Pregnant patients with Severe Life threatening conditions e.g serious trauma, cardiac arrest, serious medical condition

• Manage as per ALS/ATLS/MOET guidance (Don’t forget uterine displacement manually).
• Complete triage of patient and assess fetal gestation and viability. This is not primarily to assess fetal well-being but to influence maternal management
• Obstetric/Gynae Registrar to be fast bleeped and to attend resus as soon as possible. If they are not contactable or unable to immediately attend, contact the on-call obstetric consultant.
• Phone the midwifery LDRP coordinator on Tel 01422 223524
• Senior midwife to accompany SpR.
• Prepare resus area for emergency caesarean section (equipment in ED).
• Call the obstetric consultant on call if not already done.
• Contact the neonatal unit if delivery is imminent. (But do not delay delivery awaiting neonatal team’s arrival)

Pregnant patients with a major medical illness potentially requiring admission, e.g. severe asthma/suspected PE

• Manage as per normal protocols for that condition.
• Obstetric/Midwifery input may be required, therefore contact the LDRP Coordinator telephone 01422 223524.
• Dependent on the clinical situation, appropriate specialty team to review and/or inform the consultant of admission.
• Daily review/status check of the patient in relevant clinical areas.

Minor injury or medical illness not necessarily requiring admission, e.g. minor fracture or mild asthma attack

• Manage as per normal protocols and treat as appropriate.
• If there are no fetal or obstetric concerns, discharge as appropriate.
• Pregnant women attending less than 16 weeks to be discussed with the Early Pregnancy Assessment Unit( EPAU)
• All pregnant women attending ED with reduced fetal movements should be referred to either the Maternity Assessment Centre (MAC) as soon as possible.
• If there is a history of reduced fetal movements, bleeding per vagina, headache, raised blood pressure or history of a knock to the abdomen or abdominal pain or concerns or anxiety; then an antenatal review would be indicated by an obstetric/gynae doctor or midwife.
• It may be appropriate for the women to be reviewed in ED or Maternity Assessment Centre (MAC) after discussion with a midwife, the obstetric registrar or SHO on call. If the woman is to be reviewed in MAC or other maternity areas she should be escorted to the area.
• NB: have a low threshold for suspected thromboembolic disease and possibly escalate

Stable women with an obstetric problem with no other issues, e.g. labour, PV bleeding, abdominal pain, reduced foetal movements, raised blood pressure, or headache

• All pregnant women attending with reduced ED with reduced fetal movements should be referred to either the Maternity Assessment Centre (MAC) or Antenatal Day Unit (ANDU) as soon as possible.
• Contact the maternity unit via the midwifery co-ordinator on LDRP Tel 01422 223524
• Transfer to ANDU/MAC/LDRP as advised by above.
• If the woman is to be reviewed in ANDU/ MAC/ LDRP she should be escorted to the area.
• Pregnant women attending less than 16 weeks to be discussed with the Early Pregnancy Assessment Unit (EPAU)
• Ensure the woman has booked for maternity care. If she has not booked for care she should be asked to arrange the booking appointment

If these women have presented during working hours the on call registrar (bleep 509) can assess if the patient can be managed in ANDU at HRI depending on gestation and severity of symptoms. Out of hours contact MAC or LDRP at CRH.

Pregnant patients who have attempted suicide or presented with a psychiatric problem

• Contact the mental health liaison team to come and review the patient
• Psychiatric services to be contacted following the Guideline for. The Care of Pregnant Women Suffering Maternal Mental Health Problems available on the Intranet.
• Associated injuries/illness to be treated appropriately as per previous categories.
• If there is a history of reduced fetal movements, bleeding per vagina, headache, raised blood pressure or history of abdominal trauma or abdominal pain, call the obstetric Registrar on call for advice and possible review.
• The on call team should inform the patient’s consultant or assign a consultant as per unit policy.
• Contact the LDRP co-ordinator Tel 01422 223524 to inform community midwifery team and Perinatal Mental Health Lead.
• Antenatal follow-up (with community midwife or consultant as appropriate) appointment to be arranged within 10 days of discharge from hospital or psychiatric care.

Pregnant patients who present as victims of domestic abuse (suspected or confirmed)

• Treat any injuries sustained as discussed depending on the category.
• If there are any obstetric concerns, a history of reduced fetal movements, bleeding per vagina, headache, raised blood pressure or history of a trauma to the abdomen or abdominal pain; or concerns raised by the woman then please contact the maternity unit via LDRP for advice and possible review.
• Safeguarding protocols should be enacted, even if this is her first pregnancy.
• Contact the LDRP co-ordinator Tel 01422 223524 to ensure community midwifery follow-up
• Provide support and information, explaining that violent assault by a partner represents a real potential threat to her life in the future, the willingness of police to protect her and the availability of domestic abuse support organisations
• Please refer to the Trust Midwifery Domestic Abuse Guideline available on the Intranet.