Guideline History

NeoMedQ: Tetracaine (amethocaine) (eye)

NMedQ19.029-V1-R24

• First publication of monograph

NeoMedQ: Ipratropium

NMedQ19.028-V1-R24

• First publication of monograph

NeoMedQ: Caffeine Citrate

NMedQ19.006-V1-R24

• First publication of monograph

NeoMedQ: Diazoxide

NMedQ19.029-V1-R24

• First publication of monograph

NeoMedQ: Glucagon

NMedQ19.021-V1-R24

• First publication of monograph

NeoMedQ: Glucose gel

NMedQ19.020-V1-R24

• First publication of monograph

NeoMedQ: HydroCHLOROTHIAZIDe

NMedQ19.022-V1-R24

• First publication of monograph

NeoMedQ: Hydrocortisone

NMedQ19.023-V1-R24

• First publication of monograph

NeoMedQ: Octreotide

NMedQ19.024-V1-R24

• First publication of monograph

NeoMedQ: lamIVUDine

NMedQ19.016-V1-R24

• First publication of monograph

NeoMedQ: Flucloxacillin

NMedQ19.014-V1-R24

• First publication of monograph

NeoMedQ: Heparinised saline

NMedQ19.015-V1-R24

• First publication of monograph

NeoMedQ: Nevirapine

NMedQ19.017-V1-R24

• First publication of monograph

NeoMedQ: Aciclovir

NMedQ19.010-V1-R24

• First publication of monograph

NeoMedQ: Ampicillin

NMedQ19.012-V1-R24

• First publication of monograph

NeoMedQ: cefOTAXIME

NMedQ19.011-V1-R24

• First publication of monograph

NeoMedQ: Zidovudine

NMedQ19.018-V1-R24

• First publication of monograph

NeoMedQ: Meropenem

NMedQ19.009-V1-R24

• First publication of monograph

NeoMedQ: Atropine

NMedQ19.7-V1-R24

• First publication of monograph

NeoMedQ: Calcium gluconate 10%

NMedQ19.8-V1-R24

• First publication of monograph

NeoMedQ: Atenolol

NMedQ19.1-V1-R24

• First publication of monograph

NeoMedQ: Choral hydrate

NMedQ19.2-V1-R24

• First publication of monograph

NeoMedQ: Chloramphenicol

NMedQ19.3-V1-R24

• First publication of monograph

NeoMedQ: Hypromellose

NMedQ19.4-V1-R24

• First publication of monograph

NeoMedQ: Mupirocin

NMedQ19.5-V1-R24

• First publication of monograph

Stillbirth care

MN19.24-V8-R24

• Change initiated to align induction of labour regimens between Termination of pregnancy and Stillbirth care guidelines
• Section 4.2.2 Induction of labour:
• Renamed to section 4.3 Induction of labour
• Deleted misoprostol and mifepristone regimens from Table 13 IOL medications
• Added Sections:
• 4.3.1 Care during induction of labour
• 4.3.2 Induction regimen for women at risk of uterine rupture
• 4.3.3 Induction regimen for women not known to be at risk of uterine rupture
• Minor formatting. References updated

Stillbirth care

MN19.24-V7-R23

• Updated reporting tool from National Perinatal Death Clinical Audit Tool (NPDCAT) to Australian Perinatal Mortality Clinical Audit Tool (APMCAT).
• Removed NPDCAT and added APMCAT to list of definitions (page 6)
• Table 7 Reporting and Documentation: amended
• Reference list updated

Intrapartum fetal surveillance

MN19.15-V6-R24

• Reviewed and re-endorsed with limited changes
• Flowchart: Abnormal fetal heart (Fetal Blood Sampling Guide): Deleted: Abnormal urgent birth and pH and lactate values
• Table 2 Facility responsibilities: Added to Systems row
  Refer to Appendix A Interpretation of CTG - Using a traffic light system can assist effective interpretation of a CTG
• Table 5 Principles of intermittent auscultation: Added to Transition to continuous monitoring:
• Hypertension:
  -Systolic greater than or equal to 160 mmHg or diastolic greater than or equal to 110mmHg between contractions or
  -Systolic greater than or equal to 140 mmHg or diastolic greater than or equal to 90mmHg on two consecutives readings taken 30 minutes apart between contractions
• Hypertonus or tachysystole
• Confirmed delay in first or second stage of labour
• Table 14 Intrapartum fetal blood sampling: Acute meningoencephalitis deleted from risks
• Section 7 Other methods of fetal monitoring:
  From: Intrauterine pressure catheters (IUPC)
  To: Intrauterine pressure catheters (IUPC) may be considered for use on obese women where palpation of contractions is difficult
• Minor formatting
• Reference to Standard care guideline added
• Relevant references updated

Intrapartum fetal surveillance

MN19.15-V7-R24

• Terminology corrected: ‘Hypersystole’ replaced with ‘tachysystole’ in flowchart Mode of fetal monitoring and Appendix B

