Antenatal

ADULT

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    First Trimester

    • Suspected or proven ectopic pregnancy
    • Heavy bleeding/severe pain (haemodynamically unstable) +/- fever (suspicion of sepsis)
    • Threatened or incomplete miscarriage if haemodynamically unstable
    • Intractable vomiting

    Post first trimester

    • Heavy bleeding/severe pain (haemodynamically unstable) +/- fever (suspicion of sepsis)
    • Threatened or incomplete miscarriage
    • Threatened preterm labour
    • Pre-term rupture of membranes
    • Evidence of cervical incompetence
    • Intractable vomiting
    • Hypertension equal to or greater than 140/90 mm Hg
    • Severe headaches or visual disturbances
    • Suspected pre-eclampsia presenting with  hypertension systolic blood pressure equal to or greater than 140 mmHg and/or diastolic blood pressure equal to or greater than 90 mmHg and
      • one or more of the following organ/system features related to the mother and/or fetus:
        • Renal
          • random urine protein to creatinine ratio greater than or equal to 30mg/mmol from an uncontaminated specimen (proteinuria)
          • Serum or plasma creatinine greater than or equal to 90 micromol/L or
          • oliguria (less than 80 mL/4hours or 500 mL/24 hours)
        • Haematological
          • thrombocytopenia (platelets under 150 x 109/L)
          • haemolysis (schistocytes or red cell fragments on blood film, raised bilirubin, raised lactate dehydrogenase (LDH), decreased haptoglobin)
          • disseminated intravascular coagulation (DIC)
        • Liver
          • new onset of raised transaminases (over 40 IU/L) with or without epigastric or right upper quadrant pain
        • Neurological
          • headache
          • persistent visual disturbances (photopsia, scotomata, cortical blindness, retinal vasospasm)
          • hyperreflexia with sustained clonus
          • convulsions (eclampsia)
          • stroke
        • Pulmonary
          • pulmonary oedema
        • Uteroplacental
          • fetal growth restriction (FGR)
          • suspected fetal compromise
          • abnormal umbilical artery Doppler wave form analysis
          • stillbirth
      • If gestational age is 23-32 weeks or fetal weight is less than 1500grams then contact local service as referral for emergency treatment may be directed to a level 6 maternity service for obstetric assessment
    • Seizures or unexplained syncope
    • Acute mental health concern needing to be seen by acute mental health service or psychiatric emergency centre.
    • Abdominal trauma – GP check with maternity booking hospital level of care required
    • Any concern regarding fetal growth requires confirmation with ultrasound (if available) and referral to maternity service as indicated.
    • Change in fetal movement pattern
    • Suspected or confirmed fetal death in utero
    • Any other significant concern

    Gestational Diabetes Mellitus

    • Diabetic ketoacidosis
    • Diabetes and severe vomiting
    • Acute severe hyperglycaemia
    • Acute severe hypoglycaemia
    • Refer to local Healthpathways or local guidelines
    • Expect the first hospital visit to be offered between 16-20 weeks unless there are issues requiring more urgent review
    • GP will be responsible for the care until review by maternity service
    • Discuss the Maternity model of care options available across Queensland, these are site specific.
    • Document woman's preferred model of care – if known or provide information and time for woman to consider options
    • Advise earlier referral if woman requesting midwifery group practice model of care
    • Advise if woman requesting GP Shared Care Model
      • Advise if GP prepared to participate in the GP shared care model (GP's wanting to participate in a shared care model will need to meet local training and CPD requirements).
    • Advise antenatal, lactation and parenting education preparation and support
    • Recommend routine vaccinations for pertussis and influenza
    • Physiotherapy – indications for referral, consider community referrals or local health pathways
      • Urinary/faecal incontinence
      • Pelvic organ prolapse
      • Significant pelvic joint pain
      • Significant back pain
      • Carpal tunnel syndrome/de Quervain's Syndrome
      • Inpatient on prolonged bed rest referred by medical team
      • Varicosities
    • Dietitian – indications for referral – consider community referrals or local health pathways
      • Gestational diabetes mellitus [no additional referral once referred to diabetic clinic].
      • Hyperemesis gravidarum (in-patient only) See: Pregnancy induced vomiting and hyperemesis gravidarum
      • History of Bariatric surgery
      • Body mass index (BMI) <18
      • BMI ≥ 35 (pre-pregnancy BMI >30)
      • Excessive weight gain during pregnancy (10 kg or more at 20 weeks)
      • Young women aged < 17 years
      • Nutrient deficiencies
      • Multiple Pregnancy
      • History of eating disorders
      • History of previous or current alcohol and/or drug abuse
    • Social Work – indications for referral consider community referrals or local health pathways
      • Domestic and family violence
      • Child Protection involvement (current and relevant past history)
      • Substance abuse / drug & alcohol issue
      • Unwanted pregnancy (refer to Termination of Pregnancy CPC)
      • Consistent poor attendance for pregnancy care
      • Multiple social concerns (i.e. a combination of poor social supports, housing and financial issues, significant relationship concerns)
      • New serious health diagnosis for mother or baby during pregnancy
      • Anticipated significant difficulties coping with the baby

    Clinician resources

Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)
  • Antenatal care requiring review within 30 days
Category 2
(appointment within 90 calendar days)
  • Antenatal care requiring review within 90 days
Category 3
(appointment within 365 calendar days)
  • No category 3 [6] criteria

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention not otherwise accessible to the patient
  • For advice regarding management
  • To engage in an ongoing shared care approach between primary and secondary care
  • Reassurance for GP/second opinion
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)

