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Termination of Pregnancy

ADULT

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


  • Ectopic pregnancy
  • Ruptured haemorrhagic ovarian cyst
  • Torsion of uterine appendages (ovarian)
  • 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

 

  • Termination of pregnancy is a legal medical procedure in Queensland from 3 December 2018 (Termination of Pregnancy Act 2018).
  • A Registered medical practitioner may perform a lawful termination on a woman who is:
    • up to a gestational limit of 22+0 weeks, for any reason
    • 22+1 weeks of gestation or more if two medical practitioners agree that, in all the circumstances, the termination should be performed.
  • Local Hospital and Health Services provide a limited number of appointments for terminations. Priority appointments for terminations will be given to women with complex health care needs and no ability to have a termination in the private sector where most terminations are performed.
  • Statewide clinical guidelines states under the Clinical Standards that:
    • Ideally, offer an assessment appointment within 5 days of referral
    • Ideally, provide termination within 2 weeks of the decision to proceed being agreed
  • Refer to Healthpathways and/or local guidelines
  • Offer referral to other services as appropriate, especially where risk factors are identified (e.g. young women, women with physical or intellectual disabilities, mental illness, rape or sexual assault, domestic violence, fertility issues and cultural beliefs/values).
  • Where a young woman is sixteen years of age or under, greater consideration of an independent and appropriate counsellor / support person being available and engaged should be considered
  • Consider primary health screening or advice. i.e. Cervical Screening, Sexual Health Check, Rubella titre, domestic and family violence or sexual violence, smoking cessation advice.
  • Counsel about pregnancy options and contraceptive advice

Clinical resources

Patient resources

Minimum Referral Criteria

  • Category 1
    (appointment within 30 calendar days)

    Local Hospital and Health Services provide a limited number of appointments for terminations. Priority appointments for terminations will be given to women with complex health care needs and no ability to have a termination in the private sector where most terminations are performed.

    • Any patient requesting a termination of pregnancy.  For optimum care, an assessment appointment should be offered within 5 days of referral.


    NB: Full termination of pregnancy services may not be offered by individual hospitals.  Referral may well be accompanied by a telephone call to the local Hospital and Health Service to establish local guidelines.  This could include discussion with the responsible clinician or delegate. Request for termination service 22+1 weeks have additional complexities and should be discussed with the responsible clinician.

     

  • Category 2
    (appointment within 90 calendar days)
    • No category 2 criteria
  • Category 3
    (appointment within 365 calendar days)
    • No category 3 criteria

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

  • Summary of relevant circumstances leading to the request for termination of pregnancy
  • Medical, surgical, obstetric and psychosocial history
  • Menstrual history and last menstrual period (LMP) date (if available)
  • Confirm the diagnosis and gestation of intra-uterine live pregnancy by ultrasound*

*Where access is limited in regional/rural centres consider referral prior to ultrasound

3. Additional referral information Useful for processing the referral

  • Blood group and type
  • Routine antenatal bloods: FBC, rubella antibody, hepatitis B serology, hepatitis C serology, HIV serology, syphilis serology
  • HPV vaccination history
  • STI screen result – endocervical swab or low vaginal SELF SWAB.  Also screen for chlamydia +/- gonorrhoea NAA, T vaginalis, M genitalium (highly desirable)
    • STI screen might not be available before referral but is an essential part of the management.
  • History of smoking and alcohol and drug use
  • If pregnancy >11 weeks, Down syndrome screening results – screen at 11 to 14 weeks: fetal ultrasound + serum βhCG + serum PAPP-A (results required if completed, not necessary if thinking of Termination of Pregnancy)

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.)
  • 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.