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Baby loss certificates are available from the UK government for all pregnancy losses under 24 weeks' gestation. These certificates are not legal documents, but are a formal recognition of your pregnancy loss. Many parents find a physical recognition of their pregnancy helpful in their recovery. The certificates are free to order and all you need is your NHS number or postcode and your date of birth.

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If your pregnancy ends before 24 weeks, you can get a certificate in memory of your baby. It's free to get a certificate.

You do not need to request a certificate if you prefer not to. It's optional.

The certificate is not a legal document - for example you cannot use it to claim benefits. The certificate will not be added to your GP record.

If your pregnancy ends from 24 weeks onwards, you need to register a stillbirth instead.

Before you start

You'll need:

your NHS number or postcode registered with your GP

the mobile phone number or email address registered with your GP

permission from the other parent and their email address, if you want their name on the certificate

You can find out your NHS number on the NHS website.

Request a certificate

You can ask for a certificate if all these apply:

you've lost a baby before the 24th week of pregnancy

you're one of the baby's parents or surrogate

you're at least 16 years old

your pregnancy ended on or after 1 September 2018

you lived in England when you lost your baby

you live in England

If you've lost more than one pregnancy, you can apply separately to get a certificate for each baby loss.

Your certificate should arrive in the post within 14 days. If you do not receive it, you can request another certificate.

Get help to request a certificate

If you want your certificate in a different format or cannot request the certificate online, email or call the helpline.

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If your pregnancy ends before 24 weeks, you can get a free certificate in memory of your baby.

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A molar pregnancy occurs when an abnormal pregnancy implants in the lining of the womb. It is rare, occurring in approx. 1 in 600 pregnancies. If you are diagnosed with a molar pregnancy, you may require referral to a specialist centre. If you are diagnosed with a suspected molar pregnancy, our clinical team will guide you through your management options and explain the next steps.

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An ectopic pregnancy is a pregnancy that is growing outside of the womb. It occurs in 1 in 80 pregnancies. In other words, it is an 'out-of-place' pregnancy. Here is some more information about what an ectopic pregnancy is, and your options regarding management.

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If you think you are having a miscarriage, or have been diagnosed with a miscarriage, we are here to help. Here you will find further information on what miscarriage is, your options for management and psychological support. There are also links to organisations that provide further information and advice for you, and your partner. Please feel free to discuss anything you see here with your clinician at your appointment. Our team are experts in managing miscarriage and other early pregnancy complications and we are happy to support you in any way we can.

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Early pregnancy scan results can be confusing. These leaflets and further information can help you to understand what your scan shows, and what the next steps might be.

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We run an online monthly pregnancy loss support group which focuses on creating a space where patients and partners are able to connect and support each other.

Scan the QR code to find out the next date, register your interest and receive a link to the meeting.

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Miscarriage in the First Trimester (Under 12 weeks)

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Miscarriage in the First Trimester (Under 12 weeks)

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Published: September 2016

Please note that this information will be reviewed every 3 years after publication.

This information is for you if you want to know more about miscarriage in the first 3 months of pregnancy.

It may also be helpful if you are a partner, relative or friend of someone who has had an early miscarriage.

This information explains the care you will receive after an early miscarriage has been confirmed. For more information on bleeding and pain in early pregnancy, see the RCOG patient information Bleeding and/or pain in early pregnancy.

Losing a baby is a deeply personal experience that affects people differently. It can be very distressing and you may need a great deal of support afterwards. You can find further information and support from the Miscarriage Association at: www.miscarriageassociation.org.uk and from NHS Choices at: www.nhs.uk/conditions/miscarriage.

The information here aims to help you better understand your health and your options for treatment and care. Your healthcare team is there to support you in making decisions that are right for you. They can help by discussing your situation with you and answering your questions.

This information covers:

What an early miscarriage is and why it happens

What you should do if you have bleeding and/or pain in the first 3 months of pregnancy

How an early miscarriage is diagnosed

What your choices are if a miscarriage is diagnosed

What to expect physically and emotionally after a miscarriage

About trying again for a baby

Further information and support available

Within this information, we may use the terms 'woman' and 'women'. However, it is not only people who identify as women who may want to access this information. Your care should be personalised, inclusive and sensitive to your needs, whatever your gender identity.

A glossary of medical terms is available at A-Z of medical terms.

Key points

Early miscarriages are very common and one in five women have a miscarriage for no apparent reason.

Bleeding and/or pain in early pregnancy can be a warning sign of miscarriage and you should seek medical advice if you are in this situation.

You may be offered tests including an ultrasound scan to check your pregnancy.

Once a miscarriage is diagnosed, your healthcare professional will tell you about your options, which include expectant, medical or surgical treatment.

Most miscarriages are a one-off event and there is a good chance of a successful pregnancy in future.

Sources and acknowledgements

This information has been developed by the RCOG Patient Information Committee. It is based on the NICE Guideline Ectopic Pregnancy and Miscarriage: Diagnosis and Initial Management.

This information was reviewed before publication by women attending clinics in Liverpool, Chester, Prescot and Wrexham, by the RCOG Women's Network and by the RCOG Women's Voices Involvement Panel.

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royal college of obstetricians and gynaecologists

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Early miscarriage patient information leaflet

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Self-Referral for Termination of Pregnancy at Chelsea and Westminster Hospital

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Self-Referral for Termination of Pregnancy at Chelsea and Westminster Hospital

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Chelsea and Westminster Women's Self-Referral Assessment Clinic

Phone number 0203 315 8381 ( please leave a message)

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Self-Referral for Termination of Pregnancy at West Middlesex Hospital 

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Self-Referral for Termination of Pregnancy at West Middlesex Hospital 

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Chelsea and Westminster Hospital NHS Foundation Trust

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Please call 020 8321 5008 if you have any queries or need to rearrange your appointment.

This clinic visit is for consultation only. The termination will be performed after a thorough discussion with you about different methods. This leaflet will explain the options available to you.

All information is confidential but please inform us if you do not wish your GP to be informed of your appointment. We would not inform your GP routinely.

What happens at the clinic?

All appointments will be at the West Middlesex University Hospital. This appointment will involve an ultrasound scan, blood tests and consultation with a nurse and a doctor to discuss this pregnancy. As there are a number of different issues to address it may take some time so expect to spend 2-3 hours at the clinic. You may be able to have the termination of pregnancy on the same day depending on the method chosen.

Who will I see?

Administrator: The administrator will check your details and direct you to the appropriate professionals.

Sonographer: This professional performs the ultrasound scan so we can date the pregnancy and check it is developing normally. This is important as the type of termination available to you will depend on the gestation of the pregnancy (number of weeks). The pregnancy may have miscarried and alternative arrangements may be made. On rare occasions the pregnancy may not be in the womb (ectopic pregnancy) and further tests may need to be performed.

Nurse/healthcare assistant: This professional takes your blood. Blood tests are taken for iron levels, blood group and blood variations such as sickle cell disease. Other tests are performed as necessary.

Counsellor: You will be seen alone and have the opportunity to discuss your reasons for choosing a termination.

Nurse: The nurse will see you to answer any questions you have. They can discuss the different methods of termination of pregnancy and help you decide which is best for you. They will discuss some health issues that are important for the procedure. They will also discuss your futurecontraceptive needs that can be started at the time of, or shortly after, the procedure. You will be asked to take your own vaginal swab-this is collected from everyone to test for chlamydia and gonorrhoea infection.

Doctor: The doctor will talk to you about this pregnancy and ensure you wish to proceed with an abortion. They will take your medical history and then discuss the options available to you. The risks and benefits of the treatments will be explained and then you will be asked to sign a consent form for the procedure you have chosen to show you understand.

What types of termination are there?

This depends on the number of weeks pregnant you are on the day of your procedure. Pregnancy is dated from the first day of your last period and/or scan dates.

Under 7 weeks pregnant: Medical termination of pregnancy (MTOP) is the advised method, although you have the option of surgical termination of pregnancy under local anaesthetic (manual vacuum aspiration)

Between 7 and 9 weeks pregnant: You can choose between a medical termination of pregnancy (MTOP) or a surgical termination of pregnancy (STOP) under local or general anaesthetic, although the former is advised

Between 9 and 14 weeks pregnant: The only method available is the surgical method using suction

Between 14 and 18 weeks pregnant: You would be referred to Chelsea and Westminster Hospital

Over 18 weeks pregnant: You may be suitable for a late medical termination using tablets or surgical procedure and will be referred to the BPAS for specialist care.

If you wish to have a coil for contraception, you may wish to consider a surgical TOP, as this can be fitted during the procedure.

Post termination

It is safe to have a bath but it may be better to have a shower initially after the procedure. You should only use sanitary pads, not tampons after the termination, and avoid sex until the bleeding stops.

Contraception

It is important to consider a long acting method of contraception such as an injection, implant, intrauterine device (coil or hormonal coil). The nurse or doctor will be able to advise you and there is written information available at the clinic. These can be adminstiered during your time with us.

Why might I choose a medical termination?

Medical termination is most suitable for you if:

You are early in the pregnancy and would need to wait for a few weeks for a surgical termination

You don't want or should not have a general anaesthetic

You wish to avoid the risks of surgical termination

Medical termination may be unsuitable for you if:

You have allergies to Mifepristone or Misoprostol

Take steroids

Have any problems with your blood clotting/take anti-coagulants

Are over 9 weeks pregnant

You have severe asthma not controlled by medication

You have liver or kidney disease

What risks are associated with a medical termination?

This is a safe procedure which is effective and has much less risk than having a baby.

Medical terminations are safer than surgical terminations of pregnancy as there is no need for a general anaesthetic and no need to introduce instruments into the womb. They are 97-99% effective. The risk of infection is smaller after a medical termination. All women having a termination are given a course of antibiotics to take afterwards.

Rare complications:

Excessive vaginal bleeding

Incomplete abortion, where some pregnancy tissue is left in the uterus and may require a general anaesthetic and operation to remove them

Ongoing pregnancy but this risk is less than 1%

Why might I choose a surgical termination?

Surgical termination is most suitable for you if:

You are more than 9 weeks pregnant

You want to get the procedure done today under local anaesthetic (you will be awake) but don't have the risk of general anaesthetic

You cannot come to 2 separate appointments at the hospital

You would rather not be awake during the termination (general anaesthetic)

Surgical termination may be unsuitable for you if:

You do not want or cannot have a local or general anaesthetic

You cannot arrange for an adult to escort you home

What risks are associated with a surgical termination?

This is a safe procedure which is effective. The most common complication is an infection in the uterus which occurs in 2-5 in 100 women. All women having a termination are given a course of antibiotics to take afterwards. If you suffer an increase in bleeding, pelvic pain, significantly smelly vaginal discharge, a fever or any combination of these, you may have an infection. In this situation we recommend you contact your GP or go to A&E as you may require further antibiotics.

It is possible for the operation to be unsuccessful and the pregnancy to continue-this occurs in approximately 1 in 1,000 operations. It is more likely the earlier the pregnancy is. This may necessitate either a medical termination or a repeat surgical procedure.

Infrequently, not all the products of pregnancy are removed which can cause heavy bleeding which may also require a further similar operation.

Very rarely a small hole can be made in the womb that may require a further operation (either keyhole or open surgery). This may be reparied at the time or at a secondary operation, particularly if there is suspected bowel or bladder damage or internal bleeding. This may occur in up to 1 in 300 cases.

All operations have a small risk associated with the general anaesthetic itself.

After the termination

Bleeding

You can expect to bleed for 2-3 weeks following the termination. Initially the bleeding can be heavy and you may pass clots. If you have any concerns about the bleeding, please contact your GP, A&E or the clinic at West Middlesex University Hospital during working hours on 020 8321 5008/5005 to leave a message and a nurse or doctor will call you back if necessary.

Pain

You may experience period-type pain after the termination. You may take paracetamol, medications like diclofenac or ibuprofen or codeine type medications if you experience this.

Infection

As with all procedures there is a risk of infection. All women are given antibiotics to take home. The main symptoms of an infection after the procedure are an offensive smelling vaginal discharge and abdominal pain. If you have any concerns you should contact either your GP or A&E.

Contraception

This would have been discussed in clinic with the doctor or family planning nurse.

Retained products of pregnancy

Some women do not expel all the pregnancy tissue following the procedure. If this is the case, then you will need to have an operation performed to remove the tissue that is left behind. This will be performed under general anaesthetic.

Further information

Contact information

Gynaecology Outpatients
1st Floor, Twickenham House

T: 020 8321 5008/5005

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Please call 020 8321 5008 if you have any queries or need to rearrange your appointment. This clinic visit is for consultation only. The termination will be performed after a thorough discussion with you about different methods. This leaflet will explain the options available to you.

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We are sorry that you have had a miscarriage. This leaflet is to tell you a bit more about expectant management of miscarriage and what to expect with this. The other options for managing a miscarriage are medical (with tablets) and surgical. You can ask your doctor or nurse for more information and leaflets on these options.

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The aim of this padlet is to help guide you through your care with us in the Early Pregnancy and Acute Gynaecology (EPAG) Unit and to direct you to useful information resources. Please feel free to browse through the topics, or if you are looking for something specific, use the search bar in the top right corner of this page.

Please note that the CW trust is not responsible for the information and links from outside organisations.

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The Early Pregnancy Unit at Chelsea and Westminster Hospital 

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The Early Pregnancy Unit at Chelsea and Westminster Hospital 

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Chelsea and Westminster Hospital NHS Foundation Trust

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Welcome to the Elizabeth Suite

In the Elizabeth Suite-our Early Pregnancy and Acute Gynaecology Unit (EPAG)-we see and look after women who are referred to us in the early stages of pregnancy and those with gynaecology emergencies.

For some women and their partners, a visit to an early pregnancy unit can be sad and distressing should they receive bad news-we ask that patients and relatives be mindful of this when in the unit.

Our team

The Elizabeth Suite is staffed by a team of specialist nurses, sonographers and doctors who are fully trained and experienced in early pregnancy care and gynaecology.

Several times a week we have consultant-led clinics. You may be referred to see one of our consultants depending on the nature of your condition.

Your appointment

At your appointment you will be seen by one of our specialist nurses or doctors.

You may wish to bring along your partner, a relative or friend to the appointment. We ask that only one adult attends the consultation with you.

You will usually have a scan, the findings of which will be explained, and you will be given an opportunity to ask questions.

Women requiring blood tests will be a given a request form to take to the Lower Ground Floor, Lift Bank C- follow the signs for 'Blood Tests'.

Scans

Most scans in the unit are done via a 'transvaginal' approach. This means the tip of the ultrasound probe is passed into the vagina. It is not in any way damaging to a developing pregnancy and should not be painful, although some women experience slight discomfort.

This scan can be done even if you are experiencing bleeding.

Women who are not pregnant or who are less than 12 weeks pregnant will be asked to pass urine before the scan, as your bladder must be empty.

Women who are more than 12 weeks pregnant will usually be scanned on your tummy (transabdominal), which requires your bladder to be full.

Waiting times

We will usually see you at your booked appointment time but please note some consultations can take longer than expected due to the nature of the situation.

For example, if a woman or couple suffers a pregnancy loss or the situation is more complicated, we may need to spend more time to offer an explanation and support.

Please bear with us-you will receive the same level of care during your consultation.

Some women who are seen in an emergency and also patients who are already admitted to hospital may need to take priority.

Children in the unit

Within The Elizabeth Suite we try to maintain a calm atmosphere for patients. For this reason we ask that you try to arrange alternative childcare for any young children or babies when visiting the unit.

Referrals, appointments and contacting us

All women seen for the first time in the unit require a referral from their GP or healthcare professional. We are not able to accept self-referrals or walk-ins. If you have previously been treated in the unit and we have advised you to have an early pregnancy scan please contact us directly for advice.

After your appointment

You will be given our contact details so you are able to call for blood test results or if you have any questions or concerns.

Our clinics are busy so we kindly advise you to please use the telephone number that applies to your query.

Evening and Saturday clinics

We run emergency clinics on some evenings and Saturday mornings. We do not usually have booked appointment slots for these sessions as they are reserved for patients who need to be seen urgently. You will need a referral from your GP or health professional for these clinics.

