Pregnancy complication referral checklist

Urgency tier

• Immediate ED/obstetric assessment for instability, heavy bleeding, syncope, severe pain or suspected ruptured ectopic pregnancy; use EMS for instability or collapse.
• Stable early-pregnancy pain/bleeding needs time-sensitive early-pregnancy service assessment with a confirmed diagnostic/follow-up plan; use the ED if this cannot be secured.
• Routine referral is generally not appropriate when active complication concern is present.

Minimum pre-referral workup

• Emergency transfer must not wait for completion of this checklist.
• Gestational context, bleeding severity, pain pattern, and vital signs.
• Relevant pregnancy history and ectopic-risk factors.
• Initial stabilization steps and current symptom trajectory.

Referral packet checklist

• Structured history with symptom onset and progression.
• Objective findings, labs/imaging available, and Rh context when known.
• Current medications and allergies.

Pre-referral optimization tasks

• Provide clear return precautions for worsening pain, bleeding, dizziness, or fever.
• Confirm safe transport and contact pathway for urgent reassessment.
• Document communication handoff details to receiving service.

References

• Emergency Care BC Ectopic pregnancy diagnosis (2020) (opens in a new tab)
• NICE NG126 Early pregnancy assessment (updated June 2026; UK guidance) (opens in a new tab)
• NICE NG126 Pregnancy of unknown location (UK guidance) (opens in a new tab)

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