The purpose of ISARIC CCP-UK (International Severe Acute Respiratory and emerging Infection Consortium Clinical Characterisation Protocol United Kingdom) is to prevent illness and deaths from infectious disease outbreaks.

It is a global federation of clinical research networks, providing a proficient, co-ordinated, and agile research response to outbreak-prone infectious diseases. The Clinical Characterisation protocol (CCP) is designed for any severe or potentially severe acute infection of public health interest and feeds into the data collated by ISARIC.

The protocol allows data and biological samples to be collected rapidly in a globally-harmonised manner. It has been previously initiated in response to other acute infections, including MERS-CoV and Ebolavirus, and has now been initiated in 2020 for COVID-19.

All patients admitted to the Trust with a diagnosis of COVID-19 are enrolled with data collected on demographics, co-morbidities, signs, symptoms, treatments and outcomes.

A subset of patients will be consented into sub studies which will include additional biological sampling. This data can be combined globally to provide information on those most at risk, common signs and symptoms and also help establish treatments.

The GenOMICC (Genetics of Susceptibility and Mortality in Critical Care) study seeks to identify the specific genes that cause some people to be susceptible to specific infections and consequences of severe injury.

When a patient is already sick, different genetic factors determine how likely they are to survive, and our genes are what determine how susceptible we are to life-threatening infection.

Susceptibility to COVID-19 is almost certainly, in part, genetic. By identifying these genes, we should be able to determine the best use of existing treatments, and design new treatments to help people survive critical illness. This will be achieved by comparing DNA and cells from carefully selected patients with samples from healthy people.

GenOMICC was designed for this crisis. Since 2016, the open, global GenOMICC collaboration has been recruiting patients with emerging infections, including COVID-19. All patients with confirmed COVID-19 in critical care are eligible for this study.

GenOMICC is prioritised as an NIHR Urgent Public Health Study in the UK.

North Bristol Trust: Thrombectomy Referral Criteria – External Hospitals

Thrombectomy service for patients from the Severn region, England operate 24/7.

Referrals from outside Severn and Wales should be discussed with your nearest thrombectomy centre. If the referral time falls outside operating hours for your nearest thrombectomy centre then please discuss with us via referapatient. 

Referrals should be made via Homepage (referapatient.org) to North Bristol Trust in the first instance

   (Search ‘Mechanical Thrombectomy’ and ‘Southmead Hospital’)

If no response is received in 10 minutes, please phone the thrombectomy phone directly

 07784 359723

In case of difficulties, alternative contacts are stroke registrar bleep 1490, or ANPs 0117 9549092.

Before referral, the following should have been carried out:

• Upload of all new brain imaging to cloud portal (Biotronics 3Dnet).
• Input all referral information via: Homepage (referapatient.org)
• Where intravenous thrombolysis is indicated this should not be delayed.

Referrals should fulfil all of the following criteria:

Clinical

• NIHSS >= 6 or disabling/fluctuating deficit
• Independent before the index stroke (modified Rankin Scale 0-2).
• Fit for emergency transfer. If concerns exist regarding patients being safe for inter-hospital transfer seek advice from local anaesthetic / critical care team
• Sufficiently well to benefit from treatment. This includes co-morbidities and frailty; while age influences fitness for treatment age does not by itself limit capacity to benefit.

Radiological

• All patients should undergo a NCCT and CTA with coverage from aortic arch to the vertex*
  • This should be uploaded to Biotronics 3DNet routinely,
  • This should have a local diagnosis of an LVO (carotid-T, M1, proximal M2 or tandem occlusions) via a consultant radiologist or automated post processing tool such as Rapid or Brainomix.

*Multi or dual phase CT angiography is preferred.

• For patients arriving at Southmead within 6 hours:
  • NCCT and CT angiography is required.

• For patients arriving at Southmead within 12 hours:
  • NCCT and CT angiography is required. 
  • Minimal early ischaemic change required (defined as NCCT ASPECTS >= 3 if perfusion imaging is not available locally).
  • Additional CT perfusion with automated post processing is preferable.

• For patients arriving at Southmead between 12 and 24 hours:
  • NCCT, CT angiography and CT perfusion is required. 

NOTE:   If a patient does not fulfil the above criteria but it is felt that they would benefit from treatment, for example young patient with large ischaemic core, basilar occlusion, referrals will still be considered

Please ensure a ReSPECT  form has been completed prior to transfer

What is diabetes?