Research and teaching

As part of your visit to the unit you may be asked to take part in a research study. This is entirely voluntary and will not affect the care you receive.

The aim of our research is to work towards improving care for women in the future.

We do understand that, for various reasons, not all women will wish to take part. You will be given an information leaflet and time to think about your answer.

As a teaching hospital we aim to train the next generation of clinical staff. We therefore often have students observing and clinical staff training to develop skills within the area of early pregnancy and gynaecology care.

Early Pregnancy and Acute Gynaecology Unit (EPAG)

For further support when you are at home, contact your GP or call the specialist nurse.

Contact information
Early Pregnancy and Acute Gynaecology Unit
Chelsea and Westminster Hospital

T: 020 3315 5073 (admin queries only 9-12pm & 2-4pm Mon-Fri).

T: 020 3315 5070 (clinical queries only 12-2pm Mon-Fri).

Useful information

Miscarriage Association
W: www.miscarriageassociation.org.uk
T: 01924 200799
E: info@miscarriageassociation.org.uk

Patient Advice and Liaison Service (PALS)

If you have concerns or wish to give feedback about services, your care or treatment, you can contact the PALS office on the Ground Floor of the hospital just behind the main reception.

Alternatively, you can send us your comments or suggestions on one of our comment cards, available at the PALS office, or on a feedback form on our website www.chelwest.nhs.uk/pals.

We value your opinion and invite you to provide us with feedback.

Chelsea and Westminster Hospital

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Early Pregnancy and Acute Gynaecology Unit (EPAG)

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In the Elizabeth Suite-our Early Pregnancy and Acute Gynaecology Unit (EPAG)-we see and look after women who are referred to us in the early stages of pregnancy and those with gynaecology emergencies. For some women and their partners, a visit to an early pregnancy unit can be sad and distressing should they receive bad news-we ask that patients and relatives be mindful of this when in the unit.

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The services we offer and what to expect from your appointment

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Women experiencing early pregnancy complications can be referred to either of our early pregnancy units at the Trust. Between Chelsea and Westminster Hospital and West Middlesex University Hospital we see women for ultrasound scanning and arrange ongoing care if they have a problem with the pregnancy.

We also provide emergency care for acute gynaecology (non-pregnancy related) complications, only by referral from our Emergency Department. At the West Mid site, this is provided by the on-call team in the Ambulatory Emergency Care (AEC) Unit.

What we do

Our team of experienced specialist nurses, sonographers and doctors provide women within a one-stop service that may include:

Ultrasound scanning

Blood tests and results

Pregnancy complications counselling

Medical and surgical procedures, if needed, for a miscarriage or ectopic pregnancy

Follow-up care

Onward referral for specialist clinics as required

Acute gynaecology

We operate an appointment-only system, which means women should be referred by a healthcare professional (such as their GP or a doctor in the Emergency Department). The only exception to this is a history of previous ectopic pregnancy, when women can self-refer.

Women who require urgent medical assistance in early pregnancy should go to the Emergency Department for review by the on-call gynaecology team.

During the COVID-19 pandemic, we have measures in place to protect patients and staff from the spread of the virus while ensuring women receive the care and advice needed in the early stages of pregnancy. Please be aware that we will ask you to wear a face covering when attending your appointment and also to comply with our Trust policy on entering the building-a temperature check, regular hand hygiene and minimising your movement within the hospital. You will also be asked about any symptoms of COVID-19 so that we can take precautions during your visit.

Vaccination is recommended in pregnancy, but the decision whether to have the vaccine is your choice.

Women experiencing bleeding and/or pain, a history of ectopic pregnancy or those with recurrent miscarriage can be seen for assessment up to 18 weeks (up to 20 weeks at the Chelsea site) into the pregnancy-after this time they will be seen within the maternity unit.

All referrals will be triaged by clinical staff and patients will be provided with specialist care. Please note that this may not involve an ultrasound scan, if it is not appropriate. We are increasing our virtual clinic capacity where appropriate.

Your appointment

Please note we are unable to accept walk-ins-you must have a referral from your GP or the Emergency Department. However, if you have had a previous ectopic pregnancy, please contact our unit as soon as you know you are pregnant to arrange and plan the correct timing of your scan.

Ultrasound scans

The majority of scans we do in our units are done 'transvaginally' which means the ultrasound probe is placed into the lower part of the vagina for improved pelvic assessment. It is not harmful to a pregnancy. It is also safe for you and should not be painful. Please let staff know when you attend your appointment if you feel unable to complete a scan this way and your healthcare professional will discuss your options.

Waiting times

We always endeavour to see patients at their appointment time, however some consultations take longer than others and emergencies do arise. We always give the same level of expert care to our patients.

Children and visitors in our units

Within our units we try to maintain a calm atmosphere, especially for women who may be experiencing a pregnancy loss or other difficult news. During the COVID-19 pandemic, children are not permitted in the department.

One partner/support person may attend any of your scans. We continue to ask them to wait outside the clinic until the appointment starts to reduce the number of people in waiting areas. Visitors must comply with our Trust policy regarding a signed declaration on entering our buildings, temperature checks, face covering, regular hand hygiene and minimising movement within the hospital. This is to protect our patients and staff. Thank you for your understanding during this time.

Further information

If your scan has confirmed an ongoing pregnancy please make sure to book your pregnancy care.

Research

We are a research-active hospital and may invite you to take part in one of our research studies. These help us to improve the care we provide women in early pregnancy and gynaecology. This is entirely voluntary and whether or not you choose to take part will not affect your care and treatment. Please speak to a member of our team if you are interested in taking part in one of our studies.

Recruiting: CERM-chronic endometritis and recurrent miscarriage study

This research trial aims to find out if antibiotics can reduce miscarriage In some women the lining of the womb (the endometrium) is inflamed. This condition is called endometritis. Researchers have found a link between endometritis and miscarriage. A healthy endometrium is important for the embryo to be able to attach to the womb. Treating endometritis with antibiotics may reduce the inflammation and make a miscarriage less likely.

What does the trial involve?

We will take an endometrial biopsy (a small sample of tissue from your endometrium) to find out if you have endometritis.

If we find endometritis in the tissue we examine, you will be eligible to take part in a random study. You will be given either:

a 14-day course of an antibiotic (doxycycline), or

a 14-day course of a placebo (a 'dummy treatment' which will look exactly the same as the antibiotic but contains no active ingredients). This is necessary to find out if taking antibiotics reduces miscarriages.

Whether you receive doxycycline or the placebo is decided by chance.

You must agree to use condoms for three months (before the biopsy and while you are waiting for the results and taking the medication).

You may be able to take part in the trial if:

You are aged 18 to 42

You have had two or more miscarriages before the end of the 12th week of consecutive pregnancies, and

Your miscarriages are unexplained

Who we are

Our expert team of clinicians provides early pregnancy services at both hospital sites.

Chelsea and Westminster

Beth Cartwright (Lead Consultant)

Yemi Kuponiyi (Consultant Obstetrician and Gynaecologist)

Dede Ofili-Yebovi (Consultant Obstetrician and Gynaecologist)

Sharmistha Guha (Consultant Obstetrician and Gynaecologist, works cross-site)

Kirsten Lafferty (Clinical Fellow)

Georgina Merriner (Receptionist and Administrator)

Euphemia Osei-Tutu (Lead Clinical Specialist Nurse)

Hannah Kilpatrick (Clinical Specialist Nurse)

Sue Collins (Clinical Specialist Nurse)

Rebecca Naughton (Clinical Nurse Specialist)

Sonography Department Team (led by Ultrasound Superintendent Ankia Meiring)

West Middlesex University Hospital

Natalie Nunes (Consultant Obstetrician and Gynaecologist and Lead Consultant)

Menike Ekanayake (Sister Gynaecology Outpatients and EPU)

Anjali Sharma (Consultant Obstetrician and Gynaecologist)

Andrea Day (Locum Consultant Obstetrician and Gynaecologist)

Sonography Department Team (led by Superintendent Radiographer Alexandra Drought)

Contact information

Our early pregnancy units are sometimes very busy-if you are unable to contact us by telephone, please leave a message on the answerphone and we will call you back as soon as possible.

Chelsea and Westminster Hospital

We are open Mon-Fri, 9am-5pm. Please note our evening clinics are currently suspended but this will be reviewed as the coronavirus situation changes. Our Saturday morning diagnostic clinic is for early pregnancy complications-access to this clinic is only possible by attendance to our Emergency Department (A&E) during the preceding 24 hours.

The Elizabeth Suite
Early Pregnancy and Acute Gynaecology (EPAG)
4th Floor, Lift Bank B
Chelsea and Westminster Hospital
369 Fulham Road
London
SW10 9NH

Referrals: For GPs and health professions only-see this page

West Middlesex University Hospital

We are open Mon-Fri, 9am-5pm.

Early Pregnancy Assessment Unit (EPAU)
East Wing, 2nd Floor (main hospital building)
West Middlesex University Hospital
Twickenham Road
Isleworth
TW7 6AF

For further information and advice please see the links below or contact the unit on:

We are open Mon-Fri, 9am-5pm.

Referrals: For GPs and health professions only-see this page

For patients: Please complete this questionnaire once you have been given your appointment time and only once -any errors or extra information should be noted during your appointment.

Further information

Websites

Leaflets

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Women experiencing early pregnancy complications can be referred to either of our early pregnancy units at the Trust. Between Chelsea and Westminster Hospital and West Middlesex University Hospital we see women for ultrasound scanning and arrange ongoing care if they have a problem with the pregnancy.

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Latest updates about COVID-19
In line with planned changes to government COVID-19 restrictions, you can now have a second support person attend for labour and birth. They will be asked to complete the health declaration form and will only be able to be present in the birth areas. Only one support person is able to be present in theatre. You can also now have one person accompany you, if you feel that it is essential, to any of your pregnancy outpatient and scan appointments. This includes early pregnancy services and all midwifery and obstetric appointments in outpatient clinic settings.
In order to continue keeping everyone safe we ask the following:

If you wish to bring someone with you, we ask that it is the same person throughout your pregnancy journey, and confirm:

they are free of any symptoms of COVID-19

if they have had COVID-19, they must have completed their period of isolation

that you haven't been advised to self-isolate in the last 14 days when returning from travel abroad

We ask that you and your support person do a lateral flow antigen test 24 hours before your routine appointment and continue to complete these twice a week as recommended by NHS England. Your midwife or doctor will ask you to verbally confirm your test result on attendance at your appointment.

We will ask your support person to wait in a separate area or outside until your appointment begins. You will need to immediately call this person to come inside when your appointment begins to avoid clinics running late.

We ask for your help to comply with the above. This is because space in many of our women's health departments is limited and they can get very busy.

Please do not bring any children or other people with you to any appointments.

Please note: We are unable to maintain 2-metre social distancing in all our outpatient settings-in particular, the waiting areas. While you are welcome to bring your support person to all appointments, please consider whether this is essential to you. Reducing the number of times your support person comes with you will help us keep everyone safe.

Thank you for your help and understanding.

For more information including COVID-19 vaccinations please follow the below link:

We are passionate about the quality of care we provide and our woman-focused approach looks at your needs throughout each and every stage of your pregnancy. We provide maternity services at Chelsea and Westminster Hospital, West Middlesex University Hospital and in the community, supporting around 12,000 women a year who give birth with us. You can choose to plan to give birth at either of our hospitals or at home.

We aim to provide the best possible experience for mothers, babies and families, and are truly delighted that so many women not only choose to return to us for second and subsequent births, but also recommend us to family and friends.

The majority of women experience very normal pregnancies and birth journeys and we have a full range of options for maternity care. As well as our fantastic midwifery-led care we also provide an excellent obstetric model of care to include specialist support for more complex pregnancies and health conditions with an excellent fetal medicine unit. We are very proud of our teamwork ethic, where staff work together to plan and deliver one-to-one care tailored to the needs of individual women.

As a team we support each other across our two hospital sites and, although you will book at one of our hospitals, there are times when you may receive certain aspects of your care at our other hospital site. We will let you know should the need arise.

Together with our state-of-the-art facilities and initiatives that go beyond immediate health and care needs-for example, our complementary therapies service-we continually strive to give babies, parents and families everything they need for the best start in life.

Did you know?

More than 9 out of 10 women would recommend our maternity services at Chelsea and Westminster* and West Middlesex** hospitals.

* CW NHS Friends and Family Test score Nov 2018
** WM NHS Friends and Family Test score Nov 2018

Our service users rated us 9 out of 10 for labour and birth in the CQC Maternity survey (published Jan 2019).

Getting referred

To book your care with us you can either get referred by your GP, walk into our antenatal clinics at the hospitals, refer from the early pregnancy unit (EPU) or complete our self-referral form:

Care Information Exchange (CIE)

The CIE is a web application provided by PatientsKnowBest (PKB) that gives patients access to their health (medical) records, which can be updated by the patient and shared with different medical teams and carers to help speed up and improve treatment.

Your information is held in the secure NHS network. It will only be used by healthcare professionals for your direct care. You can choose to share your care record with your family, carers, GP and other health professionals if you wish.

Find us

Click an image below for directions and contact details:

Chelsea and Westminster Hospital

West Middlesex University Hospital

West Mid virtual tour

Safe in our hands

Our high quality, evidenced based, safe and nurturing care is provided by a team of dedicated healthcare professionals who centre the service around your individual needs, in line with our Trust PROUD values.

In collaboration with our North West London partners, and as part of our maternity transformation plans to implement the NHS five year vision, Better Births, we are working hard to ensure you have continuity from your care providers with good access to information that will enable you to make your own decisions about the care that is right for your own needs and circumstances.

Choosing a place of birth

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In line with planned changes to government COVID-19 restrictions, you can now have a second support person attend for labour and birth. They will be asked to complete the health declaration form and will only be able to be present in the birth areas. Only one support person is able to be present in theatre.

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Chelsea and Westminster Hospital NHS Foundation Trust

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© 2023 Chelsea and Westminster Hospital NHS Foundation Trust

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Find out what food and drink you can have and what you should avoid or be careful with during pregnancy, such as some cheeses, meats, fish, eggs, nuts, caffeine and alcohol.

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Your rights at work while you're pregnant

If you're working while you're pregnant, you need to know your rights to antenatal care, maternity leave and benefits.

If you have any worries about your health while at work, talk to your doctor, midwife or occupational health nurse.

You can also talk to your employer, union representative, or someone in the personnel department (HR) where you work.

Once you tell your employer that you're pregnant, they should do a risk assessment with you to see if your job poses any risks to you or your baby.

If there are any risks, they have to make reasonable adjustments to remove them. This can include changing your working hours.

If you work with chemicals, lead or X-rays, or in a job with a lot of lifting, it may be illegal for you to continue to work.

In this case, your employer must offer you alternative work on the same terms and conditions as your original job.

If there's no safe alternative, your employer should suspend you on full pay (give you paid leave) for as long as necessary to avoid the risk.

If your employer fails to pay you during your suspension, you can bring a claim in an employment tribunal (within 3 months). This wouldn't affect your maternity pay or maternity leave. The GOV.UK website has more information about maternity pay and leave.

You may worry about using computer screens in pregnancy. But the most recent research shows no evidence of a risk to your baby or pregnancy from visual display units (VDUs) on computers.

GOV.UK, Citizens Advice and Maternity Action have more information on pregnant employees' rights, including your right to paid time off for antenatal care and what to do if you feel you're being treated unfairly.

Coping with pregnancy symptoms at work

You might get more tired than usual, particularly in the first and last few weeks of pregnancy.

Try to use your lunch break to eat and rest. If travelling in rush hour is exhausting, ask your employer if you can work slightly different hours for a while.

Don't rush home and start another job cleaning and cooking. If possible, ask your friend, partner or a member of your family to help you.

Read more about tiredness in pregnancy.

If you're struggling with nausea and vomiting (morning sickness), you might be finding it hard at work.

You can ask your employer about working slightly different hours to avoid times when you feel worse, or working from home on days when the morning sickness is bad.

Speak to a GP or midwife if you feel particularly bad or unwell.