Intrapartum fetal surveillance

MN15.15-V5-R20

• Align definitions of labour with QCG Normal birth guideline
• Definition of terms:
• From Early labour: Regular painful contractions (i.e. every five minutes and persisting for longer than 30 minutes) which may be associated with a show, intact membranes or some cervical changes (not full effacement), and or less than 4 cm dilatation.
  To Early labour (latent first stage): Irregular painful contractions which may be associated with a show, intact membranes or some cervical changes (not full effacement), and or less than 4–6 cm dilatation.
• From Established labour: Regular painful contractions (which may be associated with a show, ruptured membranes or cervical changes (full effacement, 4 cm or more dilatation).
  To: Established labour (active first stage): Regular painful contractions (which may be associated with a show, ruptured membranes or cervical changes (full effacement, 4–6 cm or more dilatation).
• Table 3 Risk factors Intrapartum:
• From:
  • Prolonged first stage of labour:
    • Less than 0.5 cm per hour in active phase (cervix greater than or equal to 4 cm and effaced
  • Prolonged second stage where birth is not imminent:
    • Greater than 1 hour in a multiparous woman
    • Greater than 2.5 hours in a primiparous woman
• To: Prolonged first or second stage of labour: Refer to Queensland Clinical Guideline:Normal birth
• Minor formatting updates

Syphilis in pregnancy

MN18.44-V1-R23

• First publication.

Preterm prelabour rupture of membranes (PPROM)

MN18.48-V1-R23

• First publication.

Term prelabour rupture of membranes (PROM)

MN18.47-V1-R23

• First publication.

Instrumental vaginal birth

MN18.49-V1-R23

• First publication.

Standard care

MN18.50-V1-R23

• First publication.
  Describes generic healthcare concepts (standard care), standards or practices assumed to be common knowledge or in common use in Queensland maternity and neonatal service delivery.

Fetal movements

MN18.46-V1-R23

• First publication of short guide

Hypoxic-ischaemic encephalopathy (HIE)

MN16.11-V9-R21

• Change initiated by clinician to improve clarity around current evidence for therapeutic cooling criteria
• Checklist for therapeutic hypothermia amended:
• Removed statement about criteria with limited evidence
• Added standard criteria for cooling to checklist.
• Base deficit changed to base excess throughout document.
• Description of base excess units of measure changed throughout document
  From '≥ minus 12 mmol/L ‘
  To ‘equal to or worse than minus 12 mmol/L’

Hypoxic-ischaemic encephalopathy (HIE)

MN17.11-V8-R21

• Checklist for therapeutic hypothermia (page 3) : re-ordered criteria.
• Assessment of encephalopathy severity (page 4): Added assessment codes for normal and not applicable. Added space to record time of assessment.
• Change requested by clinician. Supports clarity of therapeutic hypothermia criteria and documentation of Modified Sarnat assessment.

Epidural in labour

MN17.41-V1-R22

• First publication. Includes care considerations, and risks and benefits compared to opioids.

Nitrous oxide and oxygen in labour

MN17.45-V1-R22

• First publication.

Opioids in labour

MN17.43-V1-R22

• First publication. Includes comparison of morphine and pethidine.

Remifentanil via PCA in labour

MN17.42-V1-R22

• First publication. Includes comparison of remifentanil (via PCA) to epidural and other opioids.

Hypoxic-iscahemic encephalopathy

MN17.11-V7-R21

• Amendment to Passive Cooling (Table 11). Temperature monitoring using axillary temperature and frequency clarified/reworded. Appendix D amended to align.
• Amendments to reference list (typos)
• Format of medications updated (not capitalised)

Induction of labour

MN17.22-V7-R22

• Change to TGA approvals for cervidil (dinoprostone)
• Table 19: Indications for removal of dinoprostone pessary amended
  From: "Insufficient cervical ripening after 12 hours"
  To: "Insufficient cervical ripening after 24 hours"
• Table 16: Balloon (transcervical) catheter insertion amended at ‘Equipment’
  From: "26 French gauge Foley catheter"
  To: "Foley catheter with balloon capacity of at least 30 mL"
• Section 2.2 Concern for fetal wellbeing amended to align with intrapartum fetal surveillance terminology
  From: "…decreased fetal movements, oligohydramnios, non-reassuring fetal surveillance test, fetal abnormality…"
  To: "…decreased fetal movements, oligohydramnios, abnormal fetal surveillance, fetal abnormality"
• Minor updates to reference list
• Guideline Supplement: Section 4.6 National Safety and Quality Health Service Standards (NSQHS) updated to align with 2017 publication of NSQHS standards

Induction of labour

MN17.22-V6-R22

• Amendment to Table 17 Post balloon catheter insertion. Added to first row of table-monitoring: “engagement of the fetal head” and “medical review required if malpresentation or fetal head 5/5 palpable after insertion”
• Amendment to Flowchart Balloon catheter as above

Induction of labour

MN17.22-V5-R22

• First complete guideline review. Endorsed by:
• QCG Sterring committee
• Statewide Maternity and Neonatal Clinical Network

Induction of labour

MN11.22-V4-R16

• Flowchart: Oxytocin row: shaded blue; frequency of observations amended
• Table 4 Term prelabour rupture of membranes, Recommendations Deleted Recommend expedited IOL as contradicts Early onset Group B streptococcal disease guideline
• Table 5 Previous caesarean section, Risk/Benefit deleted content and added ‘Refer to guideline: Vaginal birth after caesarean section (VBAC)’
• Table 17: Maximum dose and Indications for removal rows: the timing for Dinoprostone gel administration amended to be based on the woman’s individual circumstances and the obstetrician’s discretion
• Table 18: Cautions Amended wording from ‘Oxytocin should be used with caution..’ to ‘Oxytocin is contraindicated in women with a previous uterine scar or high parity ..’

