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.