Gynaecology diagnostic and treatment unit

Our emergency early pregnancy service is for: 

• Pregnant women with pain and/or bleeding in early pregnancy (before 14 weeks) 
• Pregnant women with a high risk of an ectopic pregnancy. This includes women who have previously had an ectopic pregnancy, or women who have previously been told their fallopian tubes are dilated or blocked. We recommend a scan at approximately 5-6 weeks from your last period unless you have pain, in which case you should come sooner. 
• Pregnant women who have previously had a miscarriage managed by our unit. Unfortunately, due to limited capacity, we are not able to offer reassurance scans unless you have previously been cared for in our unit. We recommend a scan at approximately 7-8 weeks for reassurance. 

Our early pregnancy clinic is a walk-in service (you do not need an appointment) which is open to registration:  

• Monday to Friday, 9am – 12.30pm and 2pm – 3pm 
• Christmas Eve and New Year’s Eve (on weekdays), 9am – 1.30pm 

We generally see people who have walked in in the order in which they arrive, but priority will always be given to those who are found to be more unwell (in significant pain, or bleeding heavily) at initial triage assessment.  

Our clinics can become extremely busy with wait times of over 4 hours. We aim to see patients as soon as possible but would advise you to be prepared for a significant wait. You may wish to bring a phone charger or food. You may wish to pop out to get some refreshments or fresh air - please let our reception staff know if you do this.  

If you are pregnant and start to have severe pain and/or very heavy bleeding at night, over the weekend or on a bank holiday, please call NHS 111 for advice, or go straight to Accident & Emergency. 

We are able to see women in early pregnancy on Saturday and Sunday between 9am and 12:30pm, but they must attend A&E first.  

You are welcome to bring one person along with you to your appointment. 

On arrival at the unit, you will be asked to have a pregnancy test – regardless of if you have taken one prior to attending elsewhere. A pot will be provided, and you will be asked to give us a sample of urine.  

You will be asked to wait in the seating area until a specialist nurse can undertake an initial triage assessment. The nurse will ask you about your symptoms, about any past pregnancies and may check your observations, such as your heart rate and blood pressure.  

You will then be asked to wait to see a doctor. The wait is very variable according to the initial triage by our specialist nurse and can be long. Please note that other clinics have patients in the same waiting area – this can mean that other patients who have arrived after you may be seen before you.   

When it is your turn to be seen by a doctor, you will be shown to a scan room. The doctor will go over the reasons for your attendance, your past medical history and any previous pregnancies.  

It is usual practice to perform scans using an ultrasound probe (cleaned, and covered with a single use probe cover) that is inserted into the vagina in early pregnancy (a ‘transvaginal’ ultrasound). This enables us to see the pregnancy clearly, and is known to be safe. Most women do not find these scans uncomfortable. We ask you to empty your bladder before a transvaginal ultrasound. Another member of staff, usually a healthcare assistant, will be present during the scan.  

If you feel uncomfortable about the idea of a transvaginal ultrasound, please explain this to your doctor. We can often try a scan on the tummy first (for which a full bladder is helpful), but, unless the pregnancy is quite far advanced this can impact our ability to have a good view. Your doctor will be able to discuss if this would be a suitable option for you.  

Early pregnancy scans can be difficult to interpret and may need to be referred to another member of our team. In some circumstances a second scan may be required and on occasion patients may require further reviews or blood tests to make a full diagnosis. These may happen on the day, or you may be asked to return for a follow up appointment. 

Our general gynaecology service is quite unique in the UK in offering both a consultation and ultrasound scan with a doctor at the same initial appointment. This allows a treatment plan to be drawn up immediately. 

This service is for people with gynaecological issues such as: 

• ovarian cysts 
• pelvic pain 
• heavy periods 

You are welcome to bring one person along with you to your appointment.  

The doctor will call you into the clinic room and ask you about the reasons for your referral, and about your past history of other conditions, pregnancies, or surgery.   

This will usually be followed by an ultrasound scan. The best views of your womb and ovaries are obtained by inserting an ultrasound probe (cleaned, and covered with a single use probe cover) into the vagina (a ‘transvaginal’ scan). Most women do not find these scans uncomfortable. We ask you to empty your bladder before a transvaginal ultrasound. Another member of staff, usually a healthcare assistant, will be present during the scan.

If you have not had vaginal sex before, or find insertion of the probe uncomfortable, then we will usually discuss whether you would find having a scan in which the probe is inserted into your back passage (a ‘transrectal’ scan) acceptable. This can be a little uncomfortable as the probe is inserted, but most women do not experience pain.  

Sometimes we also will scan the tummy, to look at the womb from a different angle, or look at the kidneys. 

It is common for us to perform a speculum examination, and we may take some swabs to look for infection. Although this is the same examination as is performed for your smear test, we are not able to take routine cervical smears, so it is important to have your regular screening with your GP practice. Sometimes we ask your permission to take a biopsy of the lining of the womb (called a Pipelle biopsy), or to put a small amount of fluid inside the womb to make the scan clearer (called a saline sonogram).

