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Should You Go to A&E or the EPU?

Knowing where to go when something feels wrong in early pregnancy can be genuinely confusing — especially if you're anxious, in pain, or bleeding and can't think straight. The short answer is: most pregnancy-related concerns belong at the Early Pregnancy Unit (EPU), but a small number of situations require A&E or 999 immediately. Understanding the difference helps you get the right care faster.

When to Go to the EPU

The Early Pregnancy Unit (EPU) is the specialist service for concerns in the first trimester. Sonographers and clinicians there are experienced in early pregnancy problems and can perform ultrasound scans quickly to give you a clearer picture of what is happening.

Go to the EPU (or contact them to arrange an appointment) if you have:

  • Light to moderate vaginal bleeding — spotting or bleeding that is not soaking through a pad
  • Cramping or abdominal pain that is uncomfortable but manageable
  • Concerns about miscarriage — for example, you passed tissue or bleeding has increased
  • Ectopic pregnancy symptoms that are not severe — one-sided pelvic pain, light bleeding, or feeling unwell (though see A&E if severe)
  • Positive pregnancy test after a previous ectopic — you may need an early scan to confirm the location
  • Uncertainty about whether your pregnancy is continuing

Most EPUs are open Monday to Friday during daytime hours. Some have extended or weekend hours. You may need a referral from your GP or midwife, though many EPUs do accept self-referrals — it is worth calling yours directly to ask.

If the EPU is closed and your symptoms are not an emergency, call 111 for advice on the most appropriate next step.

When to Go to A&E (or Call 999)

Some situations cannot wait for an EPU appointment. Go to A&E immediately, or call 999, if you experience:

  • Very heavy bleeding — soaking through a pad in an hour or less, or passing large clots
  • Severe, sudden abdominal or pelvic pain, especially if one-sided
  • Shoulder tip pain combined with any other symptoms — this can be a sign of internal bleeding from a ruptured ectopic pregnancy, which is a life-threatening emergency
  • Feeling faint, dizzy, or collapsing
  • A high fever combined with pain or bleeding
  • Feeling very unwell in a way that came on rapidly

A ruptured ectopic pregnancy is rare but serious. If you have a positive pregnancy test and develop sudden, severe one-sided pain, shoulder tip pain, or collapse, call 999 and do not drive yourself to hospital.

When to Call 111

NHS 111 is available 24 hours a day, seven days a week. Call 111 if:

  • You are unsure whether your symptoms need A&E or the EPU
  • You have bleeding or pain but are not sure how serious it is
  • The EPU is closed and you are worried
  • You want to talk through your symptoms before deciding what to do

The 111 team can assess your situation and direct you to the most appropriate service. They can also arrange urgent GP appointments or call an ambulance on your behalf if needed.

EPU Opening Hours and Referrals

EPU services vary across the UK. In general:

  • Most EPUs operate Monday to Friday, typically 8am–5pm or similar
  • Some hospitals offer extended or Saturday hours
  • After-hours, concerns are usually directed through A&E or 111
  • Some EPUs require a GP or midwife referral; others accept self-referrals
  • You can find your nearest EPU by contacting your GP surgery or calling your hospital's maternity department

If you have already had an EPU assessment and have been given a number to call with concerns, use that route first — they will know your history.

Frequently Asked Questions

Can I self-refer to the EPU?

Many EPUs accept self-referrals, but not all. It depends on your local NHS trust. If you are unsure, call your GP surgery or the hospital's main number and ask to be connected to the EPU. Alternatively, call 111 and they can help you access the right service. If your bleeding or pain is severe, go to A&E rather than waiting for a referral.

What's the difference between A&E and EPU?

The EPU specialises entirely in early pregnancy problems. They have ultrasound equipment on site and clinicians who deal with miscarriage, ectopic pregnancy, and pregnancy loss every day. A&E is a general emergency department equipped for all medical emergencies. For pregnancy-related concerns that are not immediately life-threatening, the EPU can usually provide faster, more specialist care. A&E is the right choice when a situation is urgent and cannot wait.

What if I go to A&E with pregnancy concerns?

A&E staff will assess you and, if appropriate, contact the on-call gynaecology or obstetrics team. In some hospitals, the gynaecology team will come to assess you; in others, you may be moved to a ward or referred for an early morning EPU scan. Going to A&E does not mean you have done the wrong thing — if you were worried enough to go, it was the right call.

Always speak to your midwife or GP if you have concerns about your pregnancy, or call 111 if you are unsure where to turn.

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