Induction of labour

MN11.22-V3-R16

• Added: Section 1.5 Care if induction postponed
• Added to Table 17 Indications for removal: re use of dinoprostone gel following insufficient cervical ripening
• Added to Table 19 Administration: re use of secondary IV access
• Added to Table 21. Monitoring: Additional assessments before ARM
• Added to Table 23 Uterine hypercontractility: Use of off-licence sublingual GTN

Induction of labour

MN11.22-V2-R16

• Minor formatting corrections
• Table 18: Oxytocin considerations – Frequency of temperature monitoring amended from 4 hourly to 2 hourly

Induction of labour

MN11.22-V2-R16

• First publication
• Endorsed by:
• QCG Steering Committee
• Statewide Maternity and Neonatal Clinical Network
• Patient Safety and Quality Executive Committee

Hypoxic-ischaemic encephalopathy

NN1005.11-V1-R13

• First publication

Hypoxic-ischaemic encephalopathy

NN1005.11-V2-R13

• IV Dextrose reworded to IV Glucose

Hypoxic-ischaemic encephalopathy

MN10.11-V3-R15

• New website. Name and format updates

Hypoxic-ischaemic encephalopathy

MN10.11-V4-R15

• Appendix D: Anticonvulsant therapy deleted.
• Reference to Queensland Maternity and Neonatal Clinical Guideline Neonatal Seizures added.

Hypoxic-ischaemic encephalopathy

MN16.11-V5-R21

• First full review of original publication
• Removed sections on general medical neonatal intensive care management
• Flow charts added
• Inclusion criteria for therapeutic hypothermia amended
• First Guideline Supplement published
• Endorsed by: Statewide Maternity and Neonatal Clinical Network (Queensland)

Hypoxic-ischaemic encephalopathy

MN16.11-V6-R21

• Flow chart: Criteria for therapeutic hypothermia (cooling): “pH less than or equal to 7.00” amended to “pH less than 7.00”

Hypoxic-ischaemic encephalopathy

MN16.11-V6-R21

• Flow chart: Criteria for therapeutic hypothermia (cooling): “pH less than or equal to 7.00” amended to “pH less than 7.00”

Breastfeeding initiation

NN1010.19-V1-R13

• First publication

Breastfeeding initiation

MN10.19-V2-R15

• Review date extended.
• Identifier updated.
• Program name updated.
• Correction page 7. Removed duplicate words.

Establishing breastfeeding

MN16.19-V3-R21

• Full review and update
• Title amended to Establishing breastfeeding from Breastfeeding initiation
• Scope broadened to include:
  • Clinical standards, communication, antenatal care and common breastfeeding concerns
• Sections deleted include:
  • Appendix A: Factors influencing breastfeeding
  • Appendix E: LATCH Breastfeeding assessment tool
  • Appendix G: Storage of expressed breast milk for home use

Early pregnancy loss

MN11.29-V1-R16

• First publication

Early pregnancy loss

MN17.29-V5-R22

• Change initiated by clinical lead at Table 11: Row 5 (Ongoing management)
• From: USS not routinely recommended
• To: Repeat USS in one week and thereafter as clinically indicated. If fetal heart present on USS, refer urgently to MFM for follow-up—direct injection of potassium chloride may be indicated
• Minor corrections to reference list
• NSQH standards updated in supplement

Early pregnancy loss

MN11.29-V2-R16

• Updated Section 9: Details of Queensland Trophoblast Centre (QTC)
• Updated contact details of Appendix C: Support Contacts
• Formatting updates including name change and branding

Early pregnancy loss

MN11.29-V3-R16

• Revised recommendation at Table 10, Row 1 (Prior to commencement):
  From "Advise loading with Sodium Citrotartrate (as sachets) or IV 8.4%Sodium Bicarbonate in 100mls over 1 hour"
  To "Advise loading with Sodium Citrotartrate (as sachets)"
• Minor formatting updates

Early pregnancy loss

MN17.29-V4-R22

• First full review

Group B Streptococcus

MN1011.20-V1-R13

• First publication

Group B Streptococcus

MN10.20-V2-R15

• Review date extended.
• Identifier updated.
• Program name updated.

Group B Streptococcus

MN16.20-V3-R21

• Full review.
• Risk factor approach re-endorsed.
• Additional information added re: penicillin allergy, prelabour rupture of membranes

Gestational diabetes mellitus

MN15.33-V1-R20

• First publication

Hypertensive disorders of pregnancy

MN1008.13-V1-R13

• First publication

Hypertensive disorders of pregnancy

MN10.13-V2-R15

• Review date extended.
• Identifier updated.
• Program name updated.

Hypertensive disorders of pregnancy

MN10.13-V3-R15

• Section 1.1 Definition: Added requirement for clinical and laboratory assessment if rise in BP
• Section 10 Postpartum: Specified observations. Added reduction in frequency of monitoring requires approval from obstetric/medical team
• Appendix A: Reference to mercury sphygmomanometer deleted

Hypertensive disorders of pregnancy

MN10.13-V4-R15

• Section 6.1 Mild-moderate hypertension: BP levels for considering treatment with antihypertensive agents lowered from 140-169/90-109 mm Hg to 140-160/90-100 mmHg
• Section 6.2 Severe hypertension: BP levels requiring treatment with antihypertensive agents lowered from ≥170/110 mmHg to >160/100 mmHg
• Flowcharts updated to reflect above

Hypertensive disorders of pregnancy

MN15.13-V5-R20

• First full review.

