Pregnancy admissions, including ED referrals

Any pregnant patients referred to ED should be referred to the obstetric department unless there is some good reason not to do so. Such reasons include:

• Patient requires immediate resuscitation.
• A patient who requires the sort of care not available in the obstetric department (e.g. severe respiratory compromise, those requiring cardiac monitoring and those requiring ITU admission.
• There is some problem that clearly isn’t related to the pregnancy (e.g. fractures, lacerations etc).

It is expected that those with medical or surgical problems should be looked after in the obstetric department in the first instance. They will be admitted under the name of the on call obstetrician, but care may directed by a physician or surgeon as appropriate.

Notes

• It is accepted that all pregnant patients require triage in ED to ensure clinical stability. Those with an obvious obstetric problem should then be referred directly to labour ward. Those with an obvious gynaecology problem should be referred to the on-call FY2/GPVTS who will decide where to see the patient.
• If a call is phoned to ED that is clearly primarily obstetric (e.g. labour, abruption) it is appropriate to either re-direct the call or to send the patient directly to labour ward without them entering A&E. Labour ward would, of course, need to be contacted prior to the patient’s arrival.
• Those seen in ED or BECS not requiring admission do not need to be discussed with the obstetric team unless their condition has specific implications for the pregnancy.
• If a pregnant patient is in resus, the midwife or the obstetric registrar should be informed.

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