Early pregnancy assessment
An urgent check, usually with an internal scan and sometimes blood tests, when there is bleeding, pain or worry in early pregnancy, to find where the pregnancy is and whether it is developing.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- It is an urgent check (usually an internal scan, sometimes with blood tests) for bleeding, pain or worry in early pregnancy.
- It looks at where the pregnancy is and whether it is developing — and helps rule out an ectopic pregnancy.
- One visit may not give a final answer; a repeat scan or blood tests over a week or two are sometimes needed.
- Severe one-sided pain, shoulder-tip pain, faintness, collapse or heavy bleeding is an emergency — call 999 or go to A&E, not the unit.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Finds where the pregnancy is, which helps rule out an ectopic pregnancy
This is not the right route for emergency symptoms — severe pain, faintness, collapse or heavy bleeding need 999 or A&E, not a booked assessment.
You may feel mild pressure from the internal probe but it should not hurt. You can ask questions and ask to pause at any time.
A clear explanation of what the scan did and did not show, and the plan.
You may feel mild pressure from the internal probe but it should not hurt. You can ask questions and ask to pause...
You can usually go straight back to your day. If you were already bleeding, you may notice a little spotting after...
Many results are explained on the day. If blood tests or a repeat scan are needed, you will be told when to return...
If a miscarriage or ectopic pregnancy is found or suspected, the team will explain the options and arrange...
What is an early pregnancy assessment?
An early pregnancy assessment is a check carried out in the first weeks of pregnancy, usually because of bleeding, tummy pain, or worry — for example after a previous miscarriage or ectopic pregnancy. It is most often done at a hospital early pregnancy assessment unit (EPAU).
The main test is an ultrasound scan, usually an internal (transvaginal) scan because this gives the clearest view this early. The aim is to find where the pregnancy is (in the womb or, less commonly, outside it), and whether it is developing as expected. Blood tests measuring your pregnancy hormone (hCG) may be used as well, sometimes repeated a couple of days apart.
Bleeding and pain in early pregnancy are common and do not always mean something is wrong — but they should always be checked, partly to rule out an ectopic pregnancy. Sometimes one visit gives a clear answer; sometimes a repeat scan a week or two later is needed before anything can be confirmed, which can be an anxious wait.
If you have severe one-sided tummy pain, shoulder-tip pain, feel faint, collapse, or have very heavy bleeding, do not wait for an appointment — call 999 or go to A&E.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Options at a glance
These are the main approaches described in this guide. The right option depends on the diagnosis, your goals and what your clinician thinks is safe.
Transvaginal (internal) ultrasound scan
A slim probe, about the size of a tampon, is gently placed in the vagina to give a close, clear view of the womb and ovaries. This is the usual scan in early pregnancy...
Transabdominal (tummy) ultrasound scan
Scanning over the lower tummy, sometimes with a full bladder. It may be used as well as, or instead of, the internal scan in some situations or by preference.
Pregnancy hormone (hCG) blood tests
Blood tests that measure the pregnancy hormone, sometimes repeated about 48 hours apart, to see how the level is changing when the scan cannot yet show where the pregnancy is.
Repeat assessment
If it is too early to be sure, you may be asked to return in a week or two for another scan. This watchful approach avoids jumping to conclusions before the pregnancy is far...
Preparing for your test
- You usually do not need to fast; for a tummy scan you may be asked to have a comfortably full bladder, but an internal scan needs an empty bladder.
- Wear clothing that is easy to adjust, as you may need to undress from the waist down for an internal scan.
- Bring details of your last period, any previous pregnancies, and any previous miscarriage or ectopic pregnancy.
- Note down any bleeding, pain or other symptoms, including when they started.
- You can bring someone with you for support; a chaperone is offered for the internal scan.
- If you have had vaginal surgery, find sexual examinations difficult, or have any worries, tell the team — the scan can be adjusted.
- Prepare for the possibility that you may not get a final answer in one visit.
What happens
You will usually talk to a nurse or doctor about your symptoms and history first. The main part is the ultrasound scan, most often an internal (transvaginal) scan, which gives the clearest view this early. A chaperone is offered, and you can ask to stop at any point.
The scan looks for the pregnancy in the womb and checks the ovaries and the area around the womb. Depending on how many weeks along you are, the team may or may not be able to see a heartbeat yet. If the pregnancy cannot be located, this is called a 'pregnancy of unknown location', and you will be monitored carefully.
Blood tests measuring your pregnancy hormone may be taken, sometimes repeated a couple of days later. The team will explain what they find as clearly as they can, and what happens next — which might be reassurance, a plan to manage a miscarriage or ectopic pregnancy, or a repeat scan.
Is this test right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- This is not the right route for emergency symptoms — severe pain, faintness, collapse or heavy bleeding need 999 or A&E, not a booked assessment.
- A scan very early (before about six weeks) may be too soon to give useful information and can cause needless worry.
- It is not a substitute for routine antenatal care once a pregnancy is confirmed to be developing normally.