Hypertensive disorders of pregnancy

MN15.13-V6-R20

• Tables 3 and 7 and Appendix B: description of proteinuria changed
  from "protein to creatinine ratio greater than or equal to 30 g/mmol"
  to "protein to creatinine ratio greater than or equal to 30 mg/mmol"

Hypertensive disorders of pregnancy

MN15.13-V7-R20

• Missing words at 2.2 Diagnosis of preeclampsia reinserted.
• Appendix B: random protein to creatinine ratio units changed from "mg/mol" to "mg/mmol"
• Minor typographical corrections

Intrapartum fetal surveillance

MN1008.15-V1-R13

• First publication

Intrapartum fetal surveillance

MN10.15-V2-R15

• Review date extended. Identifier updated. Program name updated.
• Amendment to Appendix A: Reduced and Absent baseline variability – added “For longer than 40 minutes” to end of each definition

Intrapartum fetal surveillance

MN10.15-V3-R15

• Section 2.1 Antenatal risk factors: Amended to include diabetes/gestational diabetes on oral hypoglycaemics

Intrapartum fetal surveillance

MN.15.15-V4-R20

• Changes to risk factors requiring continuous CTG monitoring in labour
• Amendments to interpretation of CTG with regard to baseline, baseline variability and decelerations
• Inclusion of additional information regarding:
  • Intrapartum fetal blood sampling and paired umbilical blood gas or lactate analysis
  • Recommendations for documentation and clinical handover
  • Multiple pregnancies and preterm labour

Neonatal resuscitation

NN0911.5-V1-R11

• First publication.

Neonatal resuscitation

MN11.5-V2-R16

• Full review
• Scope revised to focus on care considerations rather than didactic instruction
• Flow chart revised to align with the Australian Resuscitation Council
• Section 3.1 Supplemental oxygen administration – target oxygen saturations amended
• Laryngeal mask information provided
• Formatting alterations
• Supplement developed

Neonatal resuscitation

MN16.5-V5-R21

• Alignment with ANZCOR. Appendix A: Equipment and medications for neonatal resuscitation updated:
  From: "Intraosseous needles 50 mm length 18/G"
  To: "Intraosseous needles"
• Oxygen saturation target ranges updated to align with QNSAG recommendations (Section 4.3 Oxygen saturation monitoring)
  From: "After 10 minutes of age the target differs for example: For term babies the target is 94%–99% SpO2. For preterm babies requiring ongoing respiratory support the target is 91%–95% SpO2."
  To: "In the absence of good quality evidence, Queensland Neonatal Services Advisory Group (QNSAG) endorse the following consensus recommendation for oxygen saturation targets for preterm and term babies after 10 minutes of age:
  - For term babies the target SpO2 range is 92–98%
  - For preterm babies the target SpO2 range is 90–95%"
• Minor typo corrections
• Supplement: Section 4: Safety and Quality Standards updated

Neonatal resuscitation

MN16.5-V3-R21

• Full review
• Amended for consistency with Australian and New Zealand Council on Resuscitation (ANZCOR)
• Temperature management and monitoring expanded
• Equipment list amended
• Timing of cord clamping clarified
• Attendance at training or refresher courses by clinicians recommended
• Initial assessment including use of oximetry clarified
• Indications for suctioning clarified
• Management of meconium exposed baby amended
• Initial pressure settings for PPV amended
• Endorsement of two thumb technique for cardiac compressions when two clinicians available
• UVC as preferred route for adrenaline (epinephrine) administration
• Naloxone doses and method of administration removed
• Reference to critical blood loss protocol added

Neonatal seizures

MN11.23-V1-R16

• First publication

Neonatal seizures

MN17.23.V2.R22

• Full review
• Initial and subsequent investigations differentiated
• Additional antiepileptic drug information:
  • Levetiracetam
  • Topiramate
  • Pyridoxine
• Additional information regarding management of suspected meningitis as a cause of seizures

Neonatal seizures

MN17.23.V3.R22

• Amendment to Table 16 Midazolam
  From:
  Maintenance IV infusion: 60–400 micrograms/kg/hour (1–7 micrograms/minute)
  To:
  Maintenance IV infusion: 60–400 micrograms/kg/hour (1–7 micrograms/kg/minute)
• Updated to current guideline template
• Supplement updated

Neonatal resuscitation

MN16.5-V4-R21

• ETT dose and administration, second dot point corrected (page 25, Table 21):
  from "Do not delay attempts at vascular access as effectiveness of IV adrenaline (epinephrine) has not been established"
  to "Do not delay attempts at vascular access as effectiveness of ETT adrenaline (epinephrine) has not been established."

Non-urgent referral for antenatal care

MN11.28-V1-R16

• First publication

Non-urgent referral for antenatal care

MN11.28-V2-R16

• Deleted: Appendix A: Obstetric risk score tool.
• Deleted: Appendix B: Antenatal referral and checklist form
• Updated: Section 3.2 with additional screening tools
• Updated: References

Non-urgent referral for antenatal care

MN11.28-V3-R16

• Content endorsed as current with minor amendments
• Added Section 3.1 Use of telehealth services

Obesity

MN1003.14-V1-R13

• First publication

Obesity

MN10.14-V2-R13

• Review date extended. Identifier updated. Program name updated.