Diabetes means the body can no longer control the level of glucose (sugar) in the blood. Our bodies make insulin (a hormone) which allows glucose in the blood to be used by the body for energy. In diabetes:

• The body doesn’t produce any insulin, or        
• The body doesn’t produce enough insulin, or            
• The body cannot use insulin efficiently (most common)

The body particularly struggles to use insulin when you are unwell. 

Aims of this page

When a person with diabetes is unwell, glucose levels often rise as a result of the illness.  High glucose levels can lead to further problems and a longer stay in hospital.  For this reason, your diabetes medication may need to be adjusted. You will have help to do this in hospital. It is also important that you continue to follow a healthy balanced diet.

The information on this page is designed to help you to:

• Understand the importance of a healthy balanced diet in diabetes
• Understand North Bristol NHS Trust’s menus
• Understand the importance of making an individualised choice at mealtimes

Does it matter what I eat?

Yes. What you eat affects the levels of glucose and fat in your blood, your blood pressure and your weight. It is therefore important to follow a healthy, balanced diet. The below recommendations are the same as for the general population. 

Healthy eating involves:

• If you are overweight, try to lose some weight (when you are well).
• Eat at regular intervals during the day i.e. breakfast, midday and evening meal. Don’t miss meals.
• Include starchy food (carbohydrate) at each meal (approximately one quarter to one third of the plate). Aim to have about the same amount of starchy food each day. Go for wholegrain, high fibre options where possible.
• Have two or three portions of vegetables each day.
• Have two or three portions of fruit spread throughout the day.
• Limit foods with a high fat content.
• Cut down on sugar, sugary foods and sugary drinks (this includes smoothies and fruit juice).
• Drink alcohol in moderation.
• Cut down on salt.
• Special diabetic foods are not necessary.

Further information is available on healthy eating with diabetes.

Is there a diabetes specific menu in hospital?

No. Healthy eating recommendations are the same as for the general population. There is no need for a specific ‘diabetes menu’ or meal options to be coded as ‘suitable for individuals with diabetes’. The main menu at Southmead Hospital offers a variety of options that allows a person to eat a balanced diet. 

Please note some main courses from the menu already contain a portion of starchy carbohydrates. For example, cheese and potato pie already has a portion of carbohydrate in it in the form of potato. In this instance, you may wish to choose two vegetable side dishes rather than a further potato, pasta or rice accompaniment.

Menu options which contain high amounts of sugar should be limited

Some options on the menu are higher in calories and sugar. Examples include: fruit crumbles, sticky toffee pudding, bread pudding or parkin cake, sponge puddings, rice pudding, chocolate crunch etc

Due to their high sugar content, these options may significantly increase blood glucose levels. Intake of these options should be limited. Small portions of these can be enjoyed occasionally.

Lower sugar and calorie alternatives include:

• Fruit in natural juices
• A portion of stewed fruit
• A small pot of yoghurt

Some patients in hospital may be identified as being at ‘higher nutritional risk’:

• If the patient is underweight.
• If the patient has recently lost weight.
• If the patient has a poor appetite and intake (how much food they eat).

These patients are encouraged to increase the amount of food they eat. They will benefit from having some of the higher calorie and sugar options, as noted above. This is not the case for everyone in hospital and meals should be chosen on an individual basis. Please ask the ward staff for support if you are unsure.

Hospital meal times

Meal times in hospital may be at different times to at home. Depending on the type of medication or insulin you take to manage your diabetes, the difference in meal times could increase your risk of having a ‘hypo’ (blood glucose less than 4mmol/L). 

If you take rapid-acting insulin (NovoRapid™, Humalog™, Apidra™ or Fiasp™) with meals, it is advised that you wait until your meal has been served to you before injecting your insulin. This reduces your risk of having a hypo if the meal is delayed, is different to what you ordered, or you don’t expect to eat the full portion.

Snacks such as cereal, toast, sweet biscuits and milky drinks are routinely available on the ward. Please ask a member of ward staff if you require a snack to prevent a hypo if your meal is delayed, at a different time to home, or, if you have been advised to have a snack before bed.

References

North Bristol NHS Trust Healthy Eating with Diabetes

British Dietetic Association:  The Nutrition and Hydration Digest: Improving Outcomes through Food and Beverage Services (PDF). 2nd Edition. Last updated July 2019. 

