• Management of disease unrelated to the pregnancy is altered by the pregnancy
• Two patients (mother plus fetus) may change treatment decisions
• Anatomical and physiological changes in pregnancy result in altered:
• clinical features during CVS, respiratory and abdominal examination
• biochemical and haematological values
• pharmacological management
• response to any systemic pathology
• protocols for the management of critical illness
• By giving consideration to the pregnancy and the fetus, maternity service providers can help with:
• assessment of maternal and fetal wellbeing
• investigations
• treatment
• Be aware of the significance of hypertension and proteinuria in pregnant women

• Ensure every pregnant woman admitted is managed promptly
• Establish communication link between admitting team and obstetric team
• to deliver the most appropriate care

Accident and emergency

• Ask apparently pregnant woman of any gestation presenting to Emergency Department if she has booked for maternity care
• if not booked for maternity care, inform delivery suite co-ordinator who can advise on appropriate follow-up and booking arrangements
• In cases of trauma or vaginal bleeding at any gestation, give consideration to woman's blood group and need for anti-D
• if in doubt, discuss with on-call middle grade obstetrician (ST3–7 or equivalent e.g. staff grade, clinical fellow)

Nursing

• Do not nurse women in the second and third trimester in supine position
  • to prevent aortocaval compression
• If the disease causes reduced mobility, consider VTE prophylaxis
  • Use obstetric risk assessment proforma
• Use national early warning score (NEWS) to help in the timely recognition, treatment and referral of women who have or are developing critical conditions

Contact

• If ≥16 weeks' gestation, contact delivery suite co-ordinator
• for advice on which healthcare professional(s) should review
• If any severely ill pregnant woman is admitted outside the maternity service:
• contact on-call middle grade obstetrician/consultant obstetrician
• if she is critically ill, or likely to need urgent surgery, refer early to critical care team and/or anaesthetist

Documentation

• Document all communication (including inter-departmental) in maternal healthcare record
• highlight pregnant or newly delivered woman's attendance/admission to non-midwifery ward/department