Termination of pregnancy

Emergency department referrals

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

Royal Brisbane and Women's Hospital (07) 3646 8111
The Prince Charles Hospital (07) 3139 4000
Redcliffe Hospital (07) 3883 7777
Caboolture Hospital (07) 5433 8888

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.

Consider providing advice that in an emergency situation, medical and clinical staff cannot conscientiously object to providing care following a failed early medical termination. All Hospital and Health Services will provide services to women who present for emergency care.

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

Ectopic pregnancy
Ruptured haemorrhagic ovarian cyst
Torsion of uterine appendages
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
Any molar pregnancy
Inevitable and/or incomplete miscarriage
Hyperemesis gravidarum
Ascites, secondary to known underlying gynaecological oncology

Metro North HHS Nurse Navigator – Termination of Pregnancy

Service supporting GPs and women from the point of referral, pre and post termination of pregnancy.

Clinical Advice Line (This is for Metro North GPs only and not open to patients)
Hours: Monday – Friday 8.30am– 3.30pm
Ph: 1800 569 099
Email: metronorthtop@health.qld.gov.au

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

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 days is desirable

No category 2 criteria

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

In an emergency situation, medical and clinical staff cannot conscientiously object to providing care following a failed early medical termination. All Hospital and Health Services will provide services to women who present for emergency care.
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.
Termination of pregnancy is a time sensitive service and that delays impact on the woman or pregnant persons options.
- An early medical termination that can normally happen at home and is available under the supervision of a GP up to 9 weeks (63 days) gestation
- From 9 weeks gestation the woman or pregnant person will need to be admitted to hospital to have a termination.
Legal requirements if a medical practitioner conscientiously objects to provide termination of pregnancy services.

“Clinical staff may have a conscientious objection to ToP and choose not to provide counselling or prescribe medications / perform surgical TOP. Their objection must not impede or disrupt patients’ access to care relating to ToP. They must treat any patient who has requested ToP with respect and compassion. They must inform the patient of their objection and their right to seek care from another doctor and ensure the patient has sufficient information to exercise that right.

Clinical staff should be familiar with their rights and obligations in relation to ToP legislation in their local jurisdiction. If unsure, clinical staff should consult with their medical defence organisation, union and/or State or Territory AMA office for appropriate advice.

At times, a patient admitted to an institution may request ToP that the institution does not provide due to conscientious objection. In these cases, Clinicians should be allowed to refer patients seeking ToP to another institution outside the facility without repercussions for the doctor”.

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 Termination of pregnancy 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 Queensland Clinical 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

Referral requirements

A referral may be rejected without the following information.

Essential referral information

Summary of relevant circumstances leading up 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

Additional referral information (useful for processing the referral)

BMI
Blood group and type
HPV vaccination history
Asymptomatic STI screen result – endocervical swab or low vaginal SELF SWAB. Also screen for chlamydia +/- gonorrhoea NAA, T vaginalis, (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 >10 weeks nil bloods
For surgical termination requests please include STI screen, PCR swab, blood group

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.

Clinical Modifiers (where relevant)

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

Reason for Referral (essential)

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 Information (essential)

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

Patient’s Demographic Details (essential)

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 (essential)

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

Other Information (where relevant)

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.)

Other Gynaecology conditions

Send referral

Hotline: 1300 364 938

Electronic:

GP Smart Referrals (preferred)
eReferral system templates

Medical Objects ID: MQ40290004P
HealthLink EDI: qldmnhhs

Mail:
Metro North Central Patient Intake
Aspley Community Centre
776 Zillmere Road
ASPLEY QLD 4034

Health pathways

Access to Health Pathways is free for clinicians in Metro North Brisbane.

For login details email:
healthpathways@brisbanenorthphn.org.au

Locations

13 HEALTH
13 43 25 84 is a phone line that provides health information, referral and services to the public