Diabetes UK (May 2011) Evidence-based Nutrition Guidelines for the prevention and management of diabetes (PDF).

National Institute of Clinical Excellence. NICE. (Last updated July 2016) Type 1 diabetes in adults: diagnosis and management

National Institute of Clinical Excellence. NICE. (Last updated May 2017). Type 2 diabetes in adults: management

How to contact us

See your appointment letter for the number to phone with any queries you may have.

If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice.

If you’re an overseas visitor, you may need to pay for your treatment or you could face fraud or bribery charges, so please contact the overseas office:

• Telephone: 0117 414 3764
• Email: overseas.patients@nbt.nhs.uk

Promoting a culture of supporting and working in partnership with carers within our hospitals

North Bristol NHS Trust (NBT) and University Hospitals Bristol and Weston NHS Foundation Trust (UHBW) value the vital work done by those with unpaid caring responsibilities (referred to as ‘carers’ within this charter) and are committed to working together with them as expert partners in care.

A carer is someone who provides care for someone else who, due to illness, mental health problems, substance misuse, physical and learning disability, old age or frailty, is unable to care for themselves without their support. This charter includes young carers and parent carers.

Carers as equal partners

We will ensure that the role you have, as a carer, is valued by all staff and will make sure that we respect, listen to and understand carers and what they do. We will identify carers as early as possible.

Supporting carers

We will inform you as a carer of your right to an assessment under the Care Act 2014 and the Children & Families Act 2014, providing information about the range of support and advice services available to you as a carer. We recognise the importance of your needs being met and will support you to have breaks away from the ward when you need them.

Young carers

We will ensure that we involve young carers and will work to support you and recognise the valuable role you play in the health of our patients.

Sharing information

With the relevant consent obtained, we will provide information that is timely, appropriate and accessible. We will involve you in decision making, with the patient wherever possible, whilst respecting the need for confidentiality.

Having a voice

We will ensure that you have an easily accessible means of giving feedback, that this is responded to and that you are involved in the planning and development of our services.

Discharge planning

We will begin discharge planning as soon after admission as possible. We will help you understand the processes, including you in all discussions, respecting your detailed knowledge of what happens outside the hospital. With the relevant consent obtained, we will include you in all discussions on all aspects of care and medication. 

To contact us

Please email: carerliaison@carersbsg.org.uk

Ring and ask for the Carers Liaison Support Worker for North Bristol Trust:

CarersLine: 0117 965 2200

Young Carers: 0117 958 9980

Ask the ward to refer you.

This information is for patients who have been directed to this page as you are starting, or already taking, a medicine, known as enoxaparin. It is most likely that the enoxaparin brand you will be using is called Inhixa®. Enoxaparin is part of a group of medicines called anticoagulants. An anticoagulant medicine prevents blood clots forming in your blood vessels by making your blood take longer to clot.

Enoxaparin contains a product derived from pigs. If you have any ethical objections to the use of animal products please discuss this with a healthcare professional before using enoxaparin.

Enoxaparin reduces blood clot risk

A blood clot can develop in the large veins of the body, usually in the legs. This is called a deep vein thrombosis (DVT). 

Sometimes, a blood clot can break free and travel through your blood vessels. If a clot lodges in the blood vessels of your lungs it is called a pulmonary embolism (PE). A PE can cause chest pain and difficulty in breathing and, if severe, can cause death. Rarely, a clot may move to the brain and cause a stroke. 

After surgery there is an increased risk of blood clots forming. Evidence shows that following some types of surgery, an extended period of treatment with enoxaparin reduces this risk. You will usually need to inject enoxaparin for between 10 and 28 days after your surgery.

Why do I need enoxaparin?

There are lots of reasons why you may be at higher risk of blood clots. Here are some of the most common ones:

• Age over 40, as the risk increases with age.
• Taking any kind of oral contraceptive pill (OCP).
• Taking hormone replacement therapy (HRT).
• Some heart problems.
• Severe breathing difficulties.
• Varicose veins.
• Obesity .
• If you have had a DVT before.
• If you have a family history of DVT.
• If you have previously suffered a stroke.
• The type of surgery, such as knee or hip replacement or abdominal surgery.

How can I tell if I have a DVT or PE?

