What are the indications for urgent referral to secondary care for a p

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Indications for urgent referral to secondary care in a patient with suspected ectopic pregnancy include:

Haemodynamic instability, such as pallor, tachycardia, hypotension, shock, or collapse, requiring immediate referral to Accident and Emergency (A&E) ,,.
Significant concern about the degree of bleeding or pain, warranting direct referral to A&E ,,.
Women with a positive pregnancy test and any of the following on examination: abdominal pain and tenderness, pelvic tenderness, or cervical motion tenderness, should be referred immediately to an early pregnancy assessment service or out-of-hours gynaecology service ,,.
Women presenting with bleeding or other symptoms/signs of early pregnancy complications who also have pain, a pregnancy of 6 weeks' gestation or more, or a pregnancy of uncertain gestation, should be referred with urgency depending on clinical judgement ,.
Women who return with worsening symptoms or signs suggestive of ectopic pregnancy should be referred for further assessment, with urgency based on clinical situation ,.

These criteria ensure timely specialist assessment to prevent complications such as tubal rupture and to guide appropriate management ,.

What are the indications for urgent referral to secondary care for a patient with suspected ectopic pregnancy?