Read more about vomiting and morning sickness.

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Find out how to stay safe and healthy at work during pregnancy, and when you need to take extra precautions.

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It's perfectly safe to have sex during pregnancy unless your doctor or midwife has told you not to.

Having sex will not hurt your baby. A penis or penetrative sex toy cannot penetrate beyond your vagina, and the baby cannot tell what's going on.

However, it's normal for your sex drive to change during pregnancy. This isn't something to worry about, but it's helpful to talk about it with your sexual partner.

You may find having sex very enjoyable during pregnancy, or simply feel you don't want to. You can find other ways of being loving or making love. The most important thing is to talk about your feelings with your partner.

If your pregnancy is normal and you have no complications, having sex and orgasms won't increase your risk of going into labour early or cause a miscarriage.

Later in pregnancy, an orgasm or even sex itself can set off mild contractions. If this happens, you'll feel the muscles of your womb go hard. These are known as Braxton Hicks contractions and can be uncomfortable, but they're perfectly normal and there's no need for alarm. You might want to try some relaxation techniques or just lie down until the contractions pass.

When to avoid sex in pregnancy

Your midwife or doctor will probably advise you to avoid sex if you've had any heavy bleeding in this pregnancy. Sex may increase the risk of further bleeding if the placenta is low or there's a collection of blood (haematoma).

You'll also be advised to avoid sex if:

your waters have broken - it can increase the risk of infection (ask your midwife or doctor if you're not sure whether your waters have broken)

there are any problems with the entrance to your womb (cervix) - you may be at a higher risk of going into early labour or having a miscarriage

you're having twins, or have previously had early labours, and are in the later stages of pregnancy

If you or your sexual partner are having sex with other people during your pregnancy, it's important you use a barrier form of contraception, such as a condom, to protect you and your baby from sexually transmitted infections (STIs).

Good and bad sex positions during pregnancy

While sex is safe for most couples in pregnancy, it may not be all that easy. You will probably need to find different positions. This can be a time to explore and experiment together.

Sex with your partner on top can become uncomfortable quite early in pregnancy, not just because of the bump, but because your breasts might be tender. It can also be uncomfortable if your partner penetrates you too deeply.

It may be better to lie on your sides, either facing each other or with your partner behind. You may also want to try being on top during sex or being penetrated from behind while on your hands and knees. Use pillows to make yourself comfortable.

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Video: Sex during pregnancy

This video explores the myths surrounding sex during pregnancy.

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Find out about having sex safely in pregnancy, including positions that can be more comfortable and when you should avoid sex. With video.

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Chelsea and Westminster Hospital NHS Foundation Trust

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Information for patients

We are sorry that you have suffered a miscarriage. A Specialist Nurse or Doctor will be discussing the management options available to you.

There are 3 ways in which we can manage miscarriage:

Expectant

Do nothing and wait for the miscarriage to occur naturally

Surgical Having an operation to remove the pregnancy tissue from the womb, usually done as a day-case

Medical Using tablets to induce a miscarriage at home

This information sheet describes 'Medical Management' of Miscarriage.

What does Medical Management of Miscarriage involve?

You will be given a tablet called Mifepristone to take with water when you sign the consent form for medical management of miscarriage. Mifepristone works by blocking the action of the hormone which makes the lining of the womb hold onto the fertilised egg. You may start to experience some abdominal cramping or discomfort and can take some paracetamol for this. A very small number of women will miscarry after this first part.

You will be given a prescription for a second tablet called Misoprostol. This is a type of medication called a prostaglandin which works by relaxing the cervix (neck of the womb) and making the uterus contract. This process is similar to what happens in a natural miscarriage.

The dose of misoprostol used for medical management of miscarriage is 4 tablets (800 micrograms). 48 hours after the mifepristone these 4 tablets are inserted into the vagina and usually start to work within 4‐6 hours.

Success Rate

Medical management of miscarriage is likely to work in 52 ‐ 92% of women and it is more successful in women who have already started bleeding before the tablets are given (70 ‐ 96% success).

Risks

Up to 23 in 100 women will need to have an operation to surgically manage the miscarriage (sometimes called an SMM, surgical management of miscarriage). This may be required if vaginal bleeding becomes extremely heavy or there is tissue left behind in the womb after the treatment.

3-4 in 100 women, the medicines will not work. If this happens, we may offer you a second misoprostol or advise you to have a surgical management of miscarriage (SMM).

Infection - symptoms are a discoloured or smelly discharge, lasting pain or a temperature. You should contact us if you have any signs of infection.

Other side effects which can occur include diarrhoea, dizziness, headaches, nausea, vomiting and rash. All these symptoms are self-limiting and do not last long.

Intrauterine adhesions occur in 19 in 100 women regardless of the option chosen to manage your miscarriage. Most adhesions are mild (58 in 100 women). Current evidence suggests long term fertility also does not appear affected by the management option chosen.

At any stage, if you want to change your mind and want to have a surgical evacuation of the pregnancy (SMM), you would be able to do so.

The Treatment

Medications

Following your consultation you will be given:

A tablet of Mifepristone 200mg to take with water (use to start the miscarriage)

A prescription for the following medications:

Misoprostol 800 micrograms (4 x 200microgram tablets): the medication used to induce miscarriage

Co‐dydramol 10/500 2 tablets (pain relief): this is a pain medication which can be taken 4 times a day. It may cause drowsiness or nausea.

You should also buy Ibuprofen for pain relief which is available at most supermarkets and pharmacies, to be taken as 400 milligrams (2 x 200mg tablets) up to three times daily. It should be taken with food as it can irritate the stomach lining. Some women may not be able to take this type of medication if they have had gastritis, a stomach ulcer or have asthma.

The process

48 hours after taking the initial Mifepristone tablet in hospital you should insert the 4 Misoprostol tablets into the vagina as high up as possible. Once you have placed the tablets in the vagina you should then insert a tampon. This should be removed after 3 hours and sanitary pads used thereafter during the process.

You will usually start to have cramping lower abdominal pain (like bad period pains) and heavy bleeding within 4‐6 hours although it may sometimes take longer for things to start. You should expect to have very heavy bleeding and pass clots and tissue. We advise that you have another adult with you at home during the process to provide support. You should start taking the pain relief tablets (both types) at the time you insert the Misoprostol into the vagina. Other simple things such as a hot water bottle may help. You can eat and drink as normal, although you may experience some nausea.

The heaviest bleeding will usually last for no more than 12 hours. You may however continue to have some lighter bleeding afterwards for several days and up to two weeks. If you are experiencing extremely heavy bleeding please contact us (details below) for advice. In general you should come to the hospital (Accident and Emergency) if you are soaking more than 4 large sanitary pads an hour or if you feel unwell, dizzy or lightheaded.

If you have not had heavy bleeding within 48 hours of inserting the misoprostol tablets then please contact us and we will see you again and prescribe a second dose of the tablets. If heavy bleeding does not occur after this second dose then we will discuss with you whether you would like to proceed with alternative (surgical) treatment. You should seek medical attention if you experience any symptoms of infection at any time during the process (such as fever, offensive discharge or shivering).

After Care

You will be required to do a home urine pregnancy test 3 weeks after treatment. This is to check that the pregnancy hormone level has returned to normal, suggesting that all of the pregnancy tissue has been passed and the womb is empty. Please let us know the result of the test is positive, we will see you again for a review and ultrasound scan. If there is some retained tissue we may discuss surgical management with you depending on the amount and clinical situation. If there is some retained tissue we may discuss surgical management with you depending on the amount and clinical situation.

After a miscarriage, you should expect your next period after 4‐6 weeks. If you want to try for another pregnancy, we usually advice you wait for one normal period before trying, although it will not affect the pregnancy if you conceive before this. If you have not had a period within 6 weeks of the miscarriage you should contact the Early Pregnancy Unit for advice.

Emotional Recovery

You may feel low for a while after the miscarriage, but as your body returns to normal this usually settles. Look after yourself and give yourself time to recover. If you feel it would help to talk to someone about it, you may like to talk to our EPU Specialist Nurse or your GP. The Miscarriage Association is also a useful source of information and support - (www.miscarriageassociation.org.uk)

How to contact us:

If you have any concerns immediately after your treatment (the same evening or overnight), if you are worried about the amount you are bleeding, or if you don't feel well, you should contact us as follows:

Chelsea and Westminster Hospital

Elizabeth Suite (EPAG):

Tel: 020 3315 5073 (admin queries only 9-12pm & 2-4pm Mon-Fri).

020 3315 5070 (clinical queries only 12-2pm Mon-Fri).

Annie Zunz (Gynaecology Ward): Tel: 020 331 53906 (Out of Hours from 5PM)

West Middlesex Hospital

EPU 0208 321 6070 / 6506 - Mobile 07920020800 8AM - 5PM Monday to Friday.

Out of hours (on the day of the medication) 07879445042

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We are sorry that you have suffered a miscarriage. A Specialist Nurse or Doctor will be discussing the management options available to you.

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Pregnancy is a good time to think about what you’re eating. What you eat now will help your baby to grow healthily and give them the best start in life and help you to feel your best. This food Fact Sheet will help you make those good food choices.

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Eating a healthy, varied diet in pregnancy will help you get most of the vitamins and minerals you need.

But when you're pregnant, or there's a chance you might get pregnant, it's important to also take a folic acid supplement.

It's recommended that you take:

400 micrograms of folic acid every day - from before you're pregnant until you're 12 weeks pregnant

This is to reduce the risk of problems in the baby's development in the early weeks of pregnancy.

It is also recommended that you take a daily vitamin D supplement.

Do not take cod liver oil or any supplements containing vitamin A (retinol) when you're pregnant. Too much vitamin A could harm your baby. Always check the label.
You also need to know which foods to avoid in pregnancy

Where to get pregnancy supplements

You can get supplements from pharmacies and supermarkets, or a GP may be able to prescribe them for you.

If you want to get your folic acid from a multivitamin tablet, make sure the tablet does not contain vitamin A (or retinol).

You may be able to get free vitamins if you qualify for the Healthy Start scheme.
Find out more about the Healthy Start scheme

Folic acid before and during pregnancy

It's important to take a 400 micrograms folic acid tablet every day before you're pregnant and until you're 12 weeks pregnant.

Folic acid can help prevent birth defects known as neural tube defects, including spina bifida.

If you did not take folic acid before you conceived, you should start as soon as you find out you're pregnant.

Try to eat green leafy vegetables which contain folate (the natural form of folic acid) and breakfast cereals and fat spreads with folic acid added to them.

It's difficult to get the amount of folate recommended for a healthy pregnancy from food alone, which is why it's important to take a folic acid supplement.

Higher-dose folic acid

If you have a higher chance of your pregnancy being affected by neural tube defects, you will be advised to take a higher dose of folic acid (5 milligrams). You will be advised to take this each day until you're 12 weeks pregnant.

You may have a higher chance if:

you or the baby's biological father have a neural tube defect

you or the baby's biological father have a family history of neural tube defects

you have had a previous pregnancy affected by a neural tube defect

you have diabetes

you take anti-epilepsy medicine

you take anti-retroviral medicine for HIV

If any of this applies to you, talk to a GP. They can prescribe a higher dose of folic acid.

A GP or midwife may also recommend additional screening tests during your pregnancy.
Find out about epilepsy and pregnancy

Vitamin D in pregnancy

You need 10 micrograms of vitamin D each day. It's recommended pregnant and breastfeeding women take a daily supplement containing this amount between September and March.

Vitamin D regulates the amount of calcium and phosphate in the body, which are needed to keep bones, teeth and muscles healthy. Our bodies make vitamin D when our skin is exposed to summer sunlight (from late March/early April to the end of September)

Between the months of September and March the body cannot make sufficient vitamin D from sunlight alone, which is why a supplement is recommended.

Vitamin D is also in some foods, including:

oily fish (such as salmon, mackerel, herring and sardines)

eggs

red meat

Vitamin D is also added to some breakfast cereals, fat spreads and non-dairy milk alternatives. The amounts added to these products can vary and might only be small.

Because vitamin D is only found in a small number of foods, whether naturally occurring or added, it is difficult to get enough from foods alone.

Do not take more than 100 micrograms (4,000 IU) of vitamin D a day as it could be harmful.

You can get vitamin supplements containing vitamin D free of charge if you're pregnant or breastfeeding and qualify for the Healthy Start scheme.

There have been some reports about vitamin D reducing the risk of coronavirus (COVID-19). But there is currently not enough evidence to support taking vitamin D solely to prevent or treat COVID-19.

If you have dark skin or cover your skin a lot

You may be at particular risk of not having enough vitamin D if:

you have dark skin (for example, if you're of African, African Caribbean or south Asian origin)

you cover your skin when outside or spend lots of time indoors

You may need to consider taking a daily supplement of vitamin D all year. Talk to a midwife or doctor for advice.

Iron in pregnancy

If you do not have enough iron, you'll probably get very tired and may suffer from anaemia.

Lean meat, green leafy vegetables, dried fruit and nuts contain iron.

If you'd like to eat peanuts or foods that contain peanuts (such as peanut butter) during pregnancy, you can do so as part of a healthy, balanced diet unless you're allergic to them or your health professional advises you not to.

Many breakfast cereals have iron added to them. If the iron level in your blood becomes low, a GP or midwife will advise you to take iron supplements.

Vitamin C in pregnancy

Vitamin C protects cells and helps keep them healthy.

It's found in a wide variety of fruit and vegetables, and a balanced diet can provide all the vitamin C you need.

Good sources include:

oranges and orange juice

red and green peppers

strawberries

blackcurrants

broccoli

brussels sprouts

potatoes

Calcium in pregnancy

Calcium is vital for making your baby's bones and teeth.

Sources of calcium include:

milk, cheese and yoghurt

green leafy vegetables, such as rocket, watercress or curly kale

tofu

soya drinks with added calcium

bread and any foods made with fortified flour

fish where you eat the bones, such as sardines and pilchards

Vegetarian, vegan and special diets in pregnancy

A varied and balanced vegetarian diet should provide enough nutrients for you and your baby during pregnancy.

But you might find it more difficult to get enough iron and vitamin B12.

Talk to a midwife or doctor about how to make sure you're getting enough of these important nutrients.

If you're vegan or you follow a restricted diet because of a food intolerance (for example, a gluten-free diet for coeliac disease) or for religious reasons, talk to a midwife or GP.

Ask to be referred to a dietitian for advice on how to make sure you're getting all the nutrients you need for you and your baby.
Find out more about healthy eating if you're pregnant and vegetarian or vegan

Healthy Start vitamins

The Healthy Start scheme may be able to help you buy food and milk if you're pregnant or have a child under 4 years old and receive certain benefits, or you're pregnant and under 18.

If you're eligible, you'll be sent a Healthy Start card which you can use to buy certain types of milk, infant formula, fruit and vegetables.

You can also use your card to get free vitamins.

If you're not eligible for the Healthy Start scheme, some NHS organisations still offer the vitamins for free, or sell them. Ask a midwife about what's available in your area.

More information:

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Vitamins, minerals and supplements in pregnancy

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Find out about vitamins, minerals and supplements in pregnancy, including why you should take a folic acid supplement.

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Published: September 2016

Please note that this information will be reviewed every 3 years after publication.

This information is for you if you want to know more about bleeding and/or pain in the first 3 months of pregnancy.

It may be helpful if you are a partner, relative or friend of someone who has bleeding and/or pain in early pregnancy.

The information here aims to help you better understand your health and your options for treatment and care. Your healthcare team is there to support you in making decisions that are right for you. They can help by discussing your situation with you and answering your questions.

This information includes:

What you should do if you have bleeding and/or pain in the first 3 months of pregnancy

What will happen when you attend hospital

What could be causing bleeding and/or pain at this stage of pregnancy

What symptoms you should be aware of if you are being monitored

Further information and support available

Within this information, we may use the terms 'woman' and 'women'. However, it is not only people who identify as women who may want to access this information. Your care should be personalised, inclusive and sensitive to your needs, whatever your gender identity.

A glossary of medical terms is available at A-Z of medical terms.

