Gynaecology

Conditions

Please note this is not an exhaustive list of all conditions for outpatient services and does not exclude consideration for referral unless specifically stipulated in the out of scope section.

Paediatric services

Referrals for children and young people should follow the Children’s Health Queensland referral guidelines.

If any of the following are present or suspected, phone 000 to arrange immediate transfer to the emergency department or seek emergent medical advice if in a remote region.

• Ectopic pregnancy
• Ruptured haemorrhagic ovarian cyst
• Ovarian torsion
• Torsion of uterine appendages
• Acute/severe pelvic pain
• Significant or uncontrolled vaginal bleeding
• Severe infection
• Abscess intra pelvis or PID
• Bartholin’s abscess / acute painful enlargement of a Bartholin’s gland/cyst
• Acute trauma including vulva/vaginal lacerations, haematoma and/or penetrating injuries
• Post-operative complications within 6 weeks including wound infection, wound breakdown, vaginal bleeding/discharge, retained products of conception post-op, abdominal pain
• Urinary retention
• Acute urinary obstruction
• Unstable molar pregnancy
• Inevitable and / or incomplete abortion
• Hyperemesis gravidarum
• Ascites, secondary to known underlying gynaecological oncology

Out of scope services

The following are not routinely provided in a public Gynaecology service.

• Elective cosmetic surgery e.g. labiaplasty

NB labial hypertrophy in paediatric and adolescent patients: refer to Statewide Paediatric and Adolescent Gynaecology Services (SPAG) at Queensland Children’s Hospital/RBWH.

• Elective tubal ligation is not accepted at Metro North Hospital and Health Service, however will be accepted as a Category 3 if:
  • patient cannot use/trialled other contraceptive methods
  • patient does not want to pass on any genetic disorders or disabilities
  • indicated for women suffering from medical or obstetric conditions that would contraindicate future pregnancy

NB: Please indicate previous contraception trialled and any contraindications to pregnancy

• Routine contraception counselling
• Primary menopausal care
• Cervical screening test
• Postnatal check-up
• IVF services
• Reversal of tubal ligation
• Elective termination of pregnancy*
• Gender reassignment (Referral to Gender Clinic only)**

*Termination of Pregnancy services are offered within scope of the Health service – refer to local pathways.
Information for health practitioners can be found on the Clinical Excellence website (https://clinicalexcellence.qld.gov.au/priority-areas/service-improvement/termination-pregnancy) or by contacting 13HEALTH.

**The Gender Service is located at the Royal Brisbane and Women’s Hospital and includes the following services:

• Assessment and affirmative treatment of adults with Gender Dysphoria or gender non-conforming behaviour or identity.
• Time-limited support from the Department of Social Work and Psychology for patients with social adjustments related to Gender Dysphoria.
• Adjustment support for family and significant others
• Therapeutic assessment and affirmative treatment of gender issues and other co-existing conditions
• Speech Pathology service provides voice feminisation and masculinisation services to adults who have been seen by the RBWH Gender Service and meet criteria for gender incongruence/ dysphoria. Trans and gender-diverse patients cannot be referred directly to the Speech Pathology service.
• Assessment and report by Psychiatrist for gender affirmation surgery
• Assessment for co-existing developmental disorders (Autism, ADHD) or mental illness for adults who are already accessing the service for gender affirmation, if applicable.
• Community linking and referrals to relevant services.
• Medical assessment and commencement of gender affirming hormone therapy by the Sexual Health Physician once readiness for treatment has been confirmed.
• Assessment of readiness for gender affirming hormone therapy and review following commencement of hormone therapy, as needed, by the GP with Special Interests (GPwSI).

Telehealth opportunities

The use of telehealth in a postoperative population is well supported in the literature. Telehealth is shown to be well accepted, with high patient satisfaction and improve the quality of care.  It has been safely used across various phases of surgical outpatient care, with its effectiveness evaluated by clinical outcomes, economics and user/provider satisfaction. Telehealth has multiple accepted benefits including time efficiency, patient/healthcare cost savings and community access, but with reported limitations of clinical uncertainty, technology infrastructure requirements, cybersecurity vulnerabilities and healthcare regulatory restraints

Consideration of potential surgical conditions i.e., menstrual management, routine, preventative and acute gynaecological concerns, fertility management, endometriosis^{[1, 2] [3] [4]}Conditions that could either be visible using the general exam camera at the originating site or could additionally be confirmed by an imaging study/primary care confirmation  obtained prior to the Telehealth visit.

Excluded conditions requiring a nuanced physical exam or complex decision making based on physical exam such as masses, complex abdominal pain problems and cancer.

The Following could be considered for Telehealth first appointment, as determined clinically by the surgical team and/or local services as appropriate.

Heavy menstrual bleeding (HMB)

• Post-menopausal bleeding
• Intermenstrual bleeding
• Known or suspected endometriosis
• Infertility / RPL

Specialists list