title: Early pregnancy care over time: should we promote an early pregnancy assessment unit?
abstract: In this observational study, the effect of the introduction of the first Early Pregnancy Assessment Unit (EPAU) in a university hospital in The Netherlands in 2008 on early pregnancy care is analysed. Derivatives of quality of care were measured before and after the establishment of the EPAU, with the aim of reducing unnecessary care. Care within three time periods was measured: 2006, 2009 and 2012. In 2006, 14% of women who had experienced a miscarriage were admitted to the hospital, whereas in 2009 and 2012 no women were admitted. The surgical management rate for miscarriage decreased from 79% (2006) to 6% (2009) and 28% (2012). Karyotyping of couples who had experienced recurrent miscarriage decreased from 100% (2006) to 17% (2009) and 33% (2012). The surgical management rate for ectopic pregnancy decreased from 50% (2006) to 25% (2009) and 29% (2012). The mean total cost per woman treated in 2006 was €1111 (95% CI €808 to 1426), €436 (95% CI €307 to 590) in 2009 and €633 (95% CI €586 to 788) in 2012. We can therefore conclude that an EPAU results in higher quality and cost-effective care, and has a positive effect on early pregnancy care.
authors.affiliation: Centre for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, PO Box 22700, Amsterdam 1100 DE, The Netherlands. Electronic address: m.m.bergvanden@amc.nl.
authors.forename: Merel M J
authors.initials: MM
authors.lastname: van den Berg
authors.affiliation: Centre for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, PO Box 22700, Amsterdam 1100 DE, The Netherlands.
authors.forename: Mariette
authors.initials: M
authors.lastname: Goddijn
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Centre, University Amsterdam, PO Box 22700, Amsterdam 1100 DE, The Netherlands.
authors.forename: Willem M
authors.initials: WM
authors.lastname: Ankum
authors.affiliation: Zuidoost Clinic, Out-patient clinic for Gynaecological Care, Amsterdam, The Netherlands.
authors.forename: Emmy E
authors.initials: EE
authors.lastname: van Woerden
authors.affiliation: Centre for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, PO Box 22700, Amsterdam 1100 DE, The Netherlands.
authors.forename: Fulco
authors.initials: F
authors.lastname: van der Veen
authors.affiliation: Centre for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, PO Box 22700, Amsterdam 1100 DE, The Netherlands.
authors.forename: Madelon
authors.initials: M
authors.lastname: van Wely
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Centre, University Amsterdam, PO Box 22700, Amsterdam 1100 DE, The Netherlands.
authors.forename: Petra J
authors.initials: PJ
authors.lastname: Hajenius
mesh_terms: D000026:Abortion, Habitual / Q000235:genetics*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007621:Karyotyping; D009426:Netherlands; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000601:surgery*
keywords: ectopic pregnancy; first trimester; medical care costs; miscarriage; recurrent miscarriage