If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.
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
- 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