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Termination of Pregnancy

Find assessment and management information at Brisbane South HealthPathways under:

Useful management information

  • 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 thesupervision 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.
    • The Termination of Pregnancy Act 2018 recognises that registered health practitioners have, and may exercise, the right to freedom of thought, conscience and religion. There is a requirement in the Act for a registered healthcare practitioners to inform the woman of their conscientious objectionstatus and refer the woman in a timely manner to alternate, accessible and willing registeredhealthcare practitioners who can provide the required service. 
  • 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. youngwomen, 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 (Does your patient meet the minimum criteria?)

Category 1
(appointment within 30 calendar days)

 
  • 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. . In Metro South, a referral must be provided with complete investigations and circumstances leading to request for ToP attached so as not to delay care.  This must be sent through the Central Referral Hub for timely patient care.  For any queries regarding termination provisions please call the Nurse Navigator on 0459 462 478 to discuss. 
 

Referrals are time critical, and should be complete with all investigations completed and attached.

Request for termination service 22 +1 weeks have additional complexities and should be discussed with the Nurse Navigator.
 

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

If your patient does not meet the minimum referral criteria

  • Assessment and management information can be found on a range of conditions at Brisbane South HealthPathways
  • If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested:
    • 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

Standard referral information (To be included in all referrals)

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

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
  • All conservative options that have been pursued unsuccessfully prior to referral
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes, BMI), noting these must be stable and controlled prior to referral
  • Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use
  • A comprehensive capture of information in relation to MSH Referral Criteria

Clinical modifiers

  • The presence of clinical modifiers may impact the categorisation of the patient.
  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living functioning – low/medium/high
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

Patient's Demographic Details

  • Full name (including aliases)
  • Date and country of birth
  • Residential and postal address including whether patient resides at an aged care facility
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Name of delegate and contact details (Department of Corrective Services)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander
  • Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature
  • Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

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.)

 

Essential referral information for Termination of Pregnancy referrals (Referral will be returned without this)

  • Confirm the diagnosis and gestation of intra-uterine live pregnancy by ultrasound (Ultrasound report must be included)
  • Summary of relevant circumstances leading to request for termination of pregnancy (i.e. complex health needs and/or significant social disadvantage)
  • Medical, surgical, obstetric and psychosocial history
  • Menstrual history and last menstrual period (LMP) date (if available)

If a specific test result is unable to be obtained due to access, financial, religious, cultural or consent reasons a Clinical Override may be requested. This reason must be clearly articulated in the body of the referral.

Additional referral information for Termination of Pregnancy referrals

  • BMI
  • 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)

Emergency

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
     

Out of catchment

Metro South 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 South 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.

Last updated 3 July 2024