2. Essential referral information Referral will be returned without this

  • Current pregnancy (*ensure early referral if risk factors identified, all referrals preferred by twelve weeks where possible)
    • Gravidity, Parity
    • LNMP (Last normal menstrual period),
    • EDB (Estimated Date of Birth)
    • Single or multiple pregnancy
    • Confirmation of pregnancy (positive urine or serum B-HCG)
    • BMI
    • BP
  • Past Obstetric history (if known) - for each previous pregnancy please provide details of outcome:
    • Date of birth, gestation, mode of birth, birth weight, place of birth
    • Any pregnancy complications e.g. GDM (Gestational Diabetes Mellitus), fetal growth restriction, pre-eclampsia, APH (antepartum haemorrhage)
    • Any birth complications e.g. PPH (Postpartum Haemorrhage), preterm birth, stillbirth, pre-existing birth trauma
    • Previous neonatal admission to SCN/NICU and reason
    • Miscarriage
    • Ectopic pregnancy
    • Termination of pregnancy
  • Summary of relevant medical, surgical, and psychosocial history including details of any risk factors/co-morbidities (e.g. diabetes, obesity, bariatric surgery, asthma, cardiac, renal or liver disease, hypertension, anaemia, eating disorders, mental health concerns etc)
  • Current medications including psychotropic drugs such as Sodium Valproate, Lithium and other medication with recognised fetal implications
  • Indigenous status, Ethnicity and language spoken (identify if interpreter is required)
  • Drug, alcohol, and smoking history
  • Routine antenatal bloods: FBC, blood group and antibody screen, rubella antibody screen, hepatitis B serology, hepatitis C serology, HIV serology, syphilis serology, Mid-Stream Urine for MCS

3. Additional referral information Useful for processing the referral

  • Method of conception (either spontaneous or assisted)
  • First trimester early OGTT (preferred) or HbA1c – if risk factors for gestational diabetes
    • BMI > 30 kg/m2 (pre-pregnancy or on entry to care)
    • Ethnicity (Asian, Indian subcontinent, Aboriginal, Torres Strait Islander, Pacific Islander, Maori, Middle Eastern, non-white African)
    • Previous GDM
    • Previous elevated Blood Glucose Level (BGL)
    • Maternal age ≥ 40y
    • 1st degree relative with DM or sister with GDM
    • Previous macrosomia (birth weight > 4500 g or > 90th percentile)
    • Previous perinatal loss
    • Polycystic Ovarian Syndrome
    • Medications (corticosteroids, antipsychotics)
    • Multiple pregnancy
  • Advise if new partner with this pregnancy
  • Prenatal screening and diagnostic testing for fetal chromosome and genetic conditions e.g. combined first trimester screen, NIPT, CVS, amniocentesis, genetic carrier screening
  • Ferritin
  • TSH – if > 30y or other thyroid risk factors (family history, autoimmune disease including coeliac disease, T1DM etc)
  • ELFT's and Urine protein/creatinine ratio if indicated e.g. women with BMI >30, pre-existing hypertension, diabetes
  • Chlamydia investigation for women ≤30y or if risk factors
  • STI screen result as indicated
  • Cervical screening reports if >25y or indicated
  • Include pathology relevant to any medical history i.e. known cardiac renal or liver disease
  • Dating, Nuchal Translucency and Morphology Ultrasound scans
  • Immunisation information (e.g. Influenza, COVID vaccination status, has Pertussis been discussed and planned for after 20 weeks?)
  • Include imaging relevant to any medical history i.e. known cardiac, renal or liver disease

Other considerations

  • Refugee status
  • Social history including domestic violence, living situation, drug and alcohol use
  • Identification of Gillick competence and intellectual capacity (where appropriate)
  • Recognition of sexual orientation i.e. Lesbian, Gay, and Bisexual (LGB)
  • Woman's preferred model of care
    • GP shared care (is the GP aligned?)
    • Midwifery care
      • Birth centre
      • Midwifery Group Practice (MGP)
      • Other
    • Obstetric care

4. Request

  • Patient's Demographic Details

    • Full name (including aliases)
    • Date of birth
    • Residential and postal address
    • Telephone contact number/s – home, mobile and alternative
    • Medicare number (where eligible)
    • Name of the parent or caregiver (if appropriate)
    • Preferred language and interpreter requirements
    • Identifies as Aboriginal and/or Torres Strait Islander

    Referring Practitioner Details

    • Full name
    • Full address
    • Contact details – telephone, fax, email
    • Provider number
    • Date of referral
    • Signature

    Relevant clinical information about the condition

    • Presenting symptoms (evolution and duration)
    • Physical findings
    • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
    • Body mass index (BMI)
    • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
    • Current medications and dosages
    • Drug allergies
    • Alcohol, tobacco and other drugs use

    Reason for request

    • To establish a diagnosis
    • For treatment or intervention
    • For advice and management
    • For specialist to take over management
    • Reassurance for GP/second opinion
    • For a specified test/investigation the GP can't order, or the patient can't afford or access
    • Reassurance for the patient/family
    • For other reason (e.g. rapidly accelerating disease progression)
    • Clinical judgement indicates a referral for specialist review is necessary

    Clinical modifiers

    • Impact on employment
    • Impact on education
    • Impact on home
    • Impact on activities of daily living
    • Impact on ability to care for others
    • Impact on personal frailty or safety
    • Identifies as Aboriginal and/or Torres Strait Islander

    Other relevant information

    • Willingness to have surgery (where surgery is a likely intervention)
    • Choice to be treated as a public or private patient
    • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.

    • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.

    • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

Last updated: 17 November 2022

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