- It cannot, on its own, rule out every early pregnancy problem in a single visit.
Delay or rearrange if…
- It is extremely early and a scan now is unlikely to show anything useful — a short wait may give a clearer answer.
- You actually have emergency symptoms, in which case you should seek urgent care rather than wait for this appointment.
- Key information, such as your dates or previous results, is missing and would change how the scan is interpreted.
Alternatives to discuss
- Watchful waiting with clear advice when symptoms are mild and there is no sign of an emergency.
- Pregnancy hormone (hCG) blood tests over a couple of days when a scan cannot yet locate the pregnancy.
- Going straight to A&E or 999 if emergency symptoms develop.
- Routine antenatal care if the pregnancy is confirmed to be developing normally.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- Finds where the pregnancy is, which helps rule out an ectopic pregnancy
- Checks whether the pregnancy is developing as expected
- Can reassure you when bleeding or pain turns out to be harmless
- Guides the right next step if there is a problem, including support
- Brings together scan and blood-test information in one specialist place
Risks & complications
- Anxiety while waiting for the scan and the results
- Some discomfort or a sensation of pressure during an internal scan, though it should not be painful
- Not getting a final answer in one visit, so a repeat scan or blood tests are needed
- Difficult or unexpected news, such as a miscarriage or possible ectopic pregnancy
- The pregnancy cannot be located at first (pregnancy of unknown location), needing close follow-up
- Light spotting after an internal scan if you are already bleeding
- Findings that are unclear and need senior review or another scan
- An incidental finding unrelated to the pregnancy that needs further checks
- Very rarely, an urgent problem found that needs immediate treatment
An early scan cannot always give a definite answer, especially before about six to seven weeks, and being asked to come back can be hard. A normal early scan also cannot promise the pregnancy will continue. The most important thing is to know the emergency warning signs while you wait, and to seek urgent help — not a routine appointment — if you feel faint, collapse, or have severe one-sided or shoulder-tip pain.
Published figures to discuss
An early pregnancy scan is a piece of information at one moment, not a guarantee. Its usefulness depends on how many weeks along you are, and a single visit sometimes cannot give a final answer. Where helpful, the team will use repeat scans or blood tests rather than over-interpret one result.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Early miscarriage after a positive pregnancy test | About 1 in 5 in the first 3 months in RCOG patient information | Risk rises with age and some medical/lifestyle factors; many early losses are due to chromosome problems. | RCOG — Early miscarriagercog.org.ukPublished figure |
| Ectopic pregnancy in the UK | About 1 in 90 pregnancies | A scan and serial hCG blood tests may be needed because an ectopic pregnancy is not always visible at the first visit. | NICE NG126 — Ectopic pregnancy and miscarriage: information for the publicnice.org.ukPublished figure |
| Inconclusive first assessment / pregnancy of unknown location | Common early on, especially before about 6 weeks | This usually means repeat blood tests and/or a repeat scan rather than a diagnosis on the day. | Guide sourcesClinical context |
| Physical risk from ultrasound scanning | Very low; no ionising radiation | The main issue is interpretation and follow-up, not the scan causing harm. | NICE NG126 — Ectopic pregnancy and miscarriage: information for the publicnice.org.ukSource-linked context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is no physical recovery from the assessment itself. What matters most afterwards is understanding the result, knowing the plan, and having support — especially if the news was difficult.
- Feeling relieved, anxious, or both, depending on the result
- A little spotting after an internal scan if you were already bleeding
- Being asked to return for a repeat scan or blood tests if it is too early to be sure
- Needing time to take in difficult news
- No physical after-effects from the scan itself
Aftercare
- Make sure you understand the result and the plan before you leave, and ask questions if anything is unclear.
- Keep any follow-up scan or blood-test appointments, as the picture can take a week or two to become clear.
- Note the emergency warning signs and keep the unit's contact number to hand.
- If you are bleeding, use pads rather than tampons until advised otherwise.
- Seek emotional support if the news was hard — for you and your partner.
- Contact the unit or your GP if your symptoms change or worsen.
- Continue any pregnancy advice you have been given, such as folic acid, if the pregnancy is ongoing.
- Your last period date and pregnancy history written down
- A note of your symptoms and when they started
- Comfortable, easy-to-adjust clothing
- Someone to come with you for support if you wish
- The unit's contact number and any follow-up dates saved
- Pads (not tampons) at home if you are bleeding
- Written emergency warning signs
⚠ Get urgent help if…
- Severe or one-sided tummy pain — seek urgent help; call 999 if severe
- Pain at the tip of your shoulder — this can signal internal bleeding from an ectopic pregnancy
- Feeling faint, dizzy, very pale or collapsing — call 999
- Very heavy vaginal bleeding, or passing large clots
- A high temperature, shivering or a smelly discharge (possible infection)
- Feeling very unwell, or that something is seriously wrong
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A reassuring result usually means the pregnancy is in the right place (in the womb) and, if you are far enough along, a heartbeat is seen. This is good news, but an early scan cannot promise that the pregnancy will continue, as some pregnancies are still lost afterwards.
