Red flags
Call. Nobody in the NHS thinks you are wasting their time in early pregnancy.
Call 999 now
Call 999- Heavy bleeding: soaking a pad soon after putting it on, or passing large clotsHaemorrhage. Do not drive yourself.
- Severe tummy pain that stops you doing anything normalPossible ruptured ectopic pregnancy (a pregnancy growing outside the womb).
- Pain at the very tip of the shoulder, worse when lying downBlood irritating the diaphragm. This is a classic ectopic sign and it is easy to dismiss.
- Collapse, fainting, or feeling you are about to pass outEspecially with pain or bleeding. Lie down and get someone to call.
- Dizziness or feeling faint together with bleeding or painThis combination is how an ectopic presents. With uncertain dates, treat it as an emergency, not as low blood sugar.
- Sudden severe headache, the worst you have ever hadNeurological emergency. In pregnancy this can also be severe pre-eclampsia, so do not wait it out as a migraine.
- Weakness down one side, slurred speech, a drooping face, or a seizureSigns of a stroke or an eclamptic seizure. Note the time the symptoms started and say it when you call.
- Chest pain, breathlessness, coughing up blood, or a hot swollen painful calfPossible blood clot. The risk of clots is raised in pregnancy.
If you are alone, unlock the door before you sit down.
Call today
Midwife · EPU · 111Today means today, not at the next appointment. Under 20 weeks the early pregnancy unit is the right door rather than A&E, unless anything in the red box above applies.
| Sign | Where to call |
|---|---|
| Any vaginal bleeding, even light spotting | EPU, or midwife or GP |
| One-sided pelvic pain that persists, with or without bleeding | EPU the same day. Ectopic must be ruled out |
| Unable to keep any food or fluid down for 24 hours | GP or 111. Before 14 weeks, the Early Pregnancy Unit rather than maternity triage |
| No urine for 8 hours or more, or very dark urine | GP or 111: dehydration. Before 14 weeks, the Early Pregnancy Unit rather than maternity triage |
| Vomiting blood, or vomit that looks like coffee grounds | Same day |
| Fever of 38 °C or above, or burning or stinging when passing urine | Same day. A urine infection in pregnancy needs treating |
| Severe headache with visual changes: flashing lights, blurring, spots | Same day, always |
| Sudden swelling of the face, hands or feet, especially with a headache or visual changes | Same day |
| Repeated fainting, or dizziness with a racing or irregular heartbeat | Same day |
| Weight loss, muscle weakness, palpitations, or feeling "not right" with the sickness | Same day. This is how hyperemesis gets assessed |
| New, unexplained pressure in the back passage, or pain opening your bowels | Same day. NICE lists this as a possible ectopic symptom |
| Itching on the palms of your hands or the soles of your feet, or all-over itching | Same day. UCLH lists this as a triage symptom: it is how obstetric cholestasis presents, and a blood test settles it |
| Reduced or changed baby movements (later in pregnancy, from around 24 weeks) | Maternity triage immediately, at any hour. Never wait until morning, and never wait for a second opinion |
Raise at the next appointment
Not urgent. Write it down now so it does not get lost in the room.
- Tiredness that is getting worse rather than levelling off, or comes with breathlessness on stairs, palpitations, or cravings for ice or starch. Ask for ferritin, B12, folate and TSH.
- Dizziness on standing that is now happening several times a day.
- Nausea that is still not controlled after a fair trial of the first-line measures.
- Any single faint that has already happened and settled.
- Low mood, dread, or feeling unable to cope with the pregnancy. The RCOG treats mental-health assessment as part of sickness care, not an extra.
Numbers
| Emergency | 999 | Anything in the red box. |
| NHS 111 | 111 | Out of hours, or when you cannot reach anyone else. Also 111.nhs.uk. |
| UCLH Early Pregnancy Unit | 020 3447 6515 | The right door before 14 weeks. Bleeding, pain, anything early-pregnancy. Walk-in 9am–12:30pm and 2–3pm Monday to Friday, Lower Ground Floor, Clinic 3, and UCLH accepts self-referral from anyone who has had a previous ectopic pregnancy. Out of hours or at a weekend, go through A&E instead. |
| UCLH maternity triage (MFAU) | 020 3447 9400, option 2 | Open 24 hours as a walk-in — 1st floor of the EGA wing — but only from 14 weeks onwards. Before 14 weeks this is the wrong number: use the Early Pregnancy Unit above, or 111 out of hours. |
| GP surgery | Write the number here | Sickness medication, blood tests, thyroid and iron. |
| Pregnancy Sickness Support | 0800 055 4361 | Peer support and advocacy for sickness. Not clinical triage. |
Self-referral works. You do not need a GP letter to ring the early pregnancy unit if you have had a previous ectopic, molar or recurrent miscarriage. Anyone referred to an early pregnancy assessment service should be seen within 24 hours, some immediately.
The ectopic list, in full
An ectopic pregnancy is one growing outside the womb. NICE is clear that unusual presentations are common and that about a third of ectopics happen in people with no risk factors at all, so the symptoms matter more than the risk profile.
Common: tummy or pelvic pain · a missed period · vaginal bleeding, with or without clots.
Also reported: breast tenderness · stomach and bowel symptoms · dizziness or fainting · pain at the tip of the shoulder · urinary symptoms · passing tissue · pressure in the back passage or pain opening the bowels.
Say these two things out loud
- “I am pregnant, roughly ___ weeks.” It changes the triage category instantly.
- “I have PCOS.” It is relevant to the thyroid, glucose and gestational-diabetes pathways.
Ignore one thing: ketone sticks
The 2024 RCOG guideline dropped them. Ketones in urine are not an accurate measure of dehydration and should not be used to judge how severe sickness is. If a clinician sends you home because your ketones are negative, that is out of date. Say so.
UK/NHS routes, drawn from NICE NG126 and QS69, the NHS bleeding-in-pregnancy guidance and RCOG Green-top Guideline No. 69. Not a substitute for speaking to a clinician. When in doubt, call.