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Gestational Diabetes Mellitus

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.


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

 

Minimum Referral Criteria

  • Category 1
    (appointment within 30 calendar days)
    • Gestational diabetes mellitus (GDM), or diabetes first recognised during pregnancy. For optimum care, patient should be seen within 1 week at maternity service.  

    Note: pregnancy in a patient with existing diabetes require early referral to maternity services

     

  • Category 2
    (appointment within 90 calendar days)
    • No category 2 [5] criteria
  • Category 3
    (appointment within 365 calendar days)
    • No category 3 [6] 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

  • Essential referral information required as per Antenatal CPC unless already provided
  • Ethnicity including if requires interpreter
  • Diagnostic test result e.g. OGTT, Fasting blood glucose result, HbA1c

3. Additional referral information Useful for processing the referral

  • Additional referral information required as per Antenatal CPC unless already provided
  • Past history GDM and previous management
  • Outcomes associated with previous GDM, e.g. stillbirth, macrosomia, shoulder dystocia, fetal hypoglycaemia
  • Birthweight of previous pregnancies and fetal anomaly 
  • Additional relevant investigations, ELFTs, urine protein/creatinine ratio, Fetal Ultrasound 
  • Any current BGL data and management

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.