If the scan cannot yet locate the pregnancy or confirm it is developing, this does not automatically mean bad news — it often just means it is too early, and a repeat assessment is needed. The team will explain exactly what your result does and does not tell you, and what happens next.
An early pregnancy scan reflects that moment in time. If it is reassuring, you will move on to routine antenatal care and the usual pregnancy scans. If it is inconclusive, a repeat scan or blood tests a week or two later usually clarify the picture. New symptoms at any point should always be checked.
Related tests, treatments or support
An early pregnancy assessment is often combined with pregnancy hormone (hCG) blood tests, blood-group testing (which checks whether you are rhesus D negative and, in some situations, may lead to an anti-D injection — see the FAQ below), and — depending on the result — miscarriage or ectopic pregnancy care, or onward referral to routine antenatal care.
Follow-up & long-term care
Follow-up depends on what is found. You may be reassured and discharged to routine antenatal care, asked to return for a repeat scan or blood tests, or offered care for a miscarriage or ectopic pregnancy with support. You should always leave knowing the plan and who to contact if things change.
Repeat, follow-on and what comes next
- A repeat scan a week or two later is often needed before anything can be confirmed.
- Pregnancy hormone blood tests may be repeated to clarify a pregnancy of unknown location.
- An inconclusive result is common early on and does not always mean bad news.
- The plan can change as new information or symptoms appear.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A clear explanation of what the scan did and did not show, and the plan.
- Written emergency warning signs and a contact number for the unit.
- Prompt follow-up scans or blood tests where the result is inconclusive.
- Sensitive support and counselling if difficult news is given.
- A smooth handover to routine antenatal care, or to miscarriage or ectopic pregnancy care, as needed.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Whether the assessment is on the NHS (no charge) or arranged privately
- The type of scan and whether blood tests are included
- Whether more than one visit or repeat scan is needed
- Who reports the scan and how quickly results are given
- Any follow-up appointment or onward referral
- Counselling or support services if the news is difficult
- Which scans and blood tests are included
- Whether a repeat scan, if needed, is included or charged separately
- Who reports the scan and when you will get results
- What happens, and who to contact, if a problem is found
- Whether emotional support or counselling is available
- That urgent symptoms should go to NHS emergency care, not wait for a private appointment
On the NHS? Early pregnancy assessment units are an NHS service, usually accessed through a GP, midwife, A&E or urgent non-life-threatening advice by phone. For phone advice, use NHS 111 in England, Scotland or Wales; in Northern Ireland there is no 111 service, so contact your GP out-of-hours service or your HSC Trust's Phone First arrangement instead. Private early scans are also available, but urgent symptoms should be assessed without delay.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Not being warned that a single early scan may not give a final answer.
- Implying a normal early scan guarantees a healthy ongoing pregnancy.
- Not explaining that an internal scan is usual this early, and that you can decline or pause it.
- Not giving clear emergency warning signs to watch for while waiting for results.
- Not arranging or explaining follow-up when the result is inconclusive.
Marketing red flags
- Private 'reassurance' scans sold as proof of a healthy pregnancy — they cannot promise this.
- Encouraging very early scans that are likely to be inconclusive and cause worry.
- Suggesting a private scan is an adequate substitute for urgent assessment of worrying symptoms.
- Souvenir-style imaging marketed over careful clinical assessment in someone who is bleeding or in pain.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- What did the scan show about where the pregnancy is and whether it is developing?
- If it is too early to tell, when should I come back, and what happens in the meantime?
- What symptoms should make me seek urgent help before then?
- Do I need blood tests or an anti-D injection?
- If there is a problem, what are my options and what support is available?
- What does a normal result here mean for the rest of my pregnancy?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my test, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this test not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Does the internal scan hurt?
Why do I need an internal scan rather than one over my tummy?
Why might I have to come back for another scan?
Can a normal scan guarantee a healthy pregnancy?
When should I go straight to A&E instead?
Is this available on the NHS?
Will I need an anti-D injection if I am rhesus D negative?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NICE NG126 — Ectopic pregnancy and miscarriage: information for the public NHS — Vaginal bleeding in pregnancy NHS — Ectopic pregnancy RCOG — Early miscarriage RCOG — Ectopic pregnancy NICE NG126 — Ectopic pregnancy and miscarriage RCOG — Bleeding and pain in early pregnancy (patient information) The Miscarriage Association — information and support The Ectopic Pregnancy Trust NICE NG126 — Anti-D immunoglobulin prophylaxis nidirect — Urgent and emergency care services (Northern Ireland) nidirect — GP out-of-hours service (Northern Ireland)
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
Related guides: Pelvic ultrasound scan · Miscarriage care · Ectopic pregnancy care · Antenatal care and pregnancy scans · Cervical screening (smear test)