HSE plans for early assessment unit in Limerick

THE Health Service Executive has confirmed that plans are being drawn up to introduce an Early Pregnancy Assessment Unit (EPAU) in the Mid-Western Regional Hospital, Limerick.

A spokesman for the HSE said this unit would be a dedicated area in the admission unit where women with bleeding with or without pain at less than 12 weeks gestation are assessed.
“The benefits will be rapid diagnosis, creation of a sympathetic environment, prompt medical input, accessible scanning facilities, reduced unnecessary admissions and preservation of women’s dignity,” he commented.
He added that, currently, all women are admitted to the admissions unit in the Regional Maternity Hospital, Limerick. “There is a single room in the admissions unit where a woman with a suspected miscarriage/pregnancy loss is accommodated, if it is not already in use.”
The spokesman also said that midwives at the hospital do receive specific training to help them deal sensitively with patients who are experiencing a pregnancy loss.
“Perinatal bereavement courses are provided by the clinical midwife specialist in bereavement counselling. This one-day course includes education on process of grieving and grief theories, providing quality care and the delivery of pathways of care.
“Dealing sensitively with patients who are experiencing pregnancy loss is a theme that runs throughout the course outline and one of the main objectives of the course. In addition, the CMS provides ward-based education sessions to staff to explore midwives learning needs in relation to loss and grief and to identify best practice issues in relation to the care provided for bereaved couples.”
In addition, the HSE provides practical workshops to midwives with emphasis on counselling and communication skills required when dealing with women who suffer loss. “The CMS in counselling has facilitated patient stories and provided feedback to staff on women’s experience of loss. On occasions, women come to the hospital and speak directly to staff about their experience. Care provided is based on multidisciplinary clinical guidelines which are evidence based.”
He also confirmed that the Regional Maternity Hospital in Limerick offers a bereavement counselling services.
“The bereavement counselling service in the Regional Maternity Hospital is available Monday to Thursday 7.45am to 5.30pm provided by the clinical midwife specialist/bereavement counsellor.
“Couples may not wish to see the CMS/bereavement counsellor during their stay in hospital but may wish to avail of the service following discharge from hospital. Therefore the counselling service is offered to all bereaved couples and their families by staff before discharge from hospital. Couples may then arrange an appointment by contacting the CMS/bereavement counselling on 061 483196 Monday to Thursday. At other times they may leave a message on the answering service,” the HSE spokesman explained.
Where possible, the hospital also accommodates couples in a suspected pregnancy loss situation in a single room if not already in use.
“The partner sometimes accompanies the woman in one of the cubicle areas depending on activity levels in the unit and taking into account the privacy of the other patients, as there are only curtains between the beds,” he said, adding that the introduction of the EPAU will enable women to be accompanied when they present with early pregnancy bleeding and/or pain.
In relation to the recommendation of a D&C procedure in the case of a miscarriage, the spokesman said patients are not offered this procedure until the diagnosis of miscarriage is confirmed. A doctor or consultant, he added, decides that a D&C should be offered to a patient.
In addition, patients with suspected pregnancy loss are not offered prostaglandin-type medication for a miscarriage until the diagnosis of miscarriage is confirmed.
He also said that in the vast majority of cases, a second trained observer is requested to confirm the diagnosis of a non-viable pregnancy and a second scan is offered at an appropriate interval.
“The diagnosis of a non viable pregnancy is made by trained obstetric ultrasonographers and consultants with ultrasound expertise. There are circumstances where the diagnosis is completely beyond doubt and a second scan is not necessary,” he stated.
He added that pregnancy loss is deemed a miscarriage up to 24 weeks gestation.
The HSE has recently appointed Michael Turner as the National Clinical Lead in Obstetrics and Gynaecology under the office of Dr Barry White, National Director for Quality and Clinical Care.
“This clinical programme will be seeking to introduce standardised national guidelines and care pathways across the country’s 19 maternity units and early pregnancy assessment units. Early pregnancy units have been developed to provide co-ordinated care for women experiencing pain or bleeding in early pregnancy. Early pregnancy care involves a multidisciplinary approach involving doctors, nurses, ultra-sonographers, midwives and support staff. Maternity units may alternatively assess patients with potential or actual miscarriage as emergencies via clinics, gynaecology wards, daycare, emergency departments or other mechanisms or facilities,” the HSE explained.
The spokesman added that there is a level of uncertainty in ultrasound scanning, especially in the early stages of a pregnancy.
“It is rare but situations can occur when a scan will suggest that the pregnancy is lost but subsequent scans may show a foetal heartbeat. Therefore repeat scanning is undertaken when appropriate. Scanners in place in maternity units and early pregnancy units are maintained by the hospital, similar to all diagnostic imaging devices and equipment across the healthcare system,” he said.