design-pregnancy-complication-action-plan

name	design-pregnancy-complication-action-plan
description	Use when learning pregnancy warning signs — e.g., "emergency signs during pregnancy", "when to go to the ER pregnant", "HELLP syndrome symptoms", "signs of placental abruption", "danger signs third trimester"
source	ACOG Patient Education Pamphlets 2023; RCOG Reducing Stillbirth 2019; ACOG Safe Motherhood Initiative Postpartum Hemorrhage 2019; SMFM Preeclampsia with Severe Features
tags	["pregnancy","emergency","warning-signs","preeclampsia","hellp","hemorrhage","safety","health"]
verified	true

Design Pregnancy Complication Action Plan

Recognize life-threatening warning signs and know when to call vs. go directly to the ER.

Why This Is Best Practice

Adopted by: ACOG, RCOG, WHO Safe Motherhood Initiative — patient education on warning signs is a core maternal safety intervention. Impact: ACOG's Alliance for Innovation on Maternal Health (AIM) bundles — which include warning sign education — reduced severe maternal morbidity by 20–40% in participating hospitals. 46% of maternal deaths involve a missed or delayed diagnosis (MBRRACE-UK 2020). Why best: Patients are the first responders in their own pregnancy. Knowing which symptoms are emergencies vs. "call your OB in the morning" directly determines speed of care.

Steps

1. Emergency — Call 911 or go directly to ER (do not wait for provider):
   • Severe headache unrelieved by acetaminophen
   • Vision changes: blurry vision, spots, flashing lights, sudden vision loss
   • Severe right upper quadrant or epigastric pain (HELLP syndrome)
   • Difficulty breathing or chest pain
   • Heavy vaginal bleeding (soaking more than 1 pad per hour for 2+ hours)
   • Decreased or absent fetal movement (after using kick count protocol)
   • Signs of pulmonary embolism: sudden shortness of breath, leg swelling + pain
   • Seizure
   • High fever >101°F (38.3°C) with rigors
   • Severe abdominal pain (possible placental abruption)
2. Call OB/midwife within 1–2 hours:
   • Blood pressure ≥140/90 on home monitor
   • Contractions before 37 weeks (>4/hour lasting >30 seconds)
   • Vaginal fluid leaking (possible ruptured membranes — ROM)
   • Swelling of face, hands, or feet that is sudden or severe
   • Burning/pain with urination (UTI — requires treatment, linked to preterm birth)
   • Decreased fetal movement (fewer than 10 movements in 4 hours at >28 weeks)
3. Specific conditions to recognize:
   • HELLP syndrome: headache + RUQ pain + blurry vision → ER immediately; HELLP can progress to liver rupture
   • Placental abruption: sudden, severe abdominal pain ± vaginal bleeding ± uterine rigidity → 911
   • Postpartum hemorrhage (after delivery): soaking >1 pad/hour, clots >golf ball, dizziness → ER
   • Preeclampsia with severe features: BP ≥160/110 + any symptom → emergency treatment within 30–60 min
4. Build emergency contacts list at 28 weeks:
   • OB/midwife after-hours line (confirm it is 24/7)
   • Nearest hospital with L&D (confirm it handles your risk level)
   • Partner/support person emergency contact
5. Postpartum extends the danger window: 87% of pregnancy-related deaths occur during or after delivery; same warning signs apply through 12 weeks postpartum.

Rules

• When in doubt, always call or go in — L&D triage will never penalize you for an unnecessary visit.
• Do not "wait until morning" for any severe symptom — preeclampsia and HELLP can progress to eclampsia (seizure) within hours.
• Reduced fetal movement is always an indication for monitoring, not self-reassurance.

Examples

Headache at 34 weeks: Take acetaminophen; if unrelieved in 1 hour, check home BP; if ≥140/90 → call OB immediately; if BP normal + headache persists → still call same day. Vaginal fluid leak at 37 weeks: Go to L&D triage — ruptured membranes require assessment for cord prolapse and infection risk, even without contractions.

Common Mistakes

• Attributing severe headache to "pregnancy tension" — severe headache is a preeclampsia warning sign until proven otherwise.
• Waiting overnight to report decreased fetal movement — assessment and intervention delay worsens outcomes.
• Assuming postpartum symptoms are "just normal" — hemorrhage, sepsis, and PE peak in the first 2 weeks after delivery.

Health Disclaimer: This skill lists warning signs for educational purposes only and is not medical advice. It does not replace evaluation by a qualified healthcare provider. When experiencing any warning signs, seek immediate medical evaluation. If you cannot reach your provider, go to the nearest emergency room.