South Middlesex Times

A new clinic focusing on early pregnancy care has been established by Dr. Marianne DiNapoli at New Jersey Medical School. The Early Pregnancy Assessment Clinic (EPAC), launched in October 2023, addresses the critical first trimester of pregnancy when most miscarriages occur. Traditionally, securing an obstetrics appointment can take up to two months, prompting many patients to seek emergency room care for issues that could be managed more effectively in outpatient settings.

Dr. DiNapoli explained the benefits of the clinic's setting: “The E.R. is a hard place to build rapport,” she said. “In the ambulatory setting you have time to sit down and talk in a calm environment. It builds trust.”

Located at University Hospital’s Ambulatory Care Center in Newark, EPAC provides comprehensive services such as lab work, referrals for prenatal care, same-day treatment for miscarriages and nonviable pregnancies, exams, ultrasounds, contraception and pregnancy planning, and grief counseling.

DiNapoli highlighted the importance of mental health support following a miscarriage: "10-20% of people experience depression after a miscarriage," she noted. She emphasized that these risks are higher among patients of color who often visit ERs for early pregnancy complications.

The clinic's model aims to reduce implicit bias in healthcare: “It potentially takes race out of the equation, treating all patients the same to eliminate health care disparities and miscarriage management,” DiNapoli stated.

This approach has been standard in the U.K. since the 1990s but is relatively new in the United States. The University of Pennsylvania's PEACE clinic reports significant cost savings and reduced ER personnel time with similar models.

Currently serving as EPAC's sole attending physician, Dr. DiNapoli previously practiced in Ohio before joining NJMS as an assistant professor in August 2023. Her goal was to further her career interest in family planning while working with underserved populations.

Within weeks of its opening, EPAC had scheduled 17 patients through internal referrals alone—an indication of unmet demand even before marketing efforts began.

Colleagues like Lauren Naliboff praise DiNapoli’s contributions: “Dr. DiNapoli is an excellent addition... This clinic increases access and improves quality care for patients with concerns in early pregnancy,” Naliboff commented.

Although currently supported by a small team including a chief resident or medical students occasionally assisting alongside support staff like medical assistants or licensed practical nurses, Dr. DiNapoli hopes resources will grow so appointments can be made within two days instead of six: "Right now it's a small team but hopefully one that will grow," she said.

Appointments at EPAC can be made by calling 973-972-2700 with self-referrals accepted.

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