First Trimester

• Suspected or proven ectopic pregnancy
• Heavy bleeding/severe pain (haemodynamically unstable) +/- fever (suspicion of sepsis)
• Threatened or incomplete miscarriage if haemodynamically unstable
• Intractable vomiting

Post first trimester

• Heavy bleeding/severe pain (haemodynamically unstable) +/- fever (suspicion of sepsis)
• Threatened or incomplete miscarriage
• Threatened preterm labour
• Pre-term rupture of membranes
• Evidence of cervical incompetence
• Intractable vomiting
• Hypertension equal to or greater than 140/90 mm Hg
• Severe headaches or visual disturbances
• Suspected pre-eclampsia presenting with hypertension systolic blood pressure equal to or greater than 140 mmHg and/or diastolic blood pressure equal to or greater than 90 mmHg and
• one or more of the following organ/system features related to the mother and/or fetus:
  • Renal
    • Random urine protein to creatinine ratio greater than or equal to 30mg/mmol from an uncontaminated specimen (proteinuria)
    • Serum or plasma creatinine greater than or equal to 90 micromol/L or
    • Oliguria (less than 80 mL/4hours or 500 mL/24 hours)
  • Haematological
    • Thrombocytopenia (platelets under 150 x 109/L)
    • Haemolysis (schistocytes or red cell fragments on blood film, raised bilirubin, raised lactate dehydrogenase (LDH), decreased haptoglobin)
    • Disseminated intravascular coagulation (DIC)
  • Liver
    • New onset of raised transaminases (over 40 IU/L) with or without epigastric or right upper quadrant pain
  • Neurological
    • Headache
    • Persistent visual disturbances (photopsia, scotomata, cortical blindness, retinal vasospasm)
    • Hyperreflexia with sustained clonus
    • Convulsions (eclampsia)
    • Stroke
  • Pulmonary
    • Pulmonary oedema
  • Uteroplacental
    • Fetal growth restriction (FGR)
    • Suspected fetal compromise
    • Abnormal umbilical artery Doppler wave form analysis
    • Stillbirth
• If gestational age is 23-32 weeks or fetal weight is less than 1500grams then contact local service as referral for emergency treatment may be directed to a level 6 maternity service for obstetric assessment
• Seizures or unexplained syncope
• Acute mental health concern needing to be seen by acute mental health service or psychiatric emergency centre.
• Abdominal trauma – GP check with maternity booking hospital level of care required
• Any concern regarding fetal growth requires confirmation with ultrasound (if available) and referral to maternity service as indicated.
• Change in fetal movement pattern
• Suspected or confirmed fetal death in utero
• Any other significant concern