HNY Policy and Pathway Repository - Humber

To be accessed when a woman is considering or wishes to terminate her pregnancy. Early medical procedures can be provided in a community setting if the woman wishes to have a medical procedure and she is under 8 weeks and 6 days gestation. If the woman is sure she wishes a surgical procedure or is sure she will be over 8 weeks and 6 days gestation by date of procedure, she should be referred to an alternative provider.

Referral to the community EMA service can be by clinician, advocate or self-referral by calling 01482 336338.

Bleeding with or without lower abdominal and/ or shoulder tip pain, indicative of early pregnancy loss. Refer to Early Pregnancy Assessment Unit if miscarriage suspected or A&E if heavy blood loss/ ectopic gestation suspected

If the woman has pre-existing medical conditions for which pregnancy is a risk factor, contact consultant directly or state on referral to ensure urgent consultant assessment.

Exclude Red Flag Symptoms

Women with complex medical conditions which may be aggravated by pregnancy, or which make the pregnant state dangerous e.g. history of Venous Thromboembolism, cardiac condition, should be referred marked urgent. Women are asked for pre-existing medical conditions when their referral is taken but women may not know the implications of their pre-existing condition.  

Do Not Refer

If the gestation is known to be over 8 weeks and 6 days, please refer to an alternative provider.

Abortion over 23 weeks and 6 days gestation is illegal unless the continuance of the pregnancy would involve risk to the life of the pregnant woman greater appropriate than if the pregnancy were terminated or there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped.

Referrals cannot be accepted unless on these grounds, above these gestations and below these gestations, account has to be taken of waiting times re feasibility.

The earlier procedures are done, the safer they are. In later gestations, there are not a large number of sites in England where procedures are undertaken so waiting times are longer (essentially, the further on beyond 14 weeks, the longer the wait, up to the 23 weeks and 6 days limit.)

Women can access the service for discussion, option appraisal and referral to specialist counselling alone and make a decision in her own time. The sooner a woman accesses the service, the sooner the first date she can be offered for any of these and therefore any subsequent procedure. 

The only referral criteria is patient choice.

Referral can be made via healthcare professional, patient advocate or self referral by contacting 01482 336338.

Information To Include

Referrals do not need any supporting information if straightforward; the most important thing is to get the patient into the system as soon as possible hence telephone referral.   

However, if the Practice is aware of any health or social issues they want the service to know about please contact the secretaries on sexualhealthsecretaries@nhs.net which should include patient details and history summary and salient facts that need to drawn to our attention. 

Examples of reasons to contact the service would be significant past medical including obstetric and  psychiatric history; current social situation if involves substance misuse, partner violence or other factors indicating vulnerability.

It is useful if form HSA1 is signed and faxed/ scanned in or given to the patient to bring with her.

Give the patient telephone number 01482 336338 if she has any need to speak to the service e.g.queries/ anxieties/ needs to change appointments.