Early pregnancy units (EPUs): what they are and when to go

If something doesn’t feel right in early pregnancy, you may be told to contact your early pregnancy unit. Here’s what these units are, how to reach yours and what to expect if you go.

What is an early pregnancy unit?

An early pregnancy unit (EPU) is a hospital service for problems in early pregnancy, mainly pain or bleeding. You might also see it called an early pregnancy assessment unit (EPAU) or service. Staff can scan you, do blood tests and explain the results. Some units also care for people with severe sickness (hyperemesis gravidarum).

The weeks each unit covers vary. The NHS says an EPU may be able to help if you’re less than 20 weeks pregnant, but many units stop earlier, at around 14 to 17 weeks. Some only scan from about 5 to 7 weeks, because a scan very early on may not show much yet. Your unit’s web page will say what it covers. Beyond that, your maternity unit is usually the place to call.

When to contact an EPU

Get advice straight away if you’re pregnant and have:

any bleeding, even if it’s light
tummy pain that’s severe, on one side, or not easing after resting for 30 to 60 minutes
pain in the tip of your shoulder

Contact your maternity unit or an early pregnancy unit straight away, or NHS 111 if you can’t reach them. If you haven’t seen a midwife yet, call NHS 111 or your GP surgery.

Call 999 if bleeding is heavy (soaking a pad soon after putting it on), or comes with severe tummy or shoulder pain, or with feeling sick, faint or dizzy. Also call 999 for sudden, severe tummy pain with feeling faint or dizzy, even without bleeding.

If you’re waiting for a call back and things get worse, don’t keep waiting: call 999 or go to A&E.

Can I refer myself?

It depends on the unit. NICE guidance says people who have had recurrent miscarriages, or a previous ectopic or molar pregnancy, should be able to refer themselves. Units vary: some only take self-referrals after an ectopic or molar pregnancy, and a few take them from anyone in early pregnancy. Your unit’s web page will say.

Otherwise, a GP, midwife, nurse or A&E doctor will usually assess you first, and NHS 111 can tell you where to go. NICE says services should be able to see you within 24 hours of referral if your situation needs it.

If you’ve had an ectopic pregnancy or a molar pregnancy before, you should be offered an early scan in your next pregnancy, at around 6 to 8 weeks.

How to find your EPU

Search your local NHS trust’s website for “early pregnancy”.
Check your maternity notes, which list key contact numbers.
If you can’t find it, or can’t get through, call NHS 111.

It’s worth saving the number in your phone now, so you’re not searching for it when you’re worried.

Opening hours and out of hours

Hours vary. Many units open on weekdays only, often until around 4 to 6pm, and some take referrals only at certain times of day. NICE says an early pregnancy service should be available every day of the week in each area, but your nearest unit may not always be open.

When your EPU is closed, call NHS 111. Some hospitals ask you to call their gynaecology ward out of hours, so check your unit’s page. For anything in the 999 list above, call 999.

What happens at an appointment

Questions and checks. A nurse or doctor will ask about your symptoms. They may check your blood pressure and temperature and ask for a wee sample.
A scan. In the first weeks this is often an internal (transvaginal) scan, where a slim probe is placed gently in the vagina. It gives the clearest picture early on. It can feel uncomfortable but shouldn’t be painful, and there’s no evidence it causes miscarriage. You can ask for a chaperone, or ask for a scan on your tummy instead, though the picture may be less clear.
Blood tests. If the scan can’t yet show where the pregnancy is, you might have a blood test for the pregnancy hormone hCG, then another about 2 days later to see how the level is changing.
A repeat scan. If it’s very early, it may be too soon to be sure. You might be offered another scan 7 to 14 days later, when it’s usually easier to see what’s happening.

Allow plenty of time, as appointments can take from 45 minutes to a couple of hours. Waiting for a repeat scan or results can be very hard. It’s fine to ask exactly what they’re looking for, when you’ll hear and who to call in the meantime.

If the scan shows a miscarriage, the team will talk you through your options. Miscarriages very rarely happen because of anything you did or didn’t do. You can read more about miscarriage and what happens.

Taking someone with you

Many units are happy for you to bring a partner, friend or relative, though some allow only one person. Children usually can’t come in, and a sonographer may not scan with a child in the room, so arrange childcare if you can, or call the unit if that’s difficult.

Questions people ask

Can I just turn up at an early pregnancy unit?

Usually not. Most units see people by appointment only, so phone first or call NHS 111. A few run walk-in clinics, so check your unit’s page. If you’re very unwell, call 999.

Can I go to an EPU for a reassurance scan?

Not usually without a medical reason. After a miscarriage, you can ask your GP or EPU about an early scan next time, but it isn’t always possible. See anxiety in early pregnancy and waiting for your first scan.

Do I need to have seen a midwife before I go?

No. You don’t need to be booked with a midwife, though most units need a referral from a GP, midwife, NHS 111 or A&E unless you can refer yourself. Refer yourself to a midwife as well if you haven’t yet.