Key points

Bleeding and/or pain is common in early pregnancy and does not always mean that there is a problem.

Bleeding and/or pain in early pregnancy can sometimes be a warning sign of a miscarriage.

If you have bleeding and/or pain in the early stages of pregnancy, you should seek medical advice.

You may be advised to have tests including an ultrasound scan to check your pregnancy.

If you have heavy bleeding, severe pain in your abdomen, pain in your shoulder, dizziness or fainting, you should contact your Early Pregnancy Assessment Service or nearest A&E department immediately.

Sources and acknowledgements

This information has been developed by the RCOG Patient Information Committee. It is based on the NICE Guideline Ectopic Pregnancy and Miscarriage: Diagnosis and Initial Management.

This information was reviewed before publication by women attending clinics in Liverpool, Chester, Prescot, Wrexham and Inverness, by the RCOG Women's Network and by the RCOG Women's Voices Involvement Panel.

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Bleeding and or pain in early pregnancy patient information leaflet

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A miscarriage is legally defined as the loss of a baby during the first 24 weeks. Going through a miscarriage can be extremely difficult. We’re here to answer your questions and support you as best as we can. Some people who experience a late miscarriage may feel that our information about stillbirth is more helpful.

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The Association of Early Pregnancy Units 

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The Association of Early Pregnancy Units 

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The aim of the Association of Early Pregnancy units ( AEPU) is to provide education and resources to healthcare professionals working in early pregnancy to improve / maintain standards in provision of care to women and their partners in early pregnancy.

Early pregnancy care involves doctors, nurses, ultrasonographers, midwives and support staff.

The AEPU was recognised by The Royal College of Obstetricians and Gynaecologists.

There are over 200 Early Pregnancy units across the UK in NHS hospitals.

Contact Email: aepu@rcog.org.uk

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The aim of the Association of Early Pregnancy units ( AEPU) is to provide education and resources to healthcare professionals working in early pregnancy to improve / maintain standards in provision of care to women and their partners in early pregnancy. Early pregnancy care involves doctors, nurses, ultrasonographers, midwives and support staff.

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Sands - Saving babies' lives. Supporting bereaved families.

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Sands supports anyone who has been affected by the death of a baby before, during or shortly after birth. Bereavement support is at the core of everything we do.

Sands is here to help you choose the right support for you. Some of the services that we offer include a Helpline for parents, families, carers and health professionals; a UK-wide network of support groups with trained befrienders; an online Facebook support group; a Sands online message board enabling bereaved families to connect with others and a wide range of leaflets, books and other resources available online and in print.

Although we don't offer counselling, our Helpline can help you find what is available in your area and help you request a referral from your GP.

Our free to call Helpline

The Sands National Helpline provides a safe, confidential place for anyone who has been affected by the death of a baby. Whether your baby died long ago or recently, we are here for you.

The telephone helpline is free to call from landlines and mobiles on 0808 164 3332.
Helpline calls are answered by trained bereavement support staff. If counselling is needed we recommend you seek support via your GP who can help you with a referral to your local team.
Language interpreters can be accessed via Language Line. If you are ringing to request support for for a non-English speaker please ring our Helpline and our staff will be happy to help.

The helpline team can also be contacted at helpline@sands.org.uk
Find out about more about our Helpline here
In 2017-18

The Sands Bereavement Support app

The Sands Bereavement Support app was created for anyone who has experienced the death of a baby.

It aims to help bereaved parents and families to find the right information and support at the right time. The app can also be used by healthcare professionals, who would like to know how best to support bereaved parents and their families.
Find out more about the App and how you can download here
Our Sands Groups

Many parents feel that only others who have experienced the death of a baby can offer real understanding. Our countrywide network of over 104 local support Groups, usually run by bereaved parents and family members, offer you the chance to meet others, gain support and share your experience.

Most Sands Groups offer either regular support meetings, telephone support or email support.

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Support for you | Sands - Saving babies' lives. Supporting bereaved families.

# data[].attributes.attachment_link.description
Sands supports anyone who has been affected by the death of a baby before, during or shortly after birth. Bereavement support is at the core of everything we do.

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We use cookies that help the website to function and also to track how you interact with it. We will only use the cookies if you consent to it by clicking on “Accept all cookies”. You can also manage individual cookie preferences.

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Chelsea and Westminster Hospital NHS Foundation Trust

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Nausea and vomiting in pregnancy—hyperemesis gravidarum

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Nausea and vomiting in pregnancy (NVP) is very common and affects up to 80% of pregnant women. It typically begins early in pregnancy (around the 4th–7th week), peaks at the 9th week and settles in most cases by 20 weeks. Occasionally, it can last until the end of pregnancy. A small number of women may suffer with more severe or prolonged symptoms which require hospital treatment. NVP can affect you at any time of day or night.

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Chelsea and Westminster Hospital NHS Foundation Trust

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A medical termination involves taking a tablet by mouth called mifepristone on one day and then two days later vaginal tablets called misoprostol.

The mifepristone tablet works by blocking the action of progesterone (the hormone needed to maintain a pregnancy) and sensitising the womb to the effects of misoprostol. The misoprostol tablets are put in the vagina and will induce a termination.

Visit to the hospital

You will attend the Outpatients Department 2 on the 1st floor at Chelsea and Westminster hospital on either a Monday afternoon or Wednesday morning.

You may have an ultrasound scan and blood test on the day of the appointment. If you have had a scan before, this does not need to be repeated. Blood tests are not always required.

You will then see the nurse and/or doctor for a consultation. If you are suitable, you will be offered a medical termination, which can be carried out at home.

Is this method suitable for me?

This method is suitable for patients who are less than 9 weeks pregnant but may not be suitable if you:-

Are under 18 years

Do not have someone at home to support you

Have significant medical problems

Are taking certain medications

Have had reactions to misoprostol or mifepristone

What will happen?

You will be given a tablet called MIFEPRISTONE by the doctor or nurse at the end of the clinic appointment.

You will then be given other medications each with instructions on.
2nd Day (usually approximately 36-48 hours later)
Two days later insert 4 tablets of MISOPROSTOL high up into your vagina. You can use your fingers or a cardboard tampon applicator to do this.

You can take 2 tablets of codydramol every 4 hours and 2 tablets of ibuprofen 200mg every 8 hours for pain if required.

If you are more than 7 weeks pregnant, after 4 hours take 2 more tablets misoprostol by mouth. You will have been given extra tablets to take. (Please note pregnancies are NOT dated from conception.)

In the evening you can start taking the 3 day course of the antibiotic called DOXYCYCLINE. The capsule is taken twice a day for 3 days and reduces the risk of infection.

Day 1: Mifepristone

If you vomit within 2 hours please call the number below, or come back to clinic as you will need to take another tablet.

Usually you will not have any symptoms after taking the mifepristone but some people can experience:

Crampy / period type pains / nausea / vomiting

Very occasionally you may start to bleed before you take the next tablets. There is a small chance of passing the entire pregnancy after taking the first medication.

If you experience crampy pains, you can take painkillers.

Day 2: Misoprostol

Misoprostol will cause cramping which will be painful. This will help your body pass the pregnancy. You can take co-codamol and/or ibuprofen to help with this pain. You will experience:

The pain builds up to a peak then will settle when the tissue is passed, usually within 6-8 hours.

You should have someone staying with you at home for the day and overnight.

The Medications

Mifepristone - this tablet will be given to you at the end of your clinic appointment by the doctor or nurse.

Misoprostol tablets: taken on day 2 (36-48 hours after the first tablet) - place the 4 tablets high up in the vagina. You can use a tampon applicator to help put them high into the vagina. If you are more than 7 weeks pregnant, you will take 2 more tablets of misoprostol by mouth 4 hours later.

Doxycycline is an antibiotic. One capsule is taken in the evening of the 2nd day and continued for 3 days (one tablet twice a day)

Pain relief: (check you are not sensitive to any of these)

Codydramol - you can take 2 tablets 4 times a day to help with the pain.

Ibuprofen 200mg -you can take 2 tablets 3 times a day.

You can take both codydramol and ibuprofen together.

What else to expect?

You will have heavy bleeding with pain and then this usually settles after 6-8 hours. You can continue to have light bleeding for up to 2-3 weeks.

If you experience heavy bleeding or severe pain at any time (using more than three pads soaked in an hour or any amount that you worried about), please call the helpline or attend accident and emergency and you will be referred to the gynaecologist on call for further assessment.

You can wear sanitary pads but do NOT use TAMPONS during the first week.

Please do a urine pregnancy test 3 weeks afterwards and if this is positive, please call the clinic booking number.

There is no evidence to suggest that a termination of pregnancy affects your future fertility. However, if you develop an infection and this isn't treated quickly, it could affect your fertility. If you have any symptoms of an infection such as fever, smelly discharge or an increase in bleeding after it has initially settled, you should see your GP, our clinic or accident and emergency to consider antibiotics.

You can get pregnant very quickly after a termination so you must start contraception as soon as possible. This will be discussed with you at your appointment in the hospital.

You will have your next period 3-6 weeks after the procedure.

It is also very difficult to predict how you will feel emotionally after this process. Some women feel sad and others feel relief. If you need support please contact your GP or our helpline.

Helpline telephone number: 020 3315 3905 / 3906

Clinic booking number (9am -5pm): 0203 315 8381

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A medical termination involves taking a tablet by mouth called mifepristone on one day and then two days later vaginal tablets called misoprostol. The mifepristone tablet works by blocking the action of progesterone (the hormone needed to maintain a pregnancy) and sensitising the womb to the effects of misoprostol.

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Manual Vacuum Aspiration (Surgical Management of Miscarriage Under Local Anaesthetic)

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Manual Vacuum Aspiration (Surgical Management of Miscarriage Under Local Anaesthetic)

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Chelsea and Westminster Hospital NHS Foundation Trust

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Surgical management of miscarriage is a minor procedure that is performed after an ultrasound scan shows that you have remaining pregnancy tissue inside the womb following a miscarriage or childbirth.

This was previously done primarily under a general anaesthetic but this can also be done while you are awake. A MVA is the way of removing the pregnancy or tissue from the uterus (womb) while you are awake.

MVA uses a narrow tube to enter and empty the uterus using aspiration (gentle suction). Local anaesthesia (pain relief) is injected into the cervix (neck of the womb) with the aim of reducing some of the sensation of pain.

Why have a MVA?

MVA does not involve general anaesthesia (anaesthesia which induces a state of deep unconsciousness). You attend a scheduled appointment time and will be able to go home from an hour after the procedure. Women therefore avoid the need for admission to hospital and the side effects of general anaesthesia.

MVA is offered to women in the following situations:

Delayed miscarriage (where a pregnancy has failed to develop normally but the pregnancy sac is still present within uterus [womb])

Incomplete miscarriage (where some of the pregnancy tissue remains inside the uterus [womb] even if the main pregnancy sac has passed naturally)

Retained products of conception (where some placental tissue remains in the uterus following childbirth)

Is MVA a new procedure?

No. MVA has now been performed for more than 30 years. Several studies of MVA have been reported from the United States, Europe and the United Kingdom. It has been shown to be a safe procedure, with high success rates and good patient acceptability where women overall are very satisfied with the procedure.

It offers an additional choice to women with miscarriage who want surgical management but also want to avoid a general anaesthetic.

What does an MVA involve?

Preparation

The procedure is explained to you and if you would like to proceed we complete a form in which you provide your written consent.

You will have blood tests done to check your blood group.

You should take some pain killers one to two hours before the procedure such as paracetamol, ibuprofen or something similar that you have at home.

You may also be given tablets (misoprostol) to keep under your tongue for 15 minutes one hour prior to the procedure, to help soften the cervix (neck of the womb).

Alternatively, these tablets can also be given to insert into the vagina.

You may start to have vaginal bleeding after using misoprostol. If bleeding is heavy, please contact EPU and come to hospital as soon as possible.

On the day of the procedure

If you have started bleeding prior to taking the misoprostol tablets, DO NOT take tablets - please call EPU nurse for advice or come to hospital if bleeding is heavy and does not settle. Please return any unused tablets to EPU for safe disposal.

Some women find the additional pain relief of Entonox helpful during the procedure. It is a mixture of oxygen and nitrous oxide gas you breathe in through a mouthpiece. It works in 20 seconds and the effect wears off just as quickly. Entonox is available at our Chelsea site.

You will have a speculum examination. This will allow the doctor/nurse specialist to assess the cervix (neck of the womb) and a local anaesthetic will be injected to help numb the cervix.

When you feel comfortable the womb will be emptied by a small syringe with a tube. The tube is guided by ultrasound scan. The ultrasound probe will be placed on your tummy while the procedure is being carried out. It enables us to confirm when all the pregnancy tissue has been removed and stop the procedure when the womb appears empty. You will not see the scan images.

You will hear suction noises so please do not be alarmed.

The doctor/nurse specialist may do an internal ultrasound scan to check that your womb is empty.

You will be offered an antibiotic to be taken by mouth as well as another as a suppository to reduce the chance of an infection.

How long will MVA take? What will I feel?

The whole procedure (including gently dilating the cervix) will take approximately 15-20 minutes. You may feel discomfort during the procedure (similar to a period pain). Should you feel severe pain or you feel you are not coping during the procedure please immediately inform the nurse or doctor looking after you.

What do I need to do before the MVA?

This is already covered under preparation. No additional preparation is needed

What happens after the MVA?

We will monitor you for up to one or two hours after the procedure in a quiet rest area. This includes blood pressure, pulse and any pain you may have. You can leave the department once you feel well enough to go home. We recommend someone escorts you home after the procedure. In selected cases, we may also advise you to perform a urine pregnancy test, 3 weeks after the procedure and we will contact you for the result. Alternatively, you can also contact your local Early Pregnancy Unit with the result; our contact details are at the bottom of this page.

You can expect some vaginal bleeding after the MVA. This usually settles within seven to fourteen days. You will need to contact your local Early Pregnancy Unit or nearest Accident and Emergency Department if you experience:

Excessive Bleeding(for example soaking one or more sanitary towels in one hour)

Fever (temperature greater than 38°C) or an offensive smelling discharge from the vagina

Fainting, persistent vomiting or severe abdominal pain

Persistent vaginal bleeding at 3 weeks after the MVA

We recommend you use sanitary towels instead of tampons and do not have sexual intercourse until the bleeding has fully settled. This reduces the risk of infection. You may return to work after 48 hours, or when you feel able. If your blood group is Rhesus negative you will need an injection of Anti-D. Please ask for further information on Anti-D, if required.

What are the options if I do not want MVA?

Other treatment options will be discussed with you by our team. These include:

Conservative management (waiting for the pregnancy to pass naturally)

Tablets to induce a natural miscarriage

Surgical removal of the pregnancy under general anaesthetic

How does an MVA compare to surgery under general anaesthetic?

Many studies have compared MVA to surgical evacuation under general anaesthetic. They show MVA to be equally effective. More than 97 out of 100 women having MVA will not require any further surgical treatment.

What are the possible complications of MVA?

MVA is safe but like all procedures there is a small risk of complications. The risk of complications with an MVA are similar to surgical uterine evacuation under general anaesthesia but without the complications caused by general anaesthetic.

Complications related to the procedure are uncommon or rare; they include:

Heavy bleeding (haemorrhage) (3%)

Infection (3%)

The need for a repeat operation if not all the pregnancy tissue is removed (3%)

Perforation (tear) of the womb that may need repair (less than 1 in 1000)

Adhesions or scar tissue within the womb.

If a perforation is suspected, we may need to look to see if there is any internal bleeding or internal damage to the bowel or bladder. This is done by a small cut on your tummy (abdomen) under general anaesthetic and inserting a telescope (laparoscopy).

During the MVA you may feel dizzy or light-headed. Please let the team looking after you know if this happens and the procedure will be paused until you feel better.

The risk of infection is the same with surgical (MVA or surgery under general anaesthesia), medical or conservative treatment options.

When can I get pregnant again?

Most women will have their next period within 4-6 weeks of the MVA procedure. We generally recommend that you wait for this before you start trying again.

