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

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) ¹,²,³.
• Significant concern about the degree of bleeding or pain, warranting direct referral to A&E ¹,²,³.
• 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 ¹,²,³.
• 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 ¹,².
• Women who return with worsening symptoms or signs suggestive of ectopic pregnancy should be referred for further assessment, with urgency based on clinical situation ¹,².

These criteria ensure timely specialist assessment to prevent complications such as tubal rupture and to guide appropriate management ¹,².