Early signs of a deep vein thrombosis (DVT)

Early signs of a pulmonary embolism (PE)

How should I inject enoxaparin?

You need to inject Inhixa® under the skin (a ‘subcutaneous injection’). You should have the injection at the same time every day. 

A healthcare professional will have shown you how to inject yourself using the Inhixa® syringe. They should also tell you how long the treatment will be for. It is important that you know the correct technique before you try to inject yourself. If you are unsure, you should ask a healthcare professional for advice.

Step-by-step instructions for injecting Inhixa®

Things to look out for

Heparin-induced thrombocytopenia (HIT)

Dos

Don'ts

Your questions answered

After discharge from hospital who can I contact for help or advice?

The patient information leaflet that came with enoxaparin advises against using a particular medicine that I am taking. Is this okay?

Can I inject anywhere other than my stomach?

Where should I keep the enoxaparin syringes?

What should I do if there is an air bubble in the syringe?

What should I do if I have injected too much enoxaparin?

What should I do if I miss an enoxaparin injection?

How can I find out more about enoxaparin?

What should I do with my used syringes?

© North Bristol NHS Trust. This edition published January 2024. Review due January 2027. NBT002719

This information is about pain and bleeding in early pregnancy clinics. Not all of the problems discussed will apply to you as causes of bleeding and pain are varied.

Our aim is continuity of care, however this is not always possible, and when you are in hospital you will be looked after by a team of doctors and nurses.

Is it normal to have bleeding/spotting in pregnancy before 18 weeks?

Spotting or bleeding in early pregnancy can be common. It can occur in about 20 in 100 people, and may also come with lower abdominal (tummy) pain and back pain. These symptoms do not mean there is a problem with the pregnancy.

Why am I bleeding?

There are many causes of bleeding in early pregnancy. If you have been scanned, this may help us understand why. 

If the scan is normal we will discuss with you possible causes of bleeding but may never be sure of the exact reason. The main aim of scanning is to assess whether the pregnancy is normal.

The bleeding may be coming from the neck of the womb. Some changes on the cervix related to hormones (ectropian) are common in pregnancy, which can cause bleeding. 

In an ectropian, cells that line the inside of the canal (behind the cervix) change position. These cells are more fragile and are prone to bleeding. This is not a sinister or worrying problem, and it is commonly seen. However, in pregnancy, it can make you anxious. Bleeding can be light, pink, dark, or red, and can sometimes be a heavy ‘gush’. The pregnancy is rarely affected by this.

In other cases, an area of bleeding outside of the pregnancy sac (commonly related to the placenta) has occurred. This usually resolves without any prolems. This is called a subchorionic bleed and occurs in about 1% of pregnancies. 

Sometimes on a scan, we can measure this and look at the size of the sac/pregnancy in comparison to the size of the area of bleeding. We may scan again if the bleed is the same size or larger than the the sac. 

In cases where the subchorionic bleed continues to be present on future scans and remains equal to or larger than the size of the sac, further scans may be needed including a dating scan.

If large subchorionic bleeds do not resolve the placenta can struggle to function as well as it should. This is not common.
Although bleeding in pregnancy is not uncommon, we appreciate having bleeding in pregnancy remains an anxious time for many women. 

What if the bleeding continues?

It is normal following a bleed in pregnancy to have some brown pink or vaginal bleeding/discharge for a week or so. If the bleeding becomes heavy, or you pass any blood clots, along with pain, you should contact the clinic via a self-referral form. If you are very concerned you can contact 111. You maybe advised to return to EPC for review.

Our usual advice is to allow the bleeding to settle over about 10 to 14 days. If you are having persistent slight bleeding past this time, we may consider a re-referral for advice .

Many women experience bleeding and/or pain in pregnancy and carry on to have a normal pregnancy. Some of these women have more than one bleeding episodes in the pregnancy.

This does not mean a miscarriage will happen, but if the bleeding does not settle over a number of weeks, or heavy bleeding starts, a further scan will be needed.

Sometimes bleeding is a sign of a problem with the pregnancy. If your scan is normal then this is reassuring.

Can I still have intercourse?

Sexual intercourse is perfectly safe in pregnancy. However if you have had bleeding or spotting, wait until this completely settles or any discharge stops before resuming sex.

Should I rest in bed?

