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Acute care toolkit 15: Managing acute medical problems in pregnancy

Note: The latest guidance from the Royal College of Obstetricians and Gynaecologists on coronavirus (COVID-19) infection in pregnancy.

Pregnant women can present to any acute hospital service at any time during their pregnancy or the postpartum period, which is up to 12 months post-delivery.

Women may present with acute medical problems that need to be managed differently because of pregnancy, or may present with obstetric syndromes. Over two-thirds of all maternal deaths in the UK are due to non-obstetric, medical problems in pregnancy and postpartum.

This toolkit is essential reading for front-line NHS staff who may be unfamiliar with the normal physiology of pregnancy and/or diseases that present in pregnancy. Challenges arise in managing two lives — the mother and the baby — often leading to a state of clinical inertia.

The toolkit contains:

  • practical guidance on managing women with acute medical problems in pregnancy
  • red flags to watch out for in pregnant patients
  • advice to healthcare staff to ask about a woman’s mental wellbeing when she comes to hospital for other reasons during or after pregnancy
  • recommendations to improve the standard of acute care for pregnant women.

Further educational and quality improvement tools, including flowcharts for managing pregnant patients with a variety of symptoms, are available in the appendices.

Updated on 25 November 2019: please note that page 3 of the toolkit has been amended to reflect current guidance on codeine/opiates under the heading ‘Common medications used in acute medical conditions, and their use in pregnancy’. Flowchart 1a has also been updated.