Patient Advice & Liaison Service (PALS)

If you have concerns or wish to give feedback about services, your care or treatment, you can contact the PALS office in the main atrium or you can complete a feedback form on our website www.chelwest.nhs.uk/pals. We value your opinion and invite you to provide us with feedback.

WMUH: 020 8321 6261; wmpals@chelwest.nhs.uk

C&W: 020 3315 6727; cwpals@chelwest.nhs.uk

Useful contacts

Babyloss: UK-based resource of information and support for bereaved parents
The Miscarriage Association Crossway Pregnancy Crisis Centre
(Hounslow/Richmond ladies only)

Tel: 020 8892 8483 / 07776 482350
West Middlesex University Hospital (Early Pregnancy Unit)
Tel: 020 8321 (6070) or (6506), 07920 020800

The Elizabeth Suite, Chelsea and Westminster Hospital (Early Pregnancy and Acute Gynaecology Unit)

Tel: 020 3315 5073 (admin queries only 9-12pm & 2-4pm Mon-Fri).

Tel: 020 3315 5070 (clinical queries only 12-2pm Mon-Fri)

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Surgical management of miscarriage under local anaesthetic using manual vacuum aspiration

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Surgical management of miscarriage is a minor procedure that is performed after an ultrasound scan shows that you have remaining pregnancy tissue inside the womb following a miscarriage or childbirth. This was previously done primarily under a general anaesthetic but this can also be done while you are awake.

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Chelsea and Westminster Hospital NHS Foundation Trust

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A surgical termination is performed by suction where no cutting is involved. It is called surgical because it takes place in an operating theatre. This is in the Main Theatres at West Middlesex University Hospital.

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Surgical Management of Miscarriage Under General Anaesthetic

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Surgical Management of Miscarriage Under General Anaesthetic

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Chelsea and Westminster Hospital NHS Foundation Trust

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Surgical management of miscarriage

Following a diagnosis of miscarriage, you will be able to discuss the management options available to you. In some circumstances, surgical management may be recommended and is sometimes performed as an emergency procedure, for example if a woman is experiencing heavy bleeding due to a natural miscarriage.

The process of surgical management of miscarriage involves gently opening the cervix (neck of the womb) and removing the pregnancy from within the uterus (womb). There are some risks associated with this procedure but overall it is rare to have a major complication.

Before your operation

You will be booked to have your procedure on either a morning or afternoon operating list. We will not be able to give you the exact time of your operation as the order of the list is not set beforehand and will depend on various circumstances on the day.

Most women will have their operation in the Treatment Centre which is located on the ground floor close to liftbank B. Unfortunately, the unit is not able to accommodate partners or relatives, although there is a waiting area available.

Prior to your operation you will see a member of the gynaecology team who will discuss the procedure with you, explain possible complications and ask about your medical history. You will be asked to sign a consent form which is used to confirm you have understood the operation and the potential complications. You may be asked to have a blood test to determine your blood group and haemoglobin level.

A small number of women will have a natural miscarriage prior to their planned procedure. If you have significant bleeding before the operation, please contact the unit.

Some women may need a repeat scan to determine if the surgery is still required. If the bleeding becomes very heavy, you should attend as an emergency via the A&E department.

On the day of your operation

Surgical management usually involves having a general anaesthetic which means you will be asleep whilst the operation is performed. Depending on individual circumstances, some women will be given the option of having the procedure under local anaesthetic. This means you are awake and receive a series of injections to numb the cervix (neck of the womb) prior to the procedure.

Prior to a general anaesthetic you should be fasted (have not eaten) for a minimum period of 6 hours before to ensure your stomach is completely empty. If you are not fully fasted your procedure may need to be delayed to avoid potential complications of the anaesthetic.

If you are booked on a morning list, you should not eat or drink from midnight before (12am) on the day of surgery. You can eat and drink as normal before midnight. Please attend the Treatment Centre at 7.30am.

If you are booked on an afternoon list, you may have a light breakfast before 6am on the day of the operation but nothing to eat after this time. You can drink water up until 10am (water only 6am-10am). Please attend the Treatment Centre at 1200.

Whilst you are fasting please do not have chewing gum or smoke cigarettes (including vapour devices/e- cigarettes). If you take medication for pre-existing medical problems, take this as normal on the morning of your operation with a sip of water.

Please discuss this with the doctor you see prior to the surgery as there are a few medications that need to be stopped temporarily.

Before the operation you will be given four small tablets called Misoprostol. These tablets are inserted into the vagina prior to the operation to help soften the cervix ready for the procedure. The tablets should be inserted into the vagina in a similar way to a tampon.

If you are booked onto a morning list, please insert the tablets at 7am. If you are on an afternoon list, please insert the tablets at 11:30am.

After the tablets have been inserted it is common to get some cramps and vaginal bleeding so please wear a sanitary pad.

After your operation

After the operation you will need to recover from the anaesthetic and be observed for a short time. When you wake up you may have some abdominal pain or cramps for which you will be offered pain relief.

Once you are comfortable and have sufficiently recovered from the anaesthetic you will be able to go home. You will be given a single dose of oral antibiotics to help prevent an infection developing and some pain killers to take home with you.

After a general anaesthetic you must have another adult collect you and stay with you overnight after the procedure.

If you cannot arrange for someone to collect you please tell the early pregnancy unit team beforehand; we cannot allow patients to go home alone after an operation.

Recovery

After the operation you will have some vaginal bleeding which is usually no heavier than a period. This bleeding may go on for up to 3 weeks. During this time use sanitary towels rather than tampons and do not have sex. If you have a positive pregnancy test 3 weeks after your procedure or bleeding that goes on for longer than 3 weeks, please contact the early pregnancy unit. If you have severe abdominal pain, develop a fever or offensive smelling bleeding/discharge please attend the hospital as an emergency.

You will usually have a period within 4-6 weeks of the procedure-if you have not had a period after 6 weeks, please contact the unit to arrange a follow-up.

We recommend that you take some time off work at the time of the operation and are able to provide a medical certificate for your employer if required

Patient Advice & Liaison Service (PALS)

If you have concerns or wish to give feedback about services, your care or treatment, you can contact the PALS office on the Ground Floor of the hospital just behind the main reception.

Alternatively, you can send us your comments or suggestions on one of our comment cards, available at the PALS office, or on a feedback form on our website www.chelwest.nhs.uk/pals.

We value your opinion and invite you to provide us with feedback.

T: 020 3315 6727
E: cwpals@chelwest.nhs.uk Early Pregnancy and Acute Gynaecology Unit
Contact information

Chelsea and Westminster Hospital 369 Fulham Road

T: 020 3315 5073 (admin queries only 9-12pm & 2-4pm Mon-Fri).

T:020 3315 5070 (clinical queries only 12-2pm Mon-Fri).

Useful information

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Following a diagnosis of miscarriage, you will be able to discuss the management options available to you. In some circumstances, surgical management may be recommended and is sometimes performed as an emergency procedure, for example if a woman is experiencing heavy bleeding due to a natural miscarriage.

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This information is for you if you want to know more about nausea and vomiting of pregnancy or about hyperemesis gravidarum, which is the most severe form of the condition. It may also be helpful if you are a relative or friend of someone who is in this situation.

The information here aims to help you better understand your health and your options for treatment and care. Your healthcare team is there to support you in making decisions that are right for you. They can help by discussing your situation with you and answering your questions.

Within this information we may use the terms 'woman' and 'women'. However, we know that it is not only people who identify as women who may want to access this information. Your care should be appropriate, inclusive and sensitive to your needs whatever your gender identity.

A glossary of all medical terms is available.

Key points

Nausea and vomiting of pregnancy is a common condition that settles by 20 weeks in 9 out of 10 pregnant women.

Hyperemesis gravidarum is a severe form of this condition and can affect up to 3 in 100 pregnant women.

Nausea and vomiting and hyperemesis gravidarum can affect your mood, your work, your home and your social life.

While most women can be treated at home or as outpatients in hospitals, 1 in 5 affected women may need admission to hospital for treatment.

Several different anti-sickness medicines are available that may help your symptoms. While some of these medicines may not be licensed for use in pregnancy, they are considered safe for you and your baby.

Sources and acknowledgements

This information has been developed by the RCOG Patient Information Committee. It is based on the RCOG Green-top Clinical Guideline The Management of Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum.

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Pregnancy sickness (nausea and vomiting of pregnancy and hyperemesis gravidarum) | RCOG

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This patient information leaflet provides advice for women on pregnancy sickness.

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What is pregnancy sickness?

Pregnancy sickness is often called morning sickness, but it can occur at any time of the day or night. Despite sickness being an expected part of pregnancy, severity does vary from person to person. Sickness isn't always vomiting; nausea can be so debilitating that it effects your ability to eat and drink.

Sometimes symptoms go beyond the realm of 'normal' and your quality of life becomes impacted, at this point it's important to seek medical care. Reach out to us for information and support to help you cope and get the right treatment.
Read more about pregnancy sickness
What is hyperemesis gravidarum?

Hyperemesis gravidarum is a condition at the extreme end of the pregnancy sickness spectrum. It affects approximately 3% of pregnancies and is very debilitating for sufferers. HG strongly limits everyday activities; vomiting and/or nausea are severe.

It is important that you seek medical treatment if you are unable to keep any food or fluid down as you can become dehydrated very quickly. Often IV fluids are essential to become rehydrated, and medication is necessary to try and stabilise symptoms. Contact us to talk through your options and to help you advocate for yourself with your healthcare professionals.
Read more about HG

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Pregnancy Sickness Support home page - UK Charity

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Pregnancy Sickness Support UK Charity Supporting women with Morning Sickness Pregnancy Sickness and Hyperemesis Gravidarum

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Sickness in pregnancy (sometimes called morning sickness) is common. Around 8 out of every 10 pregnant women feel sick (nausea), are sick (vomiting) or both during pregnancy. This does not just happen in the morning.

For most women, this improves or stops completely by around weeks 12 to 20, although for some women it can last longer.

Some pregnant women experience very bad nausea and vomiting. They might be sick many times a day and be unable to keep food or drink down, which can impact on their daily life.

This excessive nausea and vomiting is known as hyperemesis gravidarum (HG), and often needs hospital treatment.

Exactly how many pregnant women get HG is not known as some cases may go unreported, but it's thought to be around 1 to 3 in every 100.

If you are being sick frequently and cannot keep food down, tell your midwife or doctor, or contact the hospital as soon as possible. There is a risk you may become dehydrated, and your midwife or doctor can make sure you get the right treatment.

Symptoms of hyperemesis gravidarum

HG is much worse than the normal nausea and vomiting of pregnancy.

Signs and symptoms of HG include:

prolonged and severe nausea and vomiting

dehydration - symptoms include feeling thirsty, tired, dizzy or lightheaded, not peeing very much, and having dark yellow and strong-smelling pee

weight loss

Unlike regular pregnancy sickness, HG may not get better by 16 to 20 weeks. It may not clear up completely until the baby is born, although some symptoms may improve at around 20 weeks.

See your GP or midwife if you have severe nausea and vomiting. Getting help early can help you avoid dehydration and weight loss.

There are other conditions that can cause nausea and vomiting, and your doctor will need to rule these out first.

See videos and written interviews of women talking about their experiences of hyperemesis gravidarum on the healthtalk website.

What causes hyperemesis gravidarum?

It's not known exactly what causes HG, or why some women get it and others do not. There is evidence that it is linked to the changing hormones in your body that occur during pregnancy.

There is some evidence that it runs in families, so if you have a mother or sister who has had HG in a pregnancy, you may be more likely to get it yourself.

If you have had HG in a previous pregnancy, you are more likely to get it in your next pregnancy than women who have never had it before, so it's worth planning in advance.

Treating hyperemesis gravidarum

There are medicines that can be used in pregnancy, including the first 12 weeks, to help improve the symptoms of HG. These include anti-sickness (anti-emetic) drugs, steroids, or a combination of these.

You may need to try different types of medicine until you find what works best for you.

You can visit the Bumps website to find out which medicines are safe to use in pregnancy.

If your nausea and vomiting cannot be controlled, you may need to be admitted to hospital. This is so doctors can assess your condition and give you the right treatment to protect the health of you and your baby.

Treatment can include intravenous fluids, which are given directly into a vein through a drip. If you have severe vomiting, the anti-sickness drugs may also need to be given into a vein or a muscle.

The charity Pregnancy Sickness Support has information and tips on coping with nausea and vomiting, including HG.

Will hyperemesis gravidarum harm my baby?

HG can make you feel very unwell, but it's unlikely to harm your baby if treated effectively.

However, if it causes you to lose weight during pregnancy, there is an increased risk that your baby may be born smaller than expected (have a low birthweight).

How you might feel

The nausea and vomiting of HG can impact your life at a time when you were expecting to be enjoying pregnancy and looking forward to the birth of your baby.

It can affect you both emotionally and physically. The symptoms can be hard to cope with. Without treatment HG may also lead to further health complications, such as depression or tears in your oesophagus.

Severe sickness can be exhausting and stop you doing everyday tasks, such as going to work or even getting out of bed.

In addition to feeling very unwell and tired, you might also feel:

anxious about going out or being too far from home in case you need to vomit

isolated because you do not know anyone who understands what it's like to have HG

confused as to why this is happening to you

unsure about how to cope with the rest of the pregnancy if you continue to feel very ill

If you feel any of these, do not keep it to yourself. Talk to your midwife or doctor, and explain the impact HG is having on your life and how it is making you feel. You could also talk to a partner, family members and friends if you want to.

If you want to talk to someone who has been through HG, you can contact Pregnancy Sickness Support's help section. They have a support network across the UK and can put you in touch with someone who has had HG.

Bear in mind that HG is much worse than regular pregnancy sickness. It is not the result of anything you have or have not done, and you do need treatment and support.

Another pregnancy

If you have had HG before, it's likely you will get it again in another pregnancy.

If you decide on another pregnancy, it can help to plan ahead, such as arranging child care so you can get plenty of rest.

You could try doing things that helped last time.

Talk to your doctor about starting medicine early.

Blood clots and hyperemesis gravidarum

Because HG can cause dehydration, there's also an increased risk of having a blood clot (deep vein thrombosis), although this is rare.

If you are dehydrated and immobile, there is treatment that you can be given to prevent blood clots.

Read more about how to prevent deep vein thrombosis.

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Find out about severe vomiting in pregnancy, the condition that affects around 1 to 3 in 100 pregnant women. It's also known as hyperemesis gravidarum, or HG.

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Published: September 2020

Please note that this information will be reviewed every 3 years after publication.

This information is for you if you have been diagnosed with molar pregnancy or another type of gestational trophoblastic disease (GTD).

Molar pregnancy is one of a number of different conditions that are called gestational trophoblastic disease (GTD).

These rare conditions happen when a pregnancy does not develop normally from the very beginning.

This information may also be helpful if you are a partner, relative or friend of someone in this situation.

The information here aims to help you better understand your health and your options for treatment and care. Your healthcare team is there to support you in making decisions that are right for you. They can help by discussing your situation with you and answering your questions.

This information covers:

What GTD and molar pregnancy are

When a molar pregnancy might be suspected

What happens when a molar pregnancy is suspected

Follow-up after treatment and why this is important

Information about gestational trophoblastic neoplasia (GTN), which can sometimes develop after GTD

Information about future pregnancies

Within this information, we may use the terms 'woman' and 'women'. However, it is not only people who identify as women who may want to access this information. Your care should be personalised, inclusive and sensitive to your needs, whatever your gender identity.

A glossary of medical terms is available at A-Z of medical terms.

Key points

GTD is an uncommon group of conditions that includes complete and partial molar pregnancies.

Molar pregnancy is an abnormal form of pregnancy that cannot develop into a healthy baby.

Treatment of a molar pregnancy is usually a small operation to remove abnormal pregnancy tissue from your uterus (womb).

Uncommonly molar pregnancy tissue can persist after surgery and you might need further treatment with chemotherapy.

Gestational trophoblastic neoplasia (GTN) is a rare form of cancer which includes invasive molar pregnancy.

You will be followed up in a specialist centre with expertise in the management of molar pregnancy and GTD.