There is no reason to rest in bed – you may carry on normal activities, just be sensible and rest when you are tired.

Should I go to work?

There is no reason to stay at home, however if you have a strenuous job you may wish to remain off work until the bleeding settles off. See the GP if you need to be signed off.

Can I use tampons?

Sanitary pads are safer, and better. Make sure you change pads or liners regularly.

Can I have a bath?

Personal hygiene is important. Showers are more hygienic if you are bleeding, but it is ok to have a bath.

Pain in pregnancy

Why do I have pain?

If you have unexpected abdominal or back pain during pregnancy it is easy to worry. Some pain may need medical attention, but often pain is relatively harmless. 

We do not always find a cause for pain but we know that episodes of discomfort are common during early pregnancy.

Will the pain affect the pregnancy?

In most cases the baby will be absolutely fine, and the pain will not harm the pregnancy in the future.

Most common reasons for pain in pregnancy 

• One of the first times when you may experience pain is around the time of your first missed period. For a day or two, some women have a pain that is low down in the abdomen (tummy) and feels a bit like a dull period pain. It is thought that the embryo is beginning to implant itself in the lining of your womb at this time.
• At any time during pregnancy, constipation, bloating and wind can cause aches, pains and abdominal discomfort. Constipation is common, and pregnancy hormones slow down the way the gut works.
• As the pregnancy progresses, women often have discomfort or pain on and off as the womb begins to change more. The ligaments or muscles around your uterus stretch and thicken as they support a growing baby, and can cause of discomfort.
• In later pregnancy, Braxton-Hicks contractions may cause some pain. These contractions, (which are irregular tightenings of the uterus), can occur from early pregnancy, but most women don’t notice them until the second half of a pregnancy. This is a normal but can feel uncomfortable. 

If you are concerned, or the contractions become more frequent, do talk to your doctor or midwife, or send a new referral in to the early pregnancy clinic and we will triage you by phone.

Causes of pain

Common gynaecological causes of pain include:

• Pelvic infection. Thrush occurs in about 25 in 100 pregnant women. Chlamydia/pelvic infection in up to 5 in 100 women.
• Ovarian cysts occur in 1 to 2 in 100 women (many cysts resolve without any treatment, and are usually nothing to worry about).
• Fibroids (can occur in 1 in 1000 to 1 in 1500 women.
• Irritable bowel syndrome – can get worse in pregnancy if you already have this.
• Musculoskeletal pain for example low back pain is common in pregnancy.

Renal causes

• Urinary tract infection (water/kidney infection) are common in pregnancy and can affect 1 in 25 women.
• Renal stones (kidney stones). (Rare in pregnancy)

Other causes include:

• Appendicitis - this is rare in pregnancy.
• Gallstones (which can enlarge during pregnancy and may present for the first time) - also rare in pregnancy.

What will happen to work out why I have pain?

If you have mild pain and are well, with a normal scan, you will be discharged back to their GP. 

If you fell less well or have a lot of pain you may need to be seen by a nurse or doctor. 

What does this include?

• Asking you about your symptoms: pain history, vaginal bleeding, urinary symptoms.
• Last period date, and what your periods are usually like.
• Previous operations or medical problems.
• Examination.
• General examination - to see how you are feeling and look for signs of infection. This may include blood pressure, pulse, temperature, breathing rate, and a urine dipstick.
• Abdominal examination - to see where you are tender, and also to assess the pregnancy and uterus.
• Possibly, vaginal examination.
• The neck of the womb can be examined and bleeding assessed.

Other possible investigations

• MSU (urine testing) to look for a water infection.
• Vaginal swabs - to look for infection.
• Full blood count to look for infection and to make sure your iron count is normal.

How we look after you

We look after you by trying to find the cause of the pain and treating you once we are sure we know what the problem is. 

If we have taken any blood tests or swabs or water samples, we will let you know if there are any problems.

We will not contact you if everything is normal. 

Please note that swabs and urine samples take 1 to 2 days to come back. Some specialist swabs can take longer.

If needed we may refer you to a different specialist.

Basic painkillers (paracetamol) are used to control pain.

Summary

There are many reasons for pain in pregnancy, but the majority of women we see have nothing seriously wrong.

The main aim of assessing you is to exclude any worrying cause for pain, and to ensure the pregnancy itself is doing well.

If in the next week the pain gets worse, or does not go away, speak your GP.