Obesity

MN10.14-V2-R13

• Appendix B: Modifications to wording of “Suggested responsibilities for referral” to indicate optional nature of transfer and referral based on BMI and the need for individual assessment

Obesity

MN10.14-V4-R15

• Section 1. General principles of care added
• Appendix B: Suggested responsibilities for referral removed. Local strategies to optimise care added

Obesity in pregnancy

MN15.14-V5-R20

• Full review
• Flowchart added
• Additional detail on weight management strategies
• Supplement created

Perineal care

MN12.30-V1-R17

• First publication

Perineal care

MN12.30-V2-R17

• Minor formatting, brand and name updates
• Added to Section 7.1 Table 15 (page 20): Avoid Codeine Phosphate or Codeine containing preparations in breastfeeding women (Codeine Phosphate is a category L4 in lactation i.e. possibly hazardous. Removed example of Codeine as pain relief.
• Amendment Section 3.3 Perineal stretching device (page 10): Technique amended to more closely reflect written device instructions as provided by manufacturer

Perineal care

MN18.30-V3-R23

• Full review at scheduled review date. All evidence reviewed.

Primary postpartum haemorrhage

MN18.1-V7-R23

• Amendment to flowchart Initial response to PPH.
  Added: Dose of carboprost if administered intramyometrial (500 micrograms).

Primary postpartum haemorrhage

MN0907.1-V1-R11

• First publication

Primary postpartum haemorrhage

MN09.1-V2-R11

• New website: updated name and format changes

Primary postpartum haemorrhage

MN12.1-V3-R17

• First full review
• Flow charts amended/added:
  • Initial response
  • Massive transfusion protocol
  • Emergency donor panel activation
• Supplement added

Primary postpartum haemorrhage

MN12.1-V4-R17

• Rebranded with Queensland Government logo
• Definition of terms: Added PRIME
• Flow chart: Emergency donor panel activation: Target results: ‘Base excess < minus 6’, amended to ‘Base excess > minus 6’
• Section 3.2 Monitoring in the fourth stage of labour; Table 5 Recommended observations post birth:
  • Removed Normal birth column
  • Added oxygen saturation and level of consciousness to observations (as per National consensus statement: essential elements for recognising and responding to clinical deterioration1)
• Section 4.1 Tone: Carboprost information moved to Section 4.1.2
• Section 4.1.2 Uterine atonia and second line drugs: New section, Dinoprost added as Carboprost not readily obtainable within Australia
• Section 4.4 Thrombin; Table 15 Coagulopathy; Row Coagulopathy correction; 3rd bullet point: deleted ‘refer to Table 4’

Primary postpartum haemorrhage

MN12.1-V5-R17

• Section 4.1.2 and Flowchart–initial response: Clarified administration instructions for Carboprost
• Oxytocin infusion regimen updated from 40 IU in 1 L IV solution to 30 IU in 500 mL IV solution to align with Induction of labour clinical guideline
• Minor formatting/branding updates

Primary postpartum haemorrhage

MN18.1-V6-R23

• Second full review
• Removed:
• Emergency donor panel
• Blood transfusion administration
• PPH proforma
• Added:
• Point of care blood clot analyser use
• Fibrinogen concentrate
• Tranexamic acid administration
• Prophylactic misoprostol
• Requirements and actions for low resource settings

Normal birth

MN12.25-V1-R17

• First publication

Normal birth

MN17.25-V2-R22

• Full review at five year scheduled review point.

Normal birth

MN17.25-V3-R22

• Water immersion: risks and benefits amended
  From: “May increase genital tract trauma”
  To: “Conflicting evidence about effect on perineal trauma”
• Added: Refer to Queensland Clinical Guideline: Perineal care guideline
• References updated
• Supplement updated: Safety and Quality (Section 5.6) updated with 2017 National Safety and Quality Health Service Standards

Perinatal substance use: maternal

MN16.37-V1-R21

• First publication
• Replaces Queensland Clinical Guideline: Neonatal Abstinence Syndrome (MN10.10-V4-R15)

Assessment and management of threatened preterm labour

MN0909.6-V1-R11

• First publication

Assessment and management of threatened preterm labour

MN0909.6-V2-R11

• Correction to acknowledgements

Assessment and management of threatened preterm labour

MN09.6-V3-R11

• Minor format and name change updates

Assessment and management of threatened preterm labour

MN09.6-V4-R14

• Review date extended until 2014

Preterm labour and birth

MN14.6-V5-R19

• First full review
• Updated title to Preterm labour and birth
• Added risk reduction measures
• Added consumer advice after threatened preterm labour
• Guideline supplement created

Preterm labour and birth

MN14.6-V6-R19

• Amendment to Section 3.2 Cervical cerclage: Clarified recommendation that multiple dilation and evacuations, cervical surgery or other abnormalities are not themselves indications for cerclage.
• Amendment to Section 4 Clinical assessment of PTL: Clarified purpose of sterile speculum examination to visualise cervix and membranes

Preterm labour and birth

MN14.6-V7-R19

• Amendment to Section 5.5 Antibiotics and Flowchart:
• Ampicillin dose if signs of chorioamnionitis changed from 1 g every 4 hours to 1 g every 6 hours
• Regimen if chorioamnionitis and penicillin allergy clarified to include Clindamicin or Lincomycin 600mg IV every 8 hours and Gentamicin 5 mg IV daily and Metronidazole 500 mg IV every 12 hours

Preterm labour and birth

MN14.6-V8-R19

• Amendment to Section 5.5 Antibiotics and Flowchart: Antibiotic regimen for PPROM deleted and replaced with reference to regimen to prolong latency in Queensland Clinical Guideline: Early onset Group B Streptococcal Disease