Contacts and further information

National screening centres
Sheffield Trophoblastic Disease Centre
Weston Park Hospital
Whitham Road
Sheffield S10 2SJ

Tel: +44 114 226 5205

Email: sht-tr.trophoblastic@nhs.net

Website: www.chorio.group.shef.ac.uk

Charing Cross Trophoblastic Disease Service
Department of Medical Oncology
Charing Cross Hospital
Fulham Palace Road
London W6 8RF

Tel: +44 (20) 3311 1409

Email: hmole-chorio@imperial.nhs.uk

Website: www.hmole-chorio.org.uk

Scottish Hydatidiform Mole Service
NHS Tayside
Ninewells Hospital and Medical School
Dundee DD1 9SY

Tel: +44 1382 632748

Email: hmolescotland.tayside@nhs.net

Website: www.nss.nhs.scot/specialist-healthcare/specialist-services/hydatidiform-mole/

Further information
Molar Pregnancy - Support & Information Miscarriage Association RCOG patient information: Faculty of Sexual and Reproductive Healthcare guideline: Contraception After Pregnancy

Further information and resources for emotional support are available on the NHS website
www.nhs.uk/conditions/stress-anxiety-depression/

Sources and acknowledgements

This information has been developed by the RCOG Patient Information Committee. It is based on the RCOG guideline The Management of Gestational Trophoblastic Disease (Published September 2020). It contains a full list of the sources of evidence we have used.

Before publication this information was reviewed by the public, by the RCOG Women's Network and by the RCOG Women's Voices Involvement Panel.

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royal college of obstetricians and gynaecologists

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Molar pregnancy and gestational trophoblastic disease

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This patient information leaflet provides advice on molar pregnancy and gestational trophoblastic disease (GTD), a group of conditions that may occur when a pregnancy doesn't develop properly.

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2. What Is An Ectopic Pregnancy?

Medically Reviewed by:Jackie Ross BSc MB.BS MRCOG& Professor Andrew Horne MB ChB PhD FRCOG FRCP

Next review date: 01/11/2026

Written by: The Ectopic Pregnancy Trust

It occurs when an ovum (egg) that has been fertilised implants ("gets stuck") outside the cavity ("space") of the uterus (womb). The most common place for an ectopic pregnancy is the Fallopian tube but there are many other sites where an ectopic pregnancy can be located. It is, sadly, not possible to move an ectopic pregnancy into the uterus.

Each month, during the menstrual cycle, ovulation occurs where one of the ovaries produces an egg that is drawn into the end of the Fallopian tube by finger-like structures called fimbriae. The egg then makes its way along the Fallopian tube towards the uterus. During the course of this journey, if intercourse (sex) has occurred, it may encounter sperm, in which case it may become fertilised.

If it is fertilised, the egg implants itself into the lining of the uterus called the 'endometrium' and ultimately grows into a baby. If it is not fertilised, then both the egg and uterus lining are discharged in the menstrual flow (period), a fresh lining is prepared, and a new egg begins to mature within the ovary.

What happens if you have an ectopic pregnancy?

With an ectopic pregnancy, the fertilised egg becomes caught or delayed while progressing along the Fallopian tube. In this case, the pregnancy continues to grow inside the Fallopian tube where it can cause the Fallopian tube to burst or severely damage it. This can sometimes cause internal bleeding causing pain and requiring immediate medical attention.

How many are affected by the condition?

Each year in the UK nearly 12,000 women have ectopic pregnancies diagnosed (Source: The 2016 MBRRACE Confidential Enquiries into Maternal Deaths and Morbidity 2009-14). From anecdotal evidence, it is believed the number of cases of ectopic pregnancy may number more than 30,000 per year in the UK alone.

According to the 2019 MBRRACE Maternal Deaths and Morbidity Report 2015-17, of the six women who died from early pregnancy problems, all but one had ectopic pregnancies and all died within 48 hours of presentation with their ectopic pregnancy. Three of the six women who died (50%) were from Black or other ethnic minority groups (about 14% of UK population is from a Black or ethnic minority background). The 2022 MBRRACE Report 2018-20 shows that ectopic pregnancy remains the most frequent cause of maternal death in early pregnancy. The latest report shows that the death rate from ectopic pregnancy devastatingly has increased from five women dying to eight and all died within 48 hours of presentation with their ectopic pregnancy. You can read our statement here.
MBRRACE-UK Maternal Report 2016 MBRRACE-UK Maternal Report 2019 MBRRACE-UK Maternal Report 2022 Confidential Enquiry into Maternal Deaths
Sadly, there are on average three deaths per year in the UK and Ireland due to ectopic pregnancy. In the 21st century, no woman should die of an ectopic pregnancy. Depending on individual medical circumstances, several treatments are available. The pregnancy can never be saved.

The Ectopic Pregnancy Trust believes that the deaths and trauma associated with ectopic pregnancy should be prevented. We seek to relieve the distress associated with the experience and provide ongoing support through their treatment and beyond.

What are the different types of ectopic pregnancy?

95% are in the Fallopian tube - either ampullary (in the middle part of the Fallopian tube), isthmic (in the upper part of the Fallopian tube close to the uterus) or fimbrial (at the end of the tube)

3% are interstitial (inside the part of the Fallopian tube that crosses into the uterus)

< 1% are within a Caesarean section scar on the uterus

< 1% are cervical (on the cervix)

< 1% are cornual (within an abnormally shaped uterus)

< 1% are ovarian (in or on the ovary)

< 1% are intramural (in the muscle of the uterus)

< 1% are abdominal (in the abdomen)

< 1% are heterotopic pregnancies

This image shows where ectopic pregnancies are most likely to occur:

Types of Ectopic Pregnancy in more detail:

Tubal ectopic pregnancy - ampullary, isthmic and fimbrial Interstitial pregnancy Caesarean scar pregnancy Cervical pregnancy Cornual or Rudimentary horn pregnancy Ovarian pregnancy Intramural pregnancy Abdominal pregnancy Heterotopic pregnancy

Tubal ectopic pregnancy - ampullary, isthmic and fimbrial

The Fallopian tubes are small, hollow muscular tubes, each about ten centimetres long. The outer half lies next to, but not attached to, its ovary. The Fallopian tubes have a delicate mucous membrane lining inside the tube, thrown up into folds, which almost fill each tube. The diameter and the number of folds increase as the Fallopian tube nears the ovary and forms the fimbriae - tiny finger-like projections that move and create a suction effect to draw the egg to the Fallopian tube.

In the lining of the Fallopian tubes, half the cells are mucus-secreting and half have cilia - tiny hair like projections which waft gently to propel these secretions towards the uterus. The Fallopian tube has a natural peristaltic action (contraction and relaxation to create a pumping effect) which assists the movement of mucus.

An egg, released at ovulation, is picked up by the Fallopian tube fimbriae, and the Fallopian tube is responsible for the transport of the fertilised egg to the cavity of the uterus which takes about four days. If a pregnancy is as expected, a bundle of sixty-four cells reaches the uterus to implant six to seven days after ovulation, by which time the natural female hormones have prepared the uterine lining cells (endometrium). The embryo burrows into the endometrium and starts to form a placenta.

Where pregnancies do not reach the uterus, it is not difficult to imagine how the delicately folded Fallopian tube linings with specialised cells can become damaged by inflammation or infection, and/or the transportation of a developing embryo to the uterus may be slow for no obvious reason. In the meantime, the embryo is still trying to develop and has a natural invasive nature, so it can implant in the Fallopian tube or fimbriae to form a placenta, resulting in a potentially dangerous ectopic pregnancy.

Interstitial pregnancy

An interstitial pregnancy is a rare type of ectopic pregnancy that occurs when the fertilised egg implants in the part of the Fallopian tube as it crosses the wall of the uterus.

Pregnancies of this kind are difficult to diagnose as they may appear to be in the uterus on a scan or may be difficult to see on scan very early on. They are particularly dangerous if they are growing as they can progress further and tend to rupture later, having the potential to damage both the wall of the uterus and the Fallopian tube.

If diagnosed early enough, doctors may recommend medical treatment with methotrexate if suitable, as surgery for an interstitial pregnancy can involve surgery to the actual uterine wall and this could result in the uterus being weakened. Some interstitial ectopic pregnancies may not be growing and may even resolve without any active treatment.

It is possible to have successful uterine pregnancies after an interstitial pregnancy. Your doctor will assess you carefully and consider the need for an elective caesarean section to deliver any subsequent pregnancy and the preferred method of delivery will depend on the extent of the surgery necessary on the uterine wall to resolve the ectopic pregnancy.

Some doctors call interstitial pregnancies 'cornual' which is confusing, so the term 'interstitial' is preferred.

Caesarean scar pregnancy

Caesarean scar ectopic pregnancies are when the fertilised egg implants into the gap in the muscle of the uterus caused by a previous Caesarean section. The pregnancy may then grow out of the uterus or onto the cervix and cause torrential internal or vaginal bleeding.

In some pregnancies the placenta develops so that only part of it is within the scar and these pregnancies may proceed to delivery of a live baby, but with risk of significant bleeding from the mother and hysterectomy at the time of delivery.

The treatment of caesarean scar pregnancies is potentially difficult so management has to be individualised on a 'case by case' basis.

Most Caesarean scar pregnancies can be treated by removing the pregnancy using suction. If the pregnancy cannot be reached using suction, then keyhole surgery, or methotrexate injection/s can be used.

Research indicates that this kind of ectopic pregnancy appears to be increasing, possibly due to the impact of elective caesarean section delivery which was much less common 10 years ago than today. However, despite appearing to increase in incidence, they are still relatively uncommon and so some hospitals see very few of them. Accordingly, there are moves to focus care in these cases to regional units with experience of these cases both to optimise care and to collate information to make sure there is a better evidence base to inform treatment decisions in the future.

Cornual or Rudimentary horn pregnancy

This is another rare type of ectopic that only occurs in a uterus that has not formed as expected.

A uterus that develops as expected is when two halves join together. However, sometimes these two halves do not meet and this leaves one banana-shaped (unicornuate) side which is in contact with the cervix and vagina and another nubbin of uterus on the opposite side (that is not usually in contact with the cervix and vagina, called a rudimentary horn). Both sides have their own Fallopian tube. Sperm can reach deep inside via the one-sided uterus that is in contact with the vagina, but the opposite Fallopian tube may pick up the fertilised egg and transport it into the rudimentary horn.

Because the rudimentary horn often has a thick muscular wall, these pregnancies may advance into the second or even third trimester before they cause catastrophic rupture. The thick wall also makes them more difficult to diagnose, as the rudimentary horn may be assumed to be a normal uterus during an ultrasound scan.

Treatment is to terminate the pregnancy by surgically removing the rudimentary horn and its Fallopian tube. If the pregnancy is advanced, this is sometimes difficult to do without also removing the ovary on the same side.

A pregnancy in the uterine portion of the Fallopian tube of a uterus that forms as expected is called an interstitial pregnancy. This should not be confused with a cornual pregnancy.

Ovarian pregnancy

Ovarian ectopic pregnancies are the rarest type making up less than 1% of all ectopic gestations.

These are difficult to diagnose as they look very similar to a tubal ectopic pregnancy that is stuck to the ovary or a 'corpus luteum' which is the place that the egg was released from. This can mean that ovarian pregnancies are often not diagnosed until surgery.

The ovary is a highly vascular structure. An ectopic pregnancy located on or in the ovary will usually require surgery involving either the partial or complete removal of the ovary due to bleeding. If the ovary is partially removed, it may recover and continue to produce eggs as before.

However, even if it no longer produces eggs or is removed completely, the other ovary is perfectly capable of producing an egg every cycle, enabling the ability to conceive naturally in the future.

Do you or someone you know have symptoms?

Around 1 in 80 pregnancies are ectopic in the UK. Find out more about symptoms of an ectopic pregnancy.

Symptoms

Other pages you might find helpful

Are you experiencing symptoms that you think may be an ectopic pregnancy? Click here to find out more.

This section aims to help you make sense of some of the thoughts, feelings, and reactions you may be experiencing.

Help us support others by donating to The Ectopic Pregnancy Trust

This last year, the EPT has seen a drop in donations. Help us keep supporting those through the physical and emotional recovery of ectopic pregnancy by donating to our cause now. Every penny you donate will make such a difference!

Donate Now

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What Is An Ectopic Pregnancy? - The Ectopic Pregnancy Trust

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Ectopic pregnancy is a common, occasionally life-threatening condition that affects 1 in 80 pregnancies. Here we explain the different types of this condition.

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Ectopic Pregnancy Information from the RCOG 

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Ectopic Pregnancy Information from the RCOG 

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Because an ectopic pregnancy cannot lead to the birth of a baby, all options will end the pregnancy in order to reduce the risks to your own health.

Your options depend upon:

how many weeks pregnant you are

your symptoms and clinical condition

the level of βhCG

your scan result

your fertility status

your general health

your personal views and preferences - this should involve a discussion about your future pregnancy plans

the options available at your local hospital.

The treatment options for tubal ectopic pregnancy are listed below - not all may be suitable for you, so your healthcare professional should guide you in making an informed decision.

Expectant management (wait and see)

Ectopic pregnancies sometimes end on their own - similar to a miscarriage. Depending on your situation, it may be possible to monitor the βhCG levels with blood tests every few days until these are back to normal. Although you do not have to stay in hospital, you should go back to hospital if you have any further symptoms (see the section above on What are the symptoms of an ectopic pregnancy?). You should be given a direct contact number for the emergency ward or gynaecology ward at your hospital.

Expectant management is not an option for all women. It is usually only possible when the pregnancy is still in the early stages and when you have only a few or no symptoms. Success rates with expectant management are highly variable and range from 30% to 100%. This mainly depends on your pregnancy hormone levels, with higher serum βhCG levels associated with a lower chance of success.

Medical treatment

In certain circumstances, an ectopic pregnancy may be treated by medication (drugs). The fallopian tube is not removed. A drug (methotrexate) is given as an injection - this prevents the ectopic pregnancy from growing and the ectopic pregnancy gradually disappears.

Most women only need one injection of methotrexate for treatment. However, 15 in 100 women (15%) need to have a second injection of methotrexate. If your pregnancy is beyond the very early stages or the βhCG level is high, methotrexate is less likely to succeed. Seven in 100 women (7%) will need surgery even after medical treatment.

Many women experience some pain in the first few days after taking the methotrexate, but this usually settles with paracetamol or similar pain relief. Although it is known that long-term treatment with methotrexate for other illnesses can cause significant side effects, this is rarely the case with one or two injections as used to treat ectopic pregnancy. Treatment of ectopic pregnancy with methotrexate is not known to affect the capacity of your ovaries to produce eggs.

You may need to stay in hospital overnight and then return to the clinic or ward a few days later. You will be asked to return sooner if you have any symptoms. It is very important that you attend your follow-up appointments until your pregnancy hormone levels are back to normal. You are also advised to wait for 3 months after the injection before you try for another pregnancy.

Surgical treatment

An operation to remove the ectopic pregnancy will involve a general anaesthetic.

The surgery will either be:

Laparoscopy (known as keyhole surgery). Your stay in hospital is shorter (24-36 hours) and physical recovery is quicker than after open surgery. See the RCOG patient information Recovering well: information for you after a laparoscopy. Laparoscopy might not be an option for some women and your doctor will discuss this with you.

Open surgery (known as a laparotomy). This is done through a larger cut in your abdomen and may be needed if severe internal bleeding is suspected. You will need to stay in hospital for 2-4 days. It usually takes about 4-6 weeks to recover.

The aim of surgery is to remove the ectopic pregnancy. The type of operation you have will depend on your wishes or plans for a future pregnancy and what your surgeon finds during the operation (laparoscopy).

To have the best chance of a future pregnancy inside your uterus, and to reduce the risk of having another ectopic pregnancy, you will usually be advised to have your affected fallopian tube removed (this is known as a salpingectomy).

