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Antenatal


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

 

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 CPC out of scope section. 

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

  • Nil noted