Stillbirth care

MN18.24-V6-R23

• Full review at 5 year scheduled review date
• Additional information and guidance about communication with parents
• Information about RCA and clinical incident review added
• Induction of labour section updated
• Core and selective investigations based on maternal history and circumstances of baby’s death
• Reporting requirements updated

Stillbirth care

MN1105.24-V1-R14

• First publication

Stillbirth care

MN1105.24-V2-R14

• Correction to flowchart Perinatal Reporting

Stillbirth care

MN11.24-V3-R16

• Review date extended
• Identifier updated
• Program name updated

Stillbirth care

MN11.24-V4-R16

• Flowchart Perinatal Reporting - Left hand blue box:
  From: In-utero death AND birth occurs at less than 20 weeks and/or birth weight less than 400 g
  To: In-utero death and birth occurs at less than 20 weeks AND birth weight less than 400 g
• Flowchart Perinatal Reporting - Stillbirth box:
  From: In-utero death and birth occurs at greater than 20 weeks OR birth weight greater than 400 g
  To: In-utero death and birth occurs at greater than or equal to 20 weeks OR birth weight greater than or equal to 400 g
• Flowchart Perinatal Reporting (Middle yellow box) Addition: Footnote “Although registration with RBDM is not required, parents may choose to register the birth. Refer to Section 3.1”
• Definition of stillbirth: “where gestation is not known” deleted from definition
• Breaking the news: Addition regarding options for registration

Stillbirth care

MN11.24-V4-R16

• Review date extended until December 2017
• Corporate identity updated
• Program name updated

Termination of pregnancy

MN19.21-V4-R24

• Full review of clinical content
• Medical practitioner responsibilities and gestational age requirements for ToP services added
• Amended:
• Clinical standards updated
• Appendices incorporated into text
• Added:
• Performance of a termination definition
• Assault and domestic violence
• Memory creation and palliative care following live birth
• Considerations for late termination
• Prophylactic antibiotics for surgical termination
• Discharge instructions and follow up
• Contraception

Termination of pregnancy

MN13.21-V3-R19

• Amendments initiated following enactment of the Queensland Termination of Pregnancy Act 2018
• Titled amended from Therapeutic termination of pregnancy to Termination of pregnancy
• Termination healthcare added to Definition of terms
• All sections referencing Queensland law relevant to termination amended to align with Termination of Pregnancy Act 2018 and Crown Law advice
• Section on Facility level approvals deleted
• Local service delivery added at Section 3 Clinical standards
• Section on Indemnity deleted
• Section on Legal test for each case deleted
• Flowchart Summary of termination of pregnancy amended to align with updated content
• Flowchart Medical termination with MS-2 Step added
• Section 7.5 MS-2 Step (up to and including 63 days gestation) added
• Appendix B: Mifepristone and misoprostol protocol amended so applicable only after 63 days gestation
• TGA approvals updated
• Minor formatting and branding updates

Therapeutic termination of pregnancy

MN13.21-V1-R18

• First publication

Therapeutic termination of pregnancy

MN13.21-V2-R19

• Review date extended to December 2019 to align with the work of the Queensland Law Reform Commission on termination of pregnancy
• Minor updates to branding and formatting

Trauma in pregnancy

MN14.31-V1-R19

• First publication

Trauma in pregnancy

MN19.31-V2-R19

• Full review.
• Added sections:
  • Uterine and placental considerations
  • Haemorrhage
  • Penetrating trauma
  • Burns
  • Domestic and family violence
  • Appendix for Injury Severity Score
• Updated:
• Management of haemorrhage
• Maternal position for CPR
• Terminology for perimortem caesarean section updated to resuscitative hysterotomy

Vaginal birth after caesarean section (VBAC)

MN0911.12-V1-R11

• First publication

Vaginal birth after caesarean section (VBAC)

MN09.12-V2-R11

• New website. Name and format changes.

Vaginal birth after caesarean section (VBAC)

MN09.12-V3-R14

• Review date extended

Vaginal birth after caesarean section (VBAC)

MN15.12-V4-R19

• First full review
• Guideline supplement published
• Considerations of planned VBAC following 2 previous caesarean sections included
• Increased focus on shared decision making
• Expanded Sections:
• Flow chart
• Antenatal care
• Discussion and planning
• Induction of labour
• Uterine rupture
• Section Intrapartum care: aligned to QCG Normal birth guideline where appropriate

Venous thromboembolism (VTE) prophylaxis in pregnancy and the puerperium

MN0910.9-V1-R11

• First publication

Venous thromboembolism (VTE) prophylaxis in pregnancy and the puerperium

MN09.9-V2-R11

• New website. Name and format changes.

Venous thromboembolism (VTE) prophylaxis in pregnancy and the puerperium

MN09.9-V3-R12

• Review date extended

Venous thromboembolism (VTE) prophylaxis in pregnancy and the puerperium

MN14.9-V4-R19

• First full review of original publication
• Added: Risks associated with VTE prophylaxis, signs and symptoms of VTE, AOR of risk factors, Discharge information
• Removed: Warfarin and Heparin decision support aids