References and sources of further information

• Antenatal care NG201. 19 August 2021. 
• Bleeding and pain in pregnancy RCOG (2016) 
• Ectopic pregnancy and miscarriage NICE guidance NG126  2019 (Reviewed August 2023). 
• Tommys: www.tommys.org

Date published: 16 June 2026 Review due: 30 June 2029 PI number: BFT002073 

We are sorry that you have had a miscarriage

We are aware that this a distressing time and want to make sure you are well supported. Everybody deals with miscarriage differently, and there is no ‘right way’ to be. 

This is a guide to help you so that: 

• you are aware of what will happen
• you can make decisions
• you can work out when to seek advice/help

Understanding the terms used for miscarriage

Complete miscarriage: the scan shows your womb is empty after a miscarriage. No further treatment is needed.

Incomplete miscarriage: your scan shows that there is some tissue remaining in the womb.

Missed miscarriage: your scan shows that the baby is not developing or has not developed and there is no heartbeat, or where a sac has developed with nothing inside it. 

Expectant management of miscarriage (waiting for a natural miscarriage to happen)

Medical management of miscarriage

Surgical management of miscarriage

Frequently asked questions

How long will I bleed after the miscarriage?

Can we be told the sex of our lost baby?

What happens to the pregnancy, or pregnancy tissue after a miscarriage has happened?

When will my periods come back?

Why did I miscarry?

Will it happen again?

How soon can I resume my normal life?

When can we start having sex again?

Is there anything we can do to remember our baby?

If and when you feel ready to decide to plan another pregnancy you may wish to refer to the information below.

How soon can we try again?

Diet

Folic acid

Smoking

Medication

Pregnancy loss

Information and Support Services for patients and their families 

Grief and sadness can be hard for you, your family, and other carers. Support can help you manage more easily. The list of support agencies at the end of this leaflet does not include everything. They are options but we do not formally endorse them. You can also speak to your GP for things like counselling.  
 

Further help and advice

References

Date published: 16 June 2026 Review due: 30 June 2029 PI number: BFT002479
 

This page aims to explain how we diagnose an ectopic pregnancy. 

Sadly, an ectopic pregnancy cannot survive and losing a pregnancy in this way affects everybody differently. The diagnosis of an ectopic is often unexpected, and can be a stressful and distressing time. We want to ensure you are well supported whilst in hospital or under the care of the early pregnancy clinic (EPC).

You will be looked after by a team of doctors and nurses, and although we try hard to ensure continuity this is not always possible. Please let us know if you need additional information or support during this time.

What is an ectopic pregnancy?

An ectopic pregnancy is a pregnancy that develops outside the cavity of the womb. Most ectopic pregnancies occur in the fallopian tube (95%), however they can occur in other places (such as the ovary, the cervix, and inside the tummy). Since the fallopian tubes are not large enough for the growing pregnancy so it cannot continue normally. 

What are the causes of ectopic pregnancy?

Most ectopic pregnancies occur because the fertilized egg cannot pass through the fallopian tubes, this occurs for many reasons:

• an infection or inflammation of the tube may have partially or entirely blocked it
• Pelvic inflammatory disease (PID) is a common infection
• damage due to a previous ectopic pregnancy
• endometriosis or scar tissue (adhesions) from previous abdominal surgery or previous operations on the tubes including reversal of sterilisation

However, in many patients a cause cannot be found.

What are the symptoms of an ectopic pregnancy?

Symptoms of an ectopic pregnancy can often be vague, and difficult to diagnose because they mirror those of a normal early pregnancy. These can include:

• missed or late periods.
• irregular vaginal bleeding.
• abdominal pain.
• sharp pain in the abdomen (tummy) or pelvis which may be intermittent or constant (often one-sided).
• shoulder pain.
• dizziness or fainting.
• loose stools (poo) or diarrhoea

How is an ectopic pregnancy diagnosed?