If you already have only one fallopian tube or your other tube does not look healthy, your chances of getting pregnant are already affected. In this circumstance, you may be advised to have a different operation (known as a salpingotomy) that aims to remove the pregnancy without removing the tube. It carries a higher risk of a future ectopic pregnancy but means that you are still able to have a pregnancy in the uterus in the future. You will be advised to have blood tests for checking your pregnancy hormone levels after salpingotomy as part of follow-up. Some women may need further medical treatment or another operation to remove the tube later if the pregnancy has not been completely removed during salpingotomy. The decision to perform salpingectomy or salpingotomy may sometimes only be made during laparoscopy under anaesthetic. There are risks associated with any operation: from the surgery itself and from the use of an anaesthetic. Your surgeon and anaesthetist will discuss these risks with you.

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Ectopic pregnancy patient information leaflet

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Published: May 2015

Please note that this information will be reviewed every 3 years after publication.

Updated: May 2022

This information is for you if you are pregnant and are thinking of travelling by air.

This information is for you if you are pregnant and are thinking of travelling by air. It may also be helpful if you are a partner, relative or friend of someone in this difficult situation.

The information is relevant for short haul (under four hours), medium and long haul (over four hours) flights.

If you are a member of a flight crew or you fly frequently as part of your work, you should seek additional advice from your occupational health department concerning your own situation.

The information here aims to help you better understand your health and your options for treatment and care. Your healthcare team is there to support you in making decisions that are right for you. They can help by discussing your situation with you and answering your questions.

Within this information we may use the terms 'woman' and 'women'. However, it is not only people who identify as women who may want to access this information. Your care should be personalised, inclusive and sensitive to your needs whatever your gender identity.

A glossary of medical terms is available at A-Z of medical terms.
Key points

Occasional air travel during pregnancy is not harmful for you or your baby as long as you are having an uncomplicated pregnancy

Long flights may increase your chance of developing a blood clot. There are things you can do to reduce your chance of this happening.

It is important to check the healthcare facilities that are available at your destination, in case you need any emergency care.

Sources and acknowledgments

This information has been developed by the RCOG Patient Information Committee. It is based on the RCOG Scientific Impact Paper Air Travel and Pregnancy (May 2013), which contains a full list of the sources of evidence we have used. You can find it online here.

This information was reviewed before publication by women attending clinics in London, the Channel Isles and Northern Ireland, and by the RCOG Women's Voices Involvement Panel.

A glossary of all medical terms is available on the RCOG website at: www.rcog.org.uk/womens-health/patientinformation/medical-terms-explained.

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royal college of obstetricians and gynaecologists

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Air travel and pregnancy patient information leaflet

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Published: June 2015

Please note that this information will be reviewed every 3 years after publication.

This information is for you if you want to know more about chickenpox and pregnancy.

It may be helpful if you are a partner, relative or friend of someone who has chickenpox or who has been in contact with chickenpox.

The information here aims to help you better understand your health and your options for treatment and care. Your healthcare team is there to support you in making decisions that are right for you. They can help by discussing your situation with you and answering your questions.

This information leaflet covers:

What chicken pox is, what the symptoms are and how you catch chickenpox

Vaccination

What to do if you come into contact with chickenpox while pregnant

What chickenpox might mean for you and your baby during pregnancy and after birth

What to do if you come into contact with, or develop, shingles during pregnancy

Within this information, we may use the terms 'woman' and 'women'. However, it is not only people who identify as women who may want to access this information. Your care should be personalised, inclusive and sensitive to your needs, whatever your gender identity.

A glossary of medical terms is available at A-Z of medical terms.

Sources and acknowledgements

This information has been developed by the RCOG Patient Information Committee. It is based on the RCOG Green-top Clinical Guideline Chickenpox in Pregnancy (January 2015). The guideline contains a full list of the sources of evidence we have used.

This leaflet was reviewed before publication by women attending clinics in East Sussex, South Yorkshire and London, by the RCOG Women's Network and by the RCOG Women's Voices Involvement Panel.

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Chickenpox in pregnancy patient information leaflet

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Published 3 August 2022

Please note that this information will be reviewed every 3 years after publication.

This information is for you if you want to know more about eating healthily in pregnancy.

It also gives you advice about using vitamin supplements before you get pregnant and during pregnancy.

The information here aims to help you better understand your health and your options for treatment and care. Your healthcare team is there to support you in making decisions that are right for you. They can help by discussing your situation with you and answering your questions.

Within this information, we may use the terms 'woman' and 'women'. However, it is not only people who identify as women who may want to access this leaflet. Your care should be personalised, inclusive and sensitive to your needs whatever your gender identity

A glossary of all medical terms is available on the page A-Z of medical terms.

Key points

Eating healthily during pregnancy will benefit both you and your baby

Supplements such as folic acid and vitamin D in pregnancy will also benefit your baby

There are certain foods which are less safe in pregnancy, which you should avoid. Your healthcare team will advise you about these.

Keeping healthy when you are having a baby may depend on both the amount and the type of food you eat before you become pregnant and during your pregnancy. Simply being a correct weight for your height does not necessarily mean that you are eating healthily.

Some foods are best avoided if you are planning to become pregnant or if you are already pregnant, as they may contain substances that could affect your baby's development.

To eat healthily, you should aim to do the following:

Base your meals on starchy foods such as potatoes, bread, rice and pasta, choosing wholegrain if possible.

Eat at least five portions of different fruit and vegetables every day. Potatoes do not count towards your five-a-day target, and a portion of pure fruit juice only counts as one of your five-a-day, no matter how much you drink.

Eat as little fried food as possible and avoid drinks that are high in added sugars and other foods such as sweets, cakes and biscuits that have a high fat or sugar content. Instead, eat fibre-rich foods such as oats, beans, lentils, grains and seeds.

Eat some protein every day; choose lean meat, and try to eat two portions of fish a week. If you do not eat meat or fish, lentils, beans, nuts, eggs and tofu are also good sources of protein.

If you feel hungry between meals, chose healthier snacks such as vegetables, small sandwiches, fresh or dried fruit.

Eat dairy foods for calcium or dairy alternatives, which are calcium-fortified and unsweetened.

Watch the portion size of your meals and snack. Avoid 'eating for two'.

Try to eat breakfast.

Limit your caffeine intake to as little as possible, and less than 200 milligrams (mg) per day, for example two mugs of instant coffee. Be aware that other drinks such as tea and energy drinks also contain caffeine. Ideally avoid caffeine or switch to decaffeinated versions of tea and coffee. This is because new evidence has shown that caffeine in pregnancy can be linked to pregnancy complications such as low birth weight, miscarriage and stillbirth.

Most women do not need any extra calories during the first six months of pregnancy. It is only in the last 12 weeks that they need to eat a little more, and then only an extra 200 calories a day, which is roughly the same as two slices of bread.

Sources and acknowledgements

This information has been developed by the RCOG Patient Information Committee. It is based on information from the NHS Choices website above and the RCOG scientific impact paper Nutrition in Pregnancy (September 2010), which contains a full list of the sources of evidence we have used.

This information has been reviewed before publication by women attending clinics in London, Sheffield and Kirkcaldy.

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healthy eating and vitamin supplements in pregnancy

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Healthy eating and vitamin supplements in pregnancy | RCOG

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Healthy eating and vitamin supplements in pregnancy
This information is for you if you want to know more about eating healthily in pregnancy. It also gives you advice on using vitamin supplements before and during pregnancy.

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Shared Decision Making

If you are asked to make a choice, you may have lots of questions that you want to ask. You may also want to talk over your options with your family or friends. It can help to write a list of the questions you want answered and take it to your appointment.

Ask 3 Questions

To begin with, try to make sure you get the answers to 3 key questions, if you are asked to make a choice about your healthcare:

1. What are my options?

2. What are the pros and cons of each option for me?

3. How do I get support to help me make a decision that is right for me?

*Ask 3 Questions is based on Shepherd et al. Three questions that patients can ask to improve the quality of information physicians give about treatment options: A cross-over trial. Patient Education and Counselling, 2011;84:379-85

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This patient information leaflet provides information about the effects of smoking during pregnancy and support available to help you to stop.

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Your Options in Managing an Ectopic Pregnancy

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Your Options in Managing an Ectopic Pregnancy

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Treating An Ectopic Pregnancy - The Ectopic Pregnancy Trust

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Treatment options for ectopic pregnancy, including Surgical Management, Expectant Management, and Medical Management with Methotrexate.

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Pregnancy of Unknown Location/Inconclusive scan 

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Pregnancy of Unknown Location/Inconclusive scan 

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Chelsea and Westminster Hospital NHS Foundation Trust

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If you have a positive pregnancy test but we have been unable to see the pregnancy with an ultrasound scan it is called a 'Pregnancy of Unknown Location' (PUL)/Inconclusive scan. We know this may be confusing at first and hope this leaflet helps to clarify things.

What does that mean?

In this situation there are three possible scenarios.

The pregnancy is too early to see on scan

Over the counter pregnancy tests can sometimes detect the pregnancy hormone before your next period is due. However, a pregnancy may not be seen on ultrasound until approximately 3 weeks after conception (about 5 weeks from your period). So women sometimes attend when it is too early for us to see anything on ultrasound scan.

An early miscarriage has occurred

If you have had bleeding it could be that an early miscarriage has occurred so that the pregnancy can no longer be seen within the uterus (womb) because it has already been passed.

Sometimes the pregnancy isn't growing at a normal rate, so it takes a longer time to see it and it ends as a miscarriage.

The pregnancy is outside the womb (uterus), most commonly in the fallopian tube - an ectopic pregnancy

This is the least likely possibility but if ignored an ectopic pregnancy is potentially life threatening. We need to treat all women as if they might have an ectopic pregnancy until we confirm a miscarriage with blood tests, or confirm a pregnancy seen developing within the womb.

What happens next?

To help us find out where the pregnancy is developing, we need to look at the pregnancy hormone (hCG) level and how much it increases over a 48-hour period. This may be repeated after 48 hours. It is important that these tests are done at the right time to help us establish the nature of the pregnancy and plan the best course of action. We may also look at another ovarian hormone (progesterone) which complements the hCG levels. In a very small number of women, we do not repeat blood tests and only advise a repeat urine pregnancy test in 2-3 weeks.

In a normal pregnancy that is in the womb (uterus) we expect the hCG hormone level to approximately double every 48 hours.

In an ectopic pregnancy (and in failing pregnancies in the womb) the hCG hormone level often does not double but rises or falls slightly or stays the same.

If a miscarriage has occurred, the hCG hormone level usually falls rapidly.

How we arrange follow-up?

If the hCG level has dropped significantly a miscarriage is likely to have occurred. In this situation we will normally ask you to check a home pregnancy test in 2-3 weeks. A further telephone consultation will take place at that time and we you will be asked to do a pregnancy test before the call.

You may be required to attend for a further scan and blood test if the pregnancy test is still positive.

Where the pregnancy hormone is increasing rapidly it is more likely the pregnancy is developing in the womb and we will normally see you for a further scan over the next coming days.

If the level is neither rising nor falling significantly, we need to monitor you more closely for signs of an ectopic pregnancy. This will involve further scans and blood tests

What might you expect in the next few days?

Depending on your own individual clinical situation, you might experience bleeding at home. This might be light or even quite heavy (but not more than a period or passing large clots). Even though we did not see an actual pregnancy on the ultrasound scan, the womb lining may still be quite thickened, and this can seem like 'tissue' when passed.

Many women will also experience some mild or moderate period type cramps if the pregnancy is unfortunately not successful (a miscarriage). But in all such cases the pain should settled with mild painkillers.

Important points

Every woman is assessed individually according to their symptoms and scan findings and the above notes are just guides to what you might expect. It is important that you attend all your follow-up blood tests to help us diagnose the outcome of your pregnancy.

We will advise you about follow up as necessary. Avoid any air travel until the location of your pregnancy has been confirmed. Review all travel plans so in an emergency you can access urgent medical care, ideally with the hospital specialists who know you best.

Who should I contact for advice or help?

We know this can be a stressful time when advised you have a pregnancy of unknown location. If you have any further questions or you are worried you should contact your local Early Pregnancy Unit. We may advise professional emotional support, or to see your GP. Our contact details are overleaf.

Who should I contact in an emergency?

Bleeding - heavier than a normal period or passing large clots

Offensive discharge - if the bleeding become smelly or you think you have a fever

Sharp pain in your abdomen - any pain that increases or does not settle with mild painkillers.

Feeling faint and dizzy

Pain in your shoulders

Diarrhoea / loose stools (in combination with any of the above).

If you have any concerns or you feel unwell, please contact us for advice or go immediately to your nearest Accident & Emergency.

Further information leaflets on miscarriage or ectopic pregnancy can be found here. https://www.chelwest.nhs.uk/services/womens-health-services/early-pregnancy-assessment-unit-epau

Patient Advice & Liaison Service (PALS) - Complements or complaints

If you have concerns or wish to give feedback about services, your care or treatment, you can contact the PALS office or you can complete a feedback form on our website www.chelwest.nhs.uk/pals. We value your opinion and invite you to provide us with feedback.

C&W: 020 3315 6727; cwpals@chelwest.nhs.uk

WMUH: 020 8321 6261; wmpals@chelwest.nhs.uk

Useful contacts
The Ectopic Pregnancy Trust
Website: www.ectopic.org.uk
The Miscarriage Association
Website: www.miscarriageassociation.org.uk
Crossways (Hounslow only) Listening Service
Website: https://www.crosswaypregnancy.org.uk

Website: https://cradlecharity.org
The Elizabeth Suite, Chelsea and Westminster Hospital
Tel: 020 3315 5070 or 0203 315 5073
West Middlesex University Hospital (Early Pregnancy Unit)
Tel: 020 8321 (6070) or (6506), 07920 020800

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Pregnancy of unknown location / Inconclusive scan

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If you have a positive pregnancy test but we have been unable to see the pregnancy with an ultrasound scan it is called a 'Pregnancy of Unknown Location' (PUL)/Inconclusive scan. We know this may be confusing at first and hope this leaflet helps to clarify things. In this situation there are three possible scenarios.

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Surgical Management of Tubal Ectopic Pregnancies

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Surgical Management of Tubal Ectopic Pregnancies

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Chelsea and Westminster Hospital NHS Foundation Trust

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An ectopic pregnancy is a pregnancy outside the cavity of the uterus (womb). In the UK, 1 in 90 pregnancies (just over 1%) is an ectopic pregnancy. Most ectopic pregnancies develop in the fallopian tubes (tubal pregnancy). But in rare cases, they can develop at other sites.

Diagnosis is made based on your symptoms, examination, blood tests and ultrasound scan.

Treatment options vary depending on the type and size of ectopic pregnancy that you have and the results of your tests.

What does surgery involve?

An operation to remove the tubal ectopic pregnancy involves a general anaesthetic. The surgery will either remove the tube containing the ectopic pregnancy (salpingectomy) or just remove the ectopic pregnancy and leave the tube behind (salpingotomy). To reduce the risk of another ectopic pregnancy you will usually be advised to have the tube containing the ectopic removed. Your surgeon will discuss this with you.

The surgery can be done in two ways:

Laparoscopy (key hole surgery)

Laparotomy (open surgery)

The type of operation you will have will depend on your wishes or plans for a future pregnancy and what your surgeon finds during the operation. This will be discussed with you. There are risks associated with any operation from surgery itself and from the anaesthetic. These will be discussed with you by your surgeon and anaesthetist.

What happens to my pregnancy remains?

To confirm that you have had an ectopic pregnancy, tissue removed at time of surgery is sent for testing in the laboratory. The healthcare team will discuss with you (and your partner) the options for sensitive disposal of your pregnancy remains and confirm your wishes.

An operation to remove the tubal ectopic pregnancy will involve a general anaesthetic.

The surgery will either remove the tube containing the ectopic pregnancy (salpingectomy) or just remove the ectopic pregnancy and leave the tube behind (salpingotomy). To reduce the risk of another ectopic pregnancy you will usually be advised to have the tube containing the ectopic removed. If you already have only one fallopian tube or the other tube doesn't look healthy, you may be advised to remove the ectopic pregnancy and leave the tube behind.

