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Antenatal

Emergency department referrals

All urgent cases must be discussed with the on call Registrar to obtain appropriate prioritisation and treatment. Contact through:

  • Caboolture Hospital (07) 5433 8888
  • Redcliffe Hospital (07) 3883 7777
  • Royal Brisbane and Women's Hospital (07) 3646 8111

Urgent cases accepted via phone must be accompanied with a written referral and a copy faxed immediately to the Central Patient Intake Unit: 1300 364 952.
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.

  • Suspected or proven ectopic pregnancy
  • Heavy bleeding/severe pain (haemodynamically unstable) +/- fever (suspicion of sepsis)
  • Threatened or incomplete miscarriage if haemodynamically unstable
  • Intractable vomiting

  • 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 140mmHg and/or diastolic blood pressure equal to or greater than 90 mmHg
  • 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 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 call 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
    • Uteroplacement
      • 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 required 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

  • Diabetic ketoacidosis
  • Diabetes and severe vomiting
  • Acute severe hyperglycaemia
  • Acute severe hypoglycaemia

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

  • Antenatal care requiring review within 30 days

Category 2

Appointment within 90 days is desirable

  • Antenatal care requiring review within 90 days

Category 3

Appointment within 365 days is desirable

  • No Category 3 criteria

If your patient does not meet the minimum referral criteria

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

  • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
  • Please note that your referral may not be accepted or may be redirected to another service

Other important information for referring practitioners

Not an exhaustive list

  • Advise earlier referral if woman requesting midwifery group practice model of care or birth centre (RBWH)
  • Advise if woman requesting GP Shared Care Model
    • Advise if GP prepared to participate in the GP shared care model (GP’s wanting to participate in a shared care model will need to meet local training and CPD requirements).
  • Advise antenatal, lactation and parenting education preparation and support
  • Recommend routine vaccinations for pertussis and influenza
  • Recognition of sexual orientation i.e. Lesbian, Gay and Bisexual (LGB)
  • Physiotherapy – indications for referral, consider community referrals or local health pathways
    • Urinary/faecal incontinence
    • Pelvic organ prolapse
    • Significant pelvic joint pain
    • Significant back pain
    • Carpal tunnel syndrome/de Quervain’s Syndrome
    • Inpatient on prolonged bed rest referred by medical team
    • Varicosities
  • Dietitian – indications for referral – consider community referrals or local health pathways
    • Gestational diabetes mellitus [no additional referral once referred to diabetic clinic].
    • Hyperemesis gravidarum (in-patient only) See: Pregnancy induced vomiting and hyperemesis gravidarum
    • History of Bariatric surgery
    • Body mass index (BMI) <18
    • BMI ≥ 35 (pre-pregnancy BMI >30)
    • Excessive weight gain during pregnancy (10 kg or more at 20 weeks)
    • Young women aged < 17 years
    • Nutrient deficiencies
    • Multiple Pregnancy
    • History of eating disorders
    • History of previous or current alcohol and/or drug abuse
  • Social Work – indications for referral consider community referrals or local health pathways
    • Domestic and family violence
    • Child Protection involvement (current and relevant past history)
    • Substance abuse / drug & alcohol issue
    • Unwanted pregnancy (refer to Termination of Pregnancy CPC)
    • Consistent poor attendance for pregnancy care
    • Multiple social concerns (i.e. a combination of poor social supports, housing and financial issues, significant relationship concerns)
    • New serious health diagnosis for mother or baby during pregnancy
    • Anticipated significant difficulties coping with the baby

Referral requirements

A referral may be rejected without the following information.