If you come to the hospital with symptoms that suggest an ectopic pregnancy we may do the following tests: 

• If pregnancy has not already been confirmed, a pregnancy test will be done.
• A pelvic examination (feeling your tummy) by a nurse/ doctor may locate the areas causing pain.
• An ultrasound scan and often a vaginal scan (which may give better images) will be done to find out if there is a pregnancy inside the womb. 
• If we cannot see anything in the womb on scan and the pregnancy test is positive, an ectopic pregnancy has to be considered.
• It may just be that the pregnancy is too early to see on a scan or that a miscarriage might have already occurred, but the diagnosis of ectopic pregnancy cannot be ruled out. 
• Even with the best equipment, it is hard to see a pregnancy less than 6 weeks or an ectopic pregnancy.
• Blood levels of a hormone produced by the pregnancy may need to be assessed by a blood test. In normal pregnancy, the level of hormone nearly doubles about every two to three days during the first 10 weeks of pregnancy. 
• In an ectopic pregnancy, the levels climb slowly or stay the same (this can vary and sometimes the levels can rise or fall). 
• We may need to carry out a series of blood tests over a period of days to check these levels. An abnormal pattern in the rise of this hormone can be due to an ectopic pregnancy or sometimes a miscarriage.

The most important information while we are looking after you are your symptoms (how you feel).

You must let us know if your pain increases or if you develop any worrying symptoms (see the symptoms of ectopic pregnancy above).

Can an ectopic pregnancy cause me to be very unwell?

It is rare, but yes it can. In some cases, the embryo grows until the fallopian tube stretches and ruptures (bursts). Rupture of the fallopian tube is a medical emergency because of internal bleeding, causing abdominal pain and the risk of a person collapsing (fainting and being unwell).

Please be reassured, most people are diagnosed early and managed very safely. But your symptoms are so important because there have been cases where people have been so severely unwell that they have died due to an ectopic pregnancy. 

How will an ectopic pregnancy be treated?

There are 3 ways of treating/managing an ectopic pregnancy:

Conservative management: this involves no active medical or surgical treatment; you are simply kept under observation and may be allowed to stay at home or offered a bed in hospital.

Medical management: this involves an injection of a drug called methotrexate to resolve your ectopic pregnancy (separate leaflet available).

Surgical management: this is usually done through keyhole surgery (laparoscopy) although occasionally abdominal surgery (laparotomy) is needed.

Conservative management – ‘watching and waiting’

Conservative management means we expect your ectopic pregnancy to end naturally without treatment. Instead of immediate medical or surgical care, we will monitor you closely with regular blood tests to check that your pregnancy hormone levels are falling back to normal. This approach is commonly used, and more than half of ectopic pregnancies resolve on their own. While we take a “wait and see” approach, you will have 24-hour access to advice and support, so you can get help at any time if you have concerns.

Research has shown that in patients who are properly assessed, where their pregnancy hormone level (hCG) is dropping, up to 50% of these pregnancies will end naturally - so there will be no need for an operation or drugs.

Conservative management is the best treatment when:

• the hormone beta hCG (produced by a pregnancy) is low
• general health appears to be stable
• pain levels are considered to be acceptable
• an ultrasound scan shows a small ectopic pregnancy with no worrying bleeding into the tummy

What are the advantages of conservative management?

• You do not have to stay in hospital.
• It avoids medication/surgery with a general anaesthetic and the possible associated risks and side effects.

What are the disadvantages of conservative management?

• Further visits to the hospital are required which may include blood tests or scans.
• Medical or surgical management may be required if the pregnancy continues to develop.
• If the pregnancy continues to develop the tube may rupture and you will need emergency surgery.

Whilst at home it is important to tell Cotswold Ward or Early Pregnancy Clinic if: 

• you experience any increase in pain
• you experience pain somewhere you have not previously had it, for example, shoulder tip pain or rectal pain.
• you feel faint or dizzy

Medical management of ectopic pregnancy

Medical treatment of ectopic pregnancy is also used commonly and may avoid the need for surgery.

Methotrexate is a drug normally used in cancer treatment but the amount used is very small. It works because it kills the rapidly growing cells of an ectopic.  It has a good success rate for treating small ectopic pregnancies (more than 90 in 100) and avoids surgery. We have a separate leaflet that explains Methotrexate more fully.

Methotrexate cannot be used in all circumstances, and we will advise you as to the best treatment for you.

Side effects of the drug are: nausea/vomiting, diarrhoea, headaches, abdominal pains and bleeding. Repeated visits to the hospital are essential (with blood tests) and you may require a second dose of the drug. You will be advised to wait a minimum of 3 months before trying for a future pregnancy. 

How will I know if there is a problem and I need a different treatment?