The surgery can be done in two ways:

Laparoscopy (key hole surgery)

Laparotomy (open surgery)

The type of operation you will have will depend on your wishes or plans for a future pregnancy and what your surgeon finds during the operation. This will be discussed with you. There are risks associated with any operation from surgery itself and anaesthetic. These will be discussed with you by your surgeon and anaesthetist.

On the ward

Official ward visiting times vary for each hospital: 2-7pm for West Middlesex University Hospital and 3-8pm for Chelsea and Westminster Hospital.

You will be reviewed by gynaecology doctors prior to discharge who can answer any questions you have and advise on what to expect in the coming weeks. If you have any concerns during this recovery period, please contact us in EPU for advice or attend A&E if you feel very unwell.

What happens to my dressings?

Dressings will be checked before discharge by nurses on the ward. The plan after will depend on the type of surgery you've had:

Laparoscopy (keyhole surgery) -They can be removed by yourself at home 3 days after discharge.

Laparotomy (open surgery) - Advice will be provided to you at time of discharge.

What happens to my stitches?

Your stitches are usually dissolvable and do not need to be removed. You will be given instructions if your stitches need to be removed. Please call the gynaecology ward or the EPU if you have any queries.

When should I return to work?

This will depend on the type of surgery you have had and how you recover. If you have had key-hole surgery, you will need 1 week while if you had an open operation, it will be 6 weeks.

What happens next?
Follow up appointments
It is important to attend your follow up appointments. If you have had a salpingotomy, you will be asked to do a hormone blood test in seven days, and this will be repeated until it is negative. If you had a salpingectomy, then you will be asked to do a pregnancy test in three weeks and inform your local EPU of the result.

What about future pregnancies?

The chances of having a successful pregnancy in the future are good. Even if you only have one fallopian tube, your chances of conceiving are not significantly different. However, your overall chance of having another ectopic pregnancy is increased and is about 1 in 7-10 (about 10%) compared with 1 in 90 (just over 1%) in the general UK population. You should call us as soon as you know you are pregnant and you will be offered an early ultrasound scan around 5 weeks to confirm the location of your pregnancy. If you do not want to become pregnant, please see your GP for appropriate contraception advice.

Support

The impact of an ectopic pregnancy is a very personal experience. It might mean coming to terms with the loss of your baby, with the potential impact on future fertility or with the realization that you could have lost your life. Each woman copes in her own way. If you feel you are not coping or getting back to normal, please contact us in your local EPU.

Patient Advice & Liaison Service (PALS)

If you have concerns or wish to give feedback about services, your care or treatment, you can contact the PALS office in the main atrium or you can complete a feedback form on our website www.chelwest.nhs.uk/pals. We value your opinion and invite you to provide us with feedback.

WMUH: 020 8321 6261; wmpals@chelwest.nhs.uk

C&W: 020 3315 6727; cwpals@chelwest.nhs.uk

Useful contacts
The Ectopic Pregnancy Trust
Tel: 020 7733 2653

Website: www.ectopic.org.uk
The Miscarriage Association
Tel: 019 2420 0799

Website: www.miscarriageassociation.org.uk

Crossway Pregnancy Crisis Centre (Hounslow/Richmond ladies only)

Tel: 020 8892 8483 / 07776 482350

Website: www.crosswaypregnancy.org.uk
West Middlesex University Hospital (Early Pregnancy Unit)
Tel: 020 8321 (6070) or (6506), 07920 020800

The Elizabeth Suite, Chelsea and Westminster Hospital (Early Pregnancy and Acute Gynaecology Unit)

Tel: 020 3315 5070 or 0203 315 5073

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Surgical management of tubal ectopic pregnancies

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Practical Information Information for patients

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Pregnancy of unknown location - further information from the Ectopic Pregnancy Trust

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Pregnancy of unknown location - further information from the Ectopic Pregnancy Trust

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Histopathological Examination and Sensitive Disposal Arrangements 

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Histopathological Examination and Sensitive Disposal Arrangements 

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As part of management of miscarriage, your team may offer examination of the pregnancy tissue under a microscope (histolopathological examination). This is routinely offered as part of surgical management but can also be offered in some circumstances for medical or expectant management if you wish. After examination, you have choices regarding the management of the pregnancy tissue that has been examined. This leaflet explains your options.

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Chelsea and Westminster Hospital NHS Foundation Trust

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This leaflet explains what your options are for what happens to your pregnancy remains.

Histopathology

After any surgical procedure to remove pregnancy remains after a miscarriage or ectopic pregnancy, or surgical removal of post-pregnancy retained tissue, we may recommend histological examination of these remains. This means that the remains are examined in the laboratory under a microscope. After histopathology examination, tissue block and slides will be retained in line with Royal College of Pathology guidelines.

Why is histopathology recommended?

This is done to confirm the presence of pregnancy remains and to ensure there are no changes of molar pregnancy. This is particularly important if no fetus is seen on a scan. We will contact you if the histopathology examination shows molar pregnancy. Molar pregnancy is a rare condition where there is an abnormal growth of the cells which should become the placenta. It affects around 1 in 600 pregnancies and needs follow up and sometimes treatment to ensure that it resolves and does not develop into a more serious condition.

Sensitive Disposal

After the histopathology examination is complete the pregnancy remains will be sensitively disposed of. The Trust can organise disposal by communal cremation or alternatively you can make private arrangements.

What are the options?

The hospital can arrange that your pregnancy remains are cremated. If you would like to know the details of the cremation service please contact the Mortuary (Chelsea and Westminster 020 8746 8225; West Middlesex 020 8321 5876). Please note that this is a combined cremation with other pregnancy remains. The cremations usually take place once a month. Unfortunately it is not possible to change the time or date of the service. It usually takes a few weeks for the mortuary at Chelsea and Westminster to receive pregnancy remains back from histopathology or cytogenetic testing so there can be some delay before the cremation occurs.

You may wish to make your own arrangements for a private burial or cremation. The crematorium or burial grounds will need a certificate confirming that the pregnancy ended before 24 weeks, which we can provide for you at the time of your procedure. If you are undecided and then decide later on to make your own private arrangements please contact Elizabeth Suite at Chelsea and Westminster or Early Pregnancy Unit at West Middlesex University Hospital for the certificate.

You may wish to consider taking your pregnancy remains home to bury yourself. Current national guidelines state that legally you can take the pregnancy remains home with you for burial outside of a cemetery, providing certain requirements are met:

It must not cause any danger to others

It must not interfere with any rights other people may have on the land

There must be no danger to water supplies or watercourses

There must be no chance of bodily fluids leaking into or onto adjoining land

The fetal tissue must be buried at a depth of at least 18 inches(45cm)

Permission must be obtained from the landowner if the parents do not own the land

Careful thought must be given when considering burial in a garden, taking into account what would happen if the parents moved house or the land is used for new purpose in the future. We suggest you use a plant container that you can move to another house if necessary. If this is your choice the Institute of Cemetery and Crematorium Management (ICCM) can provide you with additional information on this choice.

What if I cannot make a decision concerning the disposal of my pregnancy remains?

If you are undecided then we will keep your pregnancy remains in the Mortuary. Please contact the Mortuary (Chelsea and Westminster 020 3315 8225; West Middlesex 020 8321 5876) when you have made a decision. If we have not heard from you within one month then the pregnancy remains will be cremated.

Patient Advice and Liaison Service (PALS)

If you require information, support or advice about our services, you can contact the PALS office on the Ground Floor of the hospital just behind the main reception. Alternatively you can feedback your comments/suggestions on one of our comment cards, available at the PALS office, or on a feedback form on our website www.chelwest.nhs.uk/pals. We value your opinion and invite you to provide us with feedback.

Care at Chelsea and Westminster
Care at West Middlesex University Hospital
E: wmpals@chelwest.nhs.uk

Support

If you feel you require any further support or have any queries please do not hesitate to contact the Elizabeth Suite/ Early pregnancy team. A chaplain is also available for pastoral support.

Useful Contacts
Care at Chelsea and Westminster Hospital

Early Pregnancy Clinical Nurse Specialist: 020 3315 5070

Bereavement Midwife :0203 315 8341 or 07826 875721

Chelsea and Westminster Hospital Chaplaincy: 020 3315 8083

Care at West Middlesex University Hospital

Early Pregnancy Clinical Nurse Specialist : 0208 321 6070 /6506

Bereavement Midwife: 07741 704432

West Middlesex Hospital Chaplaincy: 0208 321 5447

Miscarriage Association
The Ectopic Pregnancy Trust

Institute or Cemetery and Crematorium Management

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Sensitive Disposal Arrangements and Histopathology Examination of Pregnancy Remains

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This leaflet explains what your options are for what happens to your pregnancy remains. After any surgical procedure to remove pregnancy remains after a miscarriage or ectopic pregnancy, or surgical removal of post-pregnancy retained tissue, we may recommend histological examination of these remains. This means that the remains are examined in the laboratory under a microscope.

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How do we investigate pain and bleeding in early pregnancy at Chelsea and Westminster?

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How do we investigate pain and bleeding in early pregnancy at Chelsea and Westminster?

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Chelsea and Westminster Hospital NHS Foundation Trust

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The Elizabeth Suite

In the Elizabeth Suite-our Early Pregnancy and Acute Gynaecology Unit (EPAG)-we see and look after women who are referred to us in the early stages of pregnancy (under 20 weeks gestation) and those with gynaecology emergencies.

All women seen for the first time in the unit require a referral from their GP or healthcare professional. We are not able to accept self-referrals or walk-ins. Once we have received your early pregnancy referral we aim to see you within 24 hours. We see many patients on the same day that they are referred.

Bleeding and Pain in Early Pregnancy

Bleeding and pain in early pregnancy can be distressing but doesn't always mean that there is a problem. However sometimes it can be an indication of a miscarriage or other early complications in pregnancy.

Bleeding in early pregnancy may be:

Normal (implantation bleed)

A sign of a miscarriage

Subchorionic haematoma

An ectopic pregnancy

A pregnancy of unknown location

Molar pregnancy

Of unknown cause

What to do if you have bleeding

If you have mild to moderate bleeding or pain, contact your GP or other healthcare professional looking after you (eg midwife, Assisted Conception Unit nurse) who will refer you to our unit. However, if you have:

Heavy bleeding

Severe pain

Feel dizzy or unwell

Please make your way to the closest emergency department (see section below 'When to attend the Emergency Department').

We advise that you use a sanitary pad and avoid using tampons. You can take paracetamol for pain relief if required.

Your appointment

At your appointment you will be seen by one of our specialist nurses, sonographers or doctors.

You may wish to bring along your partner, a relative or friend to the appointment. We ask that only one adult attends the consultation with you.

Within The Elizabeth Suite we try to maintain a calm atmosphere for patients. For this reason we ask that you try to arrange alternative childcare for any young children or babies when visiting the unit.

You will be asked about your symptoms and your medical history. A vaginal examination may be carried out to assess your symptoms. You may be offered an ultrasound to assess the pregnancy.

It isn't always possible to give you a clear answer as to what is happening with the pregnancy at the appointment. Sometimes we need to arrange further scans or perform blood tests.

Scans

The majority of the scans performed in the unit are done via a 'transvaginal' approach. This means the tip of the ultrasound probe is passed into the vagina.

It is not in any way damaging to a developing pregnancy and should not be painful, although some women experience slight discomfort. This scan can be done even if you are experiencing bleeding.

Women who are not pregnant or who are less than 12 weeks pregnant will be asked to pass urine before the scan, as your bladder must be empty.

Women who are more than 12 weeks pregnant will usually be scanned on your tummy (transabdominal), which requires your bladder to be full.

When to attend the Emergency department (ED)

If either before or after your appointment with us you experience any of the following we would recommend you present yourself to ED.

If your bleeding is heavy and continuous, for example if you are soaking more than two large sanitary pads an hour for 4 hours or more or passing large clots (golf ball size or larger)

If you have severe pain in your abdomen or pain in your shoulder

Feel faint/dizzy or unwell

After your appointment

You will be given our contact details so you are able to call for blood test results or if you have any questions or concerns.

Our clinics are busy so we kindly advise you to please use the telephone number that applies to your query.

Early Pregnancy and Acute Gynaecology Unit (EPAG)

For further support when you are at home, contact your GP or call the specialist nurse.

Contact information

The Elizabeth Suite
Early Pregnancy and Acute Gynaecology Unit
4th Floor, Lift Bank B

T: 020 3315 5073 (admin queries only 9-12pm & 2-4pm Mon-Fri)
T: 020 3315 5070 (clinical queries only 12-2pm Mon-Fri).

Useful information

Early Pregnancy Padlets

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In the Elizabeth Suite-our Early Pregnancy and Acute Gynaecology Unit (EPAG)-we see and look after women who are referred to us in the early stages of pregnancy (under 20 weeks gestation) and those with gynaecology emergencies. All women seen for the first time in the unit require a referral from their GP or healthcare professional.

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We are part of the national NHS 'Talking Therapies for Anxiety and Depression' service. We provide a range of talking therapies for people who feel anxious and worried, or down and depressed, provided by Central and North West London NHS Foundation Trust.

What do you need help with? Click here to start a referral and receive support tailored to your needs. To find out more about the service, watch the video below:

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Find out more about the types of problems that we could help with by clicking on the buttons below:

Around 1 in 5 people suffer from anxiety or depression every year.
Talking therapies provide people with support and treatment to overcome these difficulties.

If you think you might be anxious or depressed, then you can refer yourself by giving us a call, sending us an email, or using our online self-referral form. Find out if you're eligible for our services (and if not, where your nearest service might be) by clicking on the above self-refer button.

Or if you prefer, you can ask your GP, or any health professional, about the service and they can refer you to us. If English is not your first language we will provide interpreters, including British Sign Language interpreters for all your appointments.

Our how we can help pages can tell you about the types of talking therapies we provide and has information and resources which you may find useful. Visit our about us page to find out more about us and our services.

Standing Together

Our service as a part of the wider Central and North West London (CNWL) NHS Foundation Trust take equality and diversity seriously, and you can read a message from Chief Executive, Claire Murdoch on standing together here.

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CNWL NHS Talking Therapies provide free, confidential talking therapy and specialist mental health support.

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We all deal with things in different ways.

But if you are battling #stress, #depression or #anxiety and need more support, please know you are not alone.

You can refer yourself to Community Living Well for free. Find out how we can help: https://bit.ly/2FyYyTM

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Community Living Well | Working Together For Your Mental Health

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We all deal with things in different ways. But if you are battling #stress, #depression or #anxiety and need more support, please know you are not alone. You can refer yourself to Community Living Well for free. Find out how we can help: https://bit.ly/2FyYyTM

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Information on Blood Group Testing and Anti-D

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Information on Blood Group Testing and Anti-D

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"I had amazing service by the team here. They were so caring and gave me the best service possible! I’ve been in for surgery and was very nervous coming back especially as I had pain that was similar to the time when I needed surgery. The team here really looked after me!"

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"The care we received in the Elizabeth ward was exceptional. Our nurse Lorraine was so kind and made me and my partner feel so at ease."

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"I couldn’t be more grateful for the incredibly kind and knowledgeable team. They treated me with compassion and made me feel confident about my treatment options. Thank you to Lorraine and Sarah and the whole team."

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"Lorraine was kind, reassuring and compassionate throughout our visit. She talked us through everyone and explained it to us clearly. The staff at the reception desk were also friendly and helpful."

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Intrauterine Pregnancy of Uncertain Viability (IPUV)

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Intrauterine Pregnancy of Uncertain Viability (IPUV)

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Chelsea and Westminster Hospital NHS Foundation Trust

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Intrauterine Pregnancy of Uncertain Viability

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This leaflet answers some of the questions you may have if you have been told that you have an Intrauterine Pregnancy of Uncertain Viability (IPUV). If you have any further questions or concerns, please do not hesitate to speak to the doctors or clinical nurse specialists caring for you.

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Chelsea and Westminster Hospital NHS Foundation Trust

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This is a patient information leaflet for Subchorionic Haematomas.

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What Is An Ectopic Pregnancy? - The Ectopic Pregnancy Trust

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Ectopic pregnancy is a common, occasionally life-threatening condition that affects 1 in 80 pregnancies. Here we explain the different types of this condition.