Essential referral information

History and Examination

  • Current pregnancy (*ensure early referral if risk factors identified, all referrals preferred by twelve weeks where possible)
    • Gravidity, Parity
    • LNMP (Last normal menstrual period),
    • EDB (Estimated date of Birth)
    • Single or multiple pregnancy
    • Confirmation of pregnancy (positive urine or serum B-HCG)
    • BMI
    • BP
    • Cervical length (after 16 weeks, if known)
  • Past Obstetrics history (if known) – for each previous pregnancy please provide details of outcome:
    • Date of birth, gestation, mode of birth, birth weight, place of birth
    • History of pre-term birth
    • Any pregnancy complications e.g. GDM (Gestational Diabetes Mellitus), fetal growth restrictions, pre-eclampsia, APH (Antepartum Haemorrhage)
    • Any birth complications e.g. PPH (Postpartum Haemorrhage), preterm birth, stillbirth, pre-existing birth trauma
    • Previous neonatal admission to SCN/NICU and reason
    • Miscarriage
    • Ectopic Pregnancy
    • Termination of Pregnancy
  • Summary of relevant medical, surgical, and psychosocial history including details of any risk factors/co-morbidities (e.g. diabetes, obesity, bariatric surgery, asthma, cardiac, renal or liver disease, hypertension, anaemia, eating disorders, mental health concerns etc.)
  • Current medications including psychotropic drugs such as Sodium Valproate, Lithium and other medication with recognized fetal implications
  • Indigenous status, Ethnicity and language spoken (identify if interpreter is required)
  • Drug, alcohol, and smoking

Pathology and Test Results

  • Routine antenatal bloods: FBC, Ferritin, blood group and antibody screen, rubella antibody screen, hepatitis B serology, hepatitis C serology, HIV serology, syphilis serology, Mid-Stream Urine for MCS

Additional referral information (useful for processing the referral)

History and Examination

  • Method of conception (either spontaneous or assisted)
    • Surrogate pregnancy
  • Immunisation information (e.g. Influenza, COVID vaccination status, has Pertussis been discussed and planned for after 20 weeks?)
  • First trimester early OGTT (preferred) or HbA1c – if risk factors for gestational diabetes
    • BMI ≥ 30 kg/m2 (pre-pregnancy or on entry to care)
    • Ethnicity (Asian, Indian subcontinent, Aboriginal, Torres Strait Islander, Pacific Islander, Maori, Middle Eastern, non-white African)
    • Previous GDM
    • Previous elevated Blood Glucose Level (BGL)
    • Maternal age ≥ 40y
    • 1st degree relative with DM or sister with GDM
    • Previous macrosomia (birth weight > 4500 g or > 90th percentile)
    • Previous perinatal loss
    • Polycystic Ovarian Syndrome
    • Medications (corticosteroids, antipsychotics)
    • Multiple pregnancy
  • Advise if new partner with this pregnancy

Pathology and Test Results

  • Prenatal screening and diagnostic testing for fetal chromosome and genetic conditions e.g. genetic carrier screening, combined first trimester screen, NIPT, CVS, amniocentesis,
  • TSH – if > 30y or other thyroid risk factors (family history, autoimmune disease including coeliac disease, T1DM etc.)
  • ELFTs and Urine protein/creatinine ratio if indicated e.g. women with BMI > 30, pre-existing hypertension, diabetes
  • Chlamydia investigation for women ≤30y or risk factors
  • STI screen result as indicated
  • Cervical screening reports if >25y or indicated
  • Include pathology relevant to any medical history i.e. known cardiac renal or liver disease

Imaging and reports

  • Dating, Nuchal Translucency and Morphology Ultrasound scans
  • Include imaging relevant to any medical history i.e. known cardiac, renal or liver disease

Other considerations

  • Refugee status
  • Social history including domestic violence, living situation, drug and alcohol use
  • Identification of Gillick competence and intellectual capacity (where appropriate)
  • Recognition of sexual orientation i.e. Lesbian, Gay, and Bisexual (LGB)
  • Woman’s preferred model of care
    • GP Shared Care (Is the GP aligned?)
    • Midwifery care
      • Birth centre
      • Midwifery Group Practice (MGP)
      • Other
    • Obstetric care

Complete the Maternity referral form and forward it to Metro North Central Patient Intake.

Imaging and reports

For Royal Brisbane and Women’s Hospital imaging requests, complete the Women’s Imaging Request Form.
For Royal Brisbane and Women’s Hospital dietitian requests, complete the Maternity Dietitian Outpatient Referral form.

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

  • 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

  • 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

  • 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

  • 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

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature

  • 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.)

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