Venous thromboembolism (VTE) prophylaxis in pregnancy and the puerperium

MN14.9-V5-R19

• Amendments to flowchart, guideline text (Sections 2.3, 4, 4.2, 4.4) and Appendix A
• Low risk antenatal women: removed recommendation to consider Graduated compression stockings (GCS), amended number of risk factors for low risk category from 1–2 to 0–2
• Moderate and high risk antenatal women: Added qualifier Discuss GCS to recommendation
• Low and moderate risk postnatal women: Added qualifier Discuss GCS to recommendation
• Added references to new Department of Health LMWH and factor Xa inhibitor guidelines
• Added to flowcharts, Section 4 and Appendix A. ‘Determine dose (standard, intermediate or therapeutic) based on individual assessment. Refer to full guideline - Section 5: Specific patient groups and Appendix A: Drug information’

Newborn examination

NN0907.4-V1-R11

• First publicaiton

Newborn examination

MN09.4-V2-R11

• Name and format updates

Newborn examination

MN09.4-V3-R14

• Review date extended until 2014

Routine newborn assessment

MN14.4-V4-R19

• First full review
• Updated title to Routine newborn assessment
• Inclusion of Indications for further review
• Additional information related to: discharge planning, consultation and review
• Guideline supplement developed

Routine newborn assessment

MN14.4-V5-R21

• Re-endorsed as current. Review date extended until 2021.
• Minor amendments to Table 4
• Moved: bilious vomiting from growth and feeding to abdomen
• Added to: skin–petechiae newly appearing or associated with purpura
• Added to: eyes–yellow sclera
• Amended: nose–from non-patent nares to nasal obstruction
• Added to neurological–absent/exaggerated reflexes
• Supplement: National Safety and Quality Health Service Standards updated
• Minor formatting updates

Hypoglycaemia and blood sugar level monitoring

NN1002.8-V1-R12

• First publication

Hypoglycaemia and blood sugar level monitoring

MN10.8-V2-R12

• New website. Name and format updates.

Hypoglycaemia and blood sugar level monitoring

MN10.8-V3-R12

• Hydrochlorothiazide dosage corrected
• Reference to Neofax added

Newborn hypoglycaemia

MN13.8-V4-R18

• First full review
• Name of guideline changed from Neonatal hypoglycaemia and blood glucose monitoring to Newborn hypoglycaemia
• BGL monitoring recommendations
• Definition of severe hypoglycaemia
• Addition of flow charts
• Supplement published

Newborn hypoglycaemia

MN13.8-V5-R18

• Amendment: indications for the option of using Glucose Gel 40% included
• Author changed to Queensland Clinical Guidelines
• Front cover updated

Newborn hypoglycaemia

MN19.8-V6-R24

• Full review
• Additional information added about:
• Use of glucose gel 40% and presentation of medication
• Calculation and preparation of glucose concentrations for IV administration
• Use of glucagon early in treatment
• Reference to NeoMedQ monographs for medication doses and other information
• BGL levels for baby greater than 24 hours and when to cease monitoring
• Addition of nurse practitioner to review baby
• Investigations prioritised
• Information added about six hour fast test
• Flowcharts separated into 3 levels of care-screening, BGL1.5 mmol/L–2.5 mmol/L and BGL less than 1.5 mmol/L

Newborn hypoglycaemia

MN19.8-V7-R24

• Amendment to wording
• Flowchart: Risk factors in Preventative care of the well at risk (for hypoglycaemia) newborn baby:
  From "Meconium stained liquor" to "meconium aspiration syndrome"
• Table 2 Maternal risk factors
• Maternal medications—Terbutaline: Words added as tocolysis within previous 48 hours
• Maternal conditions—Maternal pre-eclampsia/eclampsia or hypertension or other conditions causing placental insufficiency: Words added from any cause, and Reference amended

Neonatal jaundice

MN17.7-V8-R22

• Amendment following change request
• Section 4 Additional information added regarding the importance of assessment of babies with risk factors
• Measurement of bilirubin (Table 8): Additional information added regarding Context for assessing jaundice and TcB meter correlation with TBR
• Table 13 Additional information added regarding indications for phototherapy in facilities when access to TSB result is delayed, and seizure risk from phototherapy.
• Minor formatting

Neonatal jaundice: prevention, assessment and management

NN0911.7-V1-R11

• First publication

Neonatal jaundice

MN17.7-V6-R22

• Amendment
• Urine output clarified in Table 7 Clinical assessment
• INR and BGL added to investigations in flowchart and LFT, INR and BGL to Section 4 Clinical assessment for suspected conjugated hyperbilirubinaemia

Neonatal jaundice: prevention, assessment and management

MN09.7-V2-R11

• New website. Name and format updates.

Neonatal jaundice: prevention, assessment and management

MN09.7-V3-R14

• Review date extended until 2014

Neonatal jaundice

MN12.7-V4-R17

• First full review
• Title updated to 'Neonatal jaundice'
• Supplement created
• Content reviewed and updated: Inclusion of applicable guidelines from the National Institute of Health and Clinical Excellence Clinical guideline: Neonatal jaundice
• Flow chart added: Assessment and investigation of jaundice
• Neonatal jaundice treatment graphs updated

Neonatal jaundice

MN17.7-V5-R22

• Full review at 5 year scheduled review time point
• Flowchart reviewed and simplified
• Reference to Kramer’s rule removed from body of guideline and Appendix
• Information added about bilirubin induced neuropathy (BIND)
• Reference to Queensland centre for Mothers and Babies (QCMB) removed
• Transcutaneous bilirubinometer (TcB) information updated
• Operational details for organising retrieval of baby to higher level service removed
• Additional information about phototherapy added
• Detailed information about exchange
• The administration IV Ig transfusion moved to Treatments of no benefit and not recommended
• Additional information about emerging research added
• Information included about conjugated hyperbilirubinaemia (also included in parent information sheet regarding normal stools)

