When should I refer a pregnant woman to a specialist for further evaluation during antenatal care?

Refer a pregnant woman to a specialist for further evaluation during antenatal care if any of the following are present:

• Signs or symptoms suggestive of pre-eclampsia, such as severe headache, visual disturbances, severe pain below the ribs, vomiting, breathlessness, or sudden swelling of the face, hands, or feet. Emergency assessment in secondary care should be arranged if pre-eclampsia is suspected.
• Medical concerns or need for review of current long-term medications.
• Positive pregnancy test with pain, abdominal or pelvic tenderness, cervical motion tenderness, bleeding at or beyond 6 weeks' gestation, or uncertain gestation, to exclude ectopic pregnancy or other early pregnancy complications.
• Women with complex social factors or vulnerabilities, including young maternal age under 20, domestic abuse, or language barriers, may require referral to specialist or tailored antenatal services.
• Women with pre-existing conditions such as renal disease, autoimmune disease, diabetes, vascular disease, or cardiac concerns should be referred for specialist assessment.
• Women who smoke or have recently stopped smoking should be referred to NHS Stop Smoking Services.
• Any woman with safeguarding concerns or mental health issues during pregnancy should be referred appropriately.

At every antenatal appointment, a risk assessment should be carried out to identify women who need additional care or specialist referral. Communication with the woman’s GP and other relevant professionals should be arranged after discussion and agreement with the woman.

These referrals ensure timely specialist evaluation and management to optimize maternal and fetal outcomes.

References: ¹,³,⁴,⁵,⁶,⁷