After the scan, we will explain our findings and discuss next steps. We may recommend a trial of medication, or discuss the option of surgery with you. We may refer you to clinics within UCLH which offer other specialist care, such as treatment for endometriosis or fibroids.

Most women who are referred to the suspected gynaecological cancer clinic do not have cancer.  

However, if cancer is a possible diagnosis, it is important to be seen quickly. This is a fast-track service which enables us to see women usually within two weeks of the GP’s referral. 

Common reasons you might be referred to this clinic include: 

• Bleeding after the menopause (post-menopausal bleeding) 
• A suspicion of, or ultrasound finding of, a large, or complex looking, ovarian cyst 

The consultation will be very similar to a general gynaecology clinic appointment. However, since the purpose of this clinic is to exclude cancer, once we have been reassured that there is no gynaecological cancer, we will usually ask your GP to refer you to the general gynaecological clinic to discuss less urgent concerns and management of any symptoms.  

If there is a concern of cancer, you will be referred to our gynaecological cancer service within ULCH for further diagnostics and appointments. There is a dedicated clinical nurse specialist team that can offer support throughout your treatment.  

The GP gynaecology ultrasound service gives you an appointment for a scan only, which is arranged by your GP. The scan is performed by a sonographer, and a report is sent to your GP so they can discuss the findings and management with you. Your GP may refer you to our general gynaecology clinic if there are concerns or issues.  

UCLH is a teaching hospital. We are passionate about our students understanding how to care for women in early pregnancy and with gynaecological issues, so that they become the great nurses, midwives, GPs, A&E doctors and gynaecologists of the future.  

For this reason, it is common to have medical, nursing and midwifery students in the department. Students will often sit with doctors, but may occasionally take the opportunity to speak to you alone and ask about your symptoms before your scan.  

If you feel uncomfortable having a student in the room during your consultation, please make this clear to reception, or to the doctor as you are called in.

Care at our unit is consultant-led. Your scan will be done by an experienced trainee or fellow, who will discuss the scan findings with a consultant.

We are proud to be part of an organisation actively contributing to important research, which will improve the care of women in the future.  

We routinely collect anonymous data on all the women we see though the clinic so that we can audit our practice, and support wider clinical decision-making and recommendations. All anonymous clinical information is handled in accordance with the NHS Health Research Authority Guidelines. We often use anonymous images we take for training other professionals. If you are not happy for your data or images to be used in this way, please let us know.  

We actively recruit to studies that may involve taking extra measurements or swabs compared to routine care, and other studies that may involve a change to your routine care. For these studies, we clearly explain what is involved, give you written information, and ask for your consent to be involved in the study. If you are not interested in being involved in a study, it will not affect the care you receive. 

You will be more comfortable waiting for, and having, your scan and consultation if you are able to arrange alternative childcare. We understand that sometimes this is not possible, and are able to accommodate one child in the consultation room. We advise that children sit behind the curtain during the scan, so that they cannot see.  

You are not able to leave your children unattended in the waiting area, and we are not able to supervise children.  

We suggest that you download the MyCare app, where you will be able to view a copy of the report that is sent to your GP. Your doctor will be able to see on our computer system if you are registered on MyCare. 

If you do not have this app, a copy of your consultation will be sent by post.  

Many women who attend our clinic do not speak English. We have a telephone interpreting service available to support consultations. This does not need to be arranged in advance.  

We will always do our best to support those with any difficulties getting to, or understanding a consultation. If you would like to discuss plans in advance, please contact uclh.gynaeadmissions@nhs.net.

You are welcome at our clinic regardless of your gender identity.  

If you are anxious about attending the clinic because of your gender identity, or for any other reason, please email us in advance on uclh.gynaeadmissions@nhs.net so that we can plan how best to support you. 

We advise that women worried about vaginal discharge or sexually transmitted infections attend a sexual health clinic. These clinics can test for a wider variety of infections, get the results quicker, and have more expertise in their treatment.  

People needing hysterectomy (removal of the womb) as part of gender reassignment surgery are advised to be referred to the specialist Gender Affirmation Surgery service at Chelsea and Westminster Hospital 

We cannot offer cervical smear tests in our general gynaecology clinic. If you are found to have an abnormal smear, you should be referred by the GP to the Colposcopy Department. 

If you feel able to discuss these concerns at the time of your appointment, please do. If you have questions or concerns after you leave (for example, if you’ve changed your mind about the treatment you want, or have questions about how to start a medication), you can email uclh.gynaeadmissions@nhs.net. The team will forward your concern to the doctor you saw, or another member of our department, and we will contact you by email of phone to discuss further.  

If you have a complaint about the service you can contact the Patient Advice and Liaison Service.