Antenatal

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

Gestational Diabetes Mellitus

• Diabetic ketoacidosis
• Diabetes and severe vomiting
• Acute severe hyperglycaemia
• Acute severe hypoglycaemia