Clinical and cost effectiveness of early pregnancy assessment units (EPAUs)

DetailsAdditional comments
Review questionWhat is the clinical and cost effectiveness of EPAUs compared with other models of service provision in improving women's clinical and psychological outcomes?
ObjectivesTo determine whether EPAUs are the most effective venue for diagnosis and management of miscarriage and ectopic pregnancy, including both clinical care and emotional and psychological support.
Study designRCTs

Cohort studies

Comparative observational studies

Qualitative studies
StatusPublished papers
PopulationWomen presenting with pain and bleeding in early pregnancy

Women with missed miscarriage
Population includes:

e.g. verified by early urine testing
InterventionEarly pregnancy assessment units
ComparatorOther models of care:

Accident and emergency department / emergency room

Gynaecological clinics

Inpatient management (gynaecology wards)

Hospital-based care

Community-based care

Reproductive health clinics

Gynaecology emergency units

Office and primary care

Mixed settings where diagnosis is separate from management
OutcomesMaternal outcomes (listed in priority order)

Length of stay/Number of visits required during episode of pain and bleeding

Women's and partners' satisfaction and emotional and psychological outcomes

Number of investigations

Time to diagnosis

Need for further interventions

Need for admission

Measures of pain and bleeding

Need for transfusion


Subsequent pregnancy rates
Extract any information reported about patient choice
Other criteria for inclusion/exclusion of studiesExclude non-human studies

Case series

Exclude non-English papers

Exclude developing countries

From 1985 onwards
1985 earliest there are likely to be data (as 1986 the first EPAU)

From: Appendix D, Review protocols

Cover of Ectopic Pregnancy and Miscarriage
Ectopic Pregnancy and Miscarriage: Diagnosis and Initial Management in Early Pregnancy of Ectopic Pregnancy and Miscarriage.
NICE Clinical Guidelines, No. 154.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG; 2012 Dec.
Copyright © 2012, National Collaborating Centre for Women's and Children's Health.

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