Neonatal jaundice

MN17.7-V7-R22

• Amendment to less common causes of hyperbilirubinaemia (Table 6):
  Gilbert’s syndrome deleted from less common causes of conjugated hyperbilirubinaemia and added to less common causes of unconjugated hyperbilirubinaemia
• Reference styles updated
• Minor formatting

Perinatal care at the threshold of viability

MN14.32-V1-R19

• First publication

Perinatal substance use: neonatal

MN16.38-V1-R21

• First publication
• Replaces Queensland Clinical Guideline: Neonatal Abstinence Syndrome (MN10.10-V4-R15)

Perinatal substance use: neonatal

MN16.38-V2-R21

• Corrected Finnegan Neonatal Abstinence Severity Score tool (Appendix A):
  Sneezing > 3–4 in half hour score 1
  Nasal flaring score 2

Neonatal abstinence syndrome

NN1008.10-V1-R13

• First publication

Neonatal abstinence syndrome

MN10.10-V2-R15

• Review date extended. Identifier updated. Program name updated.

Neonatal abstinence syndrome

MN10.10-V3-R15

• Route of morphine administration added to flow chart
• Minor formatting to flowchart

Neonatal abstinence syndrome

MN10.10-V4-R15

• Added permission to use and full citation for Appendix A: Finnegan Neonatal Abstinence Severity Score
• Updated front cover image

Management of neonatal respiratory distress incorporating the administration of continuous positive airway pressure (CPAP)

NN0906.3-V1-R11

• First publication

Management of neonatal respiratory distress incorporating the administration of continuous positive airway pressure (CPAP)

NN0906.3-V2-R11

• Minor formatting correction

Management of neonatal respiratory distress incorporating the administration of continuous positive airway pressure (CPAP)

MN09.3-V3-R11

• New website . Name and format updates.

Management of neonatal respiratory distress incorporating the administration of continuous positive airway pressure (CPAP)

MN09.3-V4-R14

• Review date extended until 2014

Neonatal respiratory distress including CPAP

MN14.3-V5-R19

• First full review
• Flowchart added
• Expanded sections: Complications of CPAP, neonatal care and monitoring requirements
• New images added
• Supplement created

Neonatal respiratory distress including CPAP

MN14.3-V6-R19

• Oxygen saturation target ranges updated to align with QNSAG recommendations throughout.
  From: 92–96% for babies greater than 32 weeks
  To: Term babies 92–98%. Preterm babies 90– 95%
• Added to Definition of terms: Oxygen saturation target range
  "In the absence of good quality evidence, Queensland Neonatal Services Advisory Group (QNSAG) endorse the following consensus recommendation for oxygen saturation targets for babies after 10 minutes of age:
  - For term babies the target SpO2 range is 92–98%
  - For preterm babies the target SpO2 range is 90–95%"
• Minor typo corrections
• Supplement: Section 4: Safety and Quality Standards updated

Neonatal stabilisation for retrieval

MN18.18-V4-R23

• Oxygen saturation target ranges updated to align with QNSAG recommendations
  From: "Target oxygen saturation Term baby is 94%–99%; Preterm baby 91%–95%"
  To: "In the absence of good quality evidence, Queensland Neonatal Services Advisory Group (QNSAG) endorse the following consensus recommendation for oxygen saturation targets after 10 minutes of age:
  - Term baby 92–98%
  - Preterm baby 90–95%"
• Supplement: Section 4: Safety and Quality Standards updated

Neonatal stabilisation for retrieval

MN18.18-V3-R23

• Full review at 5 year scheduled review date
• Flowchart: Respiratory distress added
• Appendix removed—Peripheral intravenous insertion sites
• Appendix removed—UAC and UVC insertion distances
• Appendix removed—ETT length and size by corrected gestation
• Amendments to Checklist: Preparation for retrieval
• Specific conditions information expanded

Neonatal stabilisation for retrieval

MN11.18-V1-R16

• First publication

Neonatal stabilisation for retrieval

MN11.18-V2-R17

• Review date extended
• Identifier updated. Branding updated.
• Queensland Emergency Medical Coorindation Centre (QCC) renamed to Retrieval Services Queensland (RSQ)

Term small for gestational age (SGA) baby

MN1012.16-V1-R13

• First publication

Term small for gestational age (SGA) baby

MN10.16-V2-R15

• Review date extended. Identifier updated. Program name updated.

Term small for gestational age baby

MN16.16-V3-R21

• First full review
• Removed content covered in subsequently published Queensland Clinical Guidelines and referenced these guidelines
• Removed antenatal specific care
• Amended small for gestational age (SGA) risk factors to risk factors specific for the term SGA baby
• Expanded parental considerations
• Removed content on routine care for all babies
• Replaced Beeby growth charts with Fenton preterm growth charts which merge with the WHO growth charts

Term small for gestational age baby

MN16.16-V4-R21

• Amended Investigations (Section 3.3 Table 7):
  from "Chormosomes BoBs and SNP array in all cases"
  to "SNP array (single nucleotide polymorphism) plus consider FISH (fluorescence in situ hybridization) if clinical suspicion of specific conditions (e.g. trisomy 21,13 or 18)"

Maternity shared care

MN11.27-V1-R16

• First publicaiton

Maternity shared care

MN16.27-V2-R21

• Content endorsed as current with minor amendments and updates
• Updates to format and presentation