Referral to secondary care is indicated for women with suspected pre-eclampsia if there are any clinical concerns for the wellbeing of the woman or baby, or if high risk of adverse events is suggested by risk prediction models such as fullPIERS or PREP‑S NICE NG133.
Women with new onset of hypertension (over 140 mmHg systolic or over 90 mmHg diastolic) after 20 weeks of pregnancy should be assessed by a healthcare professional trained in hypertensive disorders of pregnancy and referred within 24 hours NICE CKS.
Referral is also recommended if there is severe hypertension (blood pressure of 160/110 mmHg or more), or if there are signs of impending eclampsia, pulmonary oedema, or other signs of severe pre-eclampsia, or suspected fetal compromise NICE NG133.
Any maternal biochemical or haematological investigations that cause concern, such as a rise in creatinine, liver enzymes, or fall in platelet count, also warrant secondary care referral NICE NG133.