What to expect from an early pregnancy assessment

Written by: Mr Keith Duncan
Edited by: Laura Burgess

It is recommended that all women should have an early pregnancy assessment during the first trimester of their pregnancy, especially those who are experiencing bleeding and pain, or women who have previously had a miscarriage or ectopic pregnancy. We were fortunate enough to ask consultant obstetrician and Director of The Chelsea Birth Clinic, Mr Keith Duncan, to explain more about having an early pregnancy assessment and what you can expect.



What is an early pregnancy assessment?

An assessment of early pregnancy would normally involve your last period and various symptoms of pregnancy that you might have had, in particular, if there is any pain or bleeding. We would also note if there is a history of any previous pregnancies, whether successful, or if there has previously been a miscarriage or ectopic pregnancy, where a fertilised egg implants on the outside of the womb, usually in one of the fallopian tubes. The fallopian tubes connect the ovaries to the womb and if an egg is stuck it means that the baby will not develop and usually, needs to be removed by operation.


In modern times, we would then admit the woman into the early pregnancy unit if they are bleeding and following this, a pregnancy test can be taken and a transvaginal ultrasound is normally performed, which can ensure that the pregnancy is within the uterus.


We can also note the number of foetuses and check the fallopian tubes to ensure there is not an ectopic pregnancy. If there are any doubts about the viability of the pregnancy, or of the location, then quantitative hCG levels can be taken via a blood test, which measures the specific levels of the hormone human chorionic gonadotropin, to see how the pregnancy is progressing. If it is without uterine progression, we then know that further intervention may be required.


Who might need to have an early pregnancy assessment?

It is very useful for all pregnant women to have an early pregnancy assessment between six to eight weeks to exclude ectopic pregnancy, confirm dates and viability, and numbers of pregnancy. Those who have had previous miscarriage, ectopic or any pain or bleeding, should have an early pregnancy assessment. 

How long does the assessment take and can my partner come with me?

Assessment usually takes between 20-30 minutes and involves medical history-taking, scan and blood tests. As it is normally quite an anxious time, we would always advise having a partner or friend there with you in case there is bad news. It is always nice to see the fetal heart together, in particular, if you have had previous problems.


What kind of tests and scans are made?

The transvaginal scan looks at the pregnancy through the cervix, looking for and confirming that the pregnancy is in the uterine and not ectopic. If there are any questions or concerns about this, it can be followed up with a hCG blood test to check the progestogen levels, which can help give reassurance if the pregnancy is good. 


What happens afterwards?

Following the scan, an appropriate and individual management plan will be made. This normally requires further scanning in seven to ten days if there were any questions, and a further quantisation of hCG level, which should normally double over 48-hours.


If you would like Mr Duncan to be the specialist to support you throughout your high-risk pregnancy, or for him to aid you during water births, hypnobirthing or perform caesarean, visit his Top Doctor’s profile and make an appointment now for a consultation. 




By Mr Keith Duncan
Obstetrics & gynaecology

Mr Keith Duncan is a highly expert and leading consultant obstetrician and director of The Chelsea Birth Clinic, London. With over 30 years' experience, Mr Duncan has delivered more than 3,000 babies both in the NHS and as one of Europe’s top private obstetricians. Mr Duncan’s expertise are in the area of caesarean, childbirth, antenatal care, multiple pregnancies, ultrasound, and high-risk pregnancies.  

Mr Duncan graduated in 1989 with a bachelor of medicine and chemistry (MB ChB) from Leeds University, and went on to undertake training in the North of England before relocating to London for his specialist training in maternal and foetal Medicine. Since 2003, he has held his NHS role as consultant in Chelsea and Westminster Hospital. In 2001, he was awarded accreditation as a sub-specialist in maternal and foetal medicine. 

Together with his personable and calm approach have gained him the reputation as a brilliant practitioner in multiple and high-risk birth situations. He is renowned for his hands-on approach, down-to-earth manner and meticulous attention to detail, making him a popular choice with both first-time mothers and a loyal following of repeat patients. He is a strong supporter of personal choice in childbirth and listening to the individual needs and wishes of each patient. Whether it’s water births, caesareans or hypno-birthing, his philosophy is to provide a positive birth experience for all parents to be. 

As a member of the British Maternal Foetal Medicine Society, he served as the representative for London and the southwest at the prestigious Royal College of Obstetricians and Gynaecologists, taking an active interest in global women’s health, ultrasound scanning, and development in utero.  

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