We will do blood tests and scans. If the pregnancy is not resolving, they will suggest other forms of treatment for you. 

Will I experience any pain?

Yes, you might have some lower pelvic pain or backache at any time during the course of the management. If required you can take paracetamol, ibuprofen, and sometimes codeine. (Always read the label/instructions before taking them and do not take more than the maximum daily dose). 

If your pain is getting worse, or are taking pain relief and it is not helping, it is important to ring us.

Will I experience any vaginal bleeding?

Yes, this can vary from dark brown spotting to heavier bright red loss. Use sanitary towels rather than tampons to reduce the risk of infection. If you are concerned that the bleeding is excessive (changing pads every half an hour) please contact us.

Surgical management of ectopic pregnancy

What will surgery involve?

It involves an operation to remove the ectopic pregnancy and will be done under a general anaesthetic. Surgery to remove the ectopic pregnancy is the most well-established form of treatment (the one that has been done for the longest time). It may also be performed if conservative or medical management have failed. 

It is usually done through keyhole surgery (called a laparoscopy), which involves inserting a camera through the umbilicus (belly button) and inserting instruments through two small cuts in the lower abdomen (tummy).  A small amount of gas is put into your abdomen to inflate it to help the surgeon get a better view. There are times when a bigger cut in the tummy at the bikini line is needed (although not common).

The most common surgery is called ‘salpingectomy’ which is removal of the damaged fallopian tube. (In some cases where there are risk factors for infertility, the doctors may make different decisions about your care/management). 

If you are rhesus D negative blood group you will need an anti-D injection (we have a separate leaflet about this). 

You are often advised to take a home pregnancy test 3 weeks after your operation. If the test is positive, you should return for further checks. 

There may be occasions where the doctor requests a blood test 48 hours or 1 week after surgery. This is usually done in the Early Pregnancy Clinic.

How does surgery affect future pregnancies?

• Having an ectopic pregnancy whatever the treatment means there may be some damage to the tube and this will slightly reduce the chance of getting pregnant in the future.
• If you have had surgical treatment the chance of getting pregnant is about 70%, but it does depend on other factors such as the health of your remaining tube.
• Once you have had an ectopic pregnancy, although more likely to have a normal pregnancy - your chances of having another ectopic pregnancy are increased. 

Should I be off work during/after treatment?

This is a very individual decision. You will need to recover physically, and it will depend on how you are feeling emotionally. Please consider some time off work, especially in the first week when frequent visits to hospital may be required. You can self-certify for the first 5 days, or the staff in the hospital can issue you with a sick note (fit note).

Emotions

It is completely normal to feel a variety of emotions during this time. You may experience days when you feel completely ‘back to normal’, but you may also have days when you feel vulnerable and tearful. 

Pregnancy loss is not straightforward, and people all react and recover in different ways - there is no right or wrong way. It is important to give yourself time to recover on a physical and emotional level. 

If you wish to talk to someone about your feelings and are unable to do so with a partner, close friend or family member, a list of counselling services and support are included at the end of this leaflet.

What about future pregnancies?

• Studies have shown that there is a 7 in 10 (70%) chance of a normal pregnancy in the future irrespective of which way the ectopic pregnancy has been managed. 
• It is perfectly safe to start trying for another pregnancy once you and your partner feel ready. 
• If you have had methotrexate treatment then you will need to wait 3 months before trying for another pregnancy. If however, you have needed 2 doses of methotrexate you would need to wait for 6 months (see methotrexate leaflet).

In the future, If you think you are pregnant:

• do a urinary pregnancy test at home
• use the self referral form to refer yourself to EPC
• if you are very early in pregnancy (below 6 weeks) but have pain, please call the clinic for advice – or  self refer to the clinic and explain that you have had an ectopic pregnancy previously
• you have ‘open access’ to attend early pregnancy clinic when you are at least 6-7 weeks pregnant so we can perform a scan, there is an open access letter at the end of this leaflet

To be as healthy as possible when you are thinking of getting pregnant again, being healthy will really help. It is best to:

• take folic acid
• reduce/stop your alcohol and caffeine intake
• stop smoking

The list of support agencies below not exhaustive and inclusion does not imply endorsement. It is also worth remembering that many GPs have counselling services at their practices.

Further help and advice

Date published: 16 June 2026 Review due: 30 June 2029 PI number: BFT002434