctor, particularly when working out of hours, may encounter and clarify ultrasound scan terminology to improve confidence when managing these patients. Learning Objectives To improve confidence in counselling early pregnancy patients about the management of pregnancy of unknown location, pregnancy of uncertain viability, miscarriage and confirmed ectopic pregnancy. To understand the significance of ultrasound findings, including normal findings, by gestational age and to convey this information to patients. To understand the impact of early pregnancy concerns on patients and signpost to appropriate support services. Ethical Issues Misdiagnosis of miscarriage. Delayed diagnosis of miscarriage. Variable access to ultrasound (both equipment and trained users) during out‐of‐hours.