A GP referral is required for all women booking in at Peninsula Health.
E-referral is preferred
Referral Forms Antenatal Clinic FAX to 9788 1879
9784 7777 for URGENT GP pregnancy concerns (obstetric registrar via switchboard)
9784 2626 for GPs who have a clinical concern about a patient you are referring (Antenatal Clinic)
9784 2643 for women who want to enquire if their booking referral has been received
Key Points for referral
- Refer Early (before 12 weeks if possible)
- Calculate BMI essential for referral
- BP and Estimated Due Date essential for referral
- Start Supplements and Aspirin (if indicated level 2 or 3 risk) early
- Order Standard Investigations (some women need more tests in first trimester)
- Patient Information – click here for helpful patient information about Maternity Services
For more information including recommended supplements and prenatal screening see Further Referral Information tab below.
Further Referral Information, Supplements and Screening
1. Refer
- Refer before 12 weeks. We are aiming for women to have their Booking-In visit at the hospital around 10-14 weeks and their first Obstetric visit by 14-16 weeks.
- Use E-referral or the paper-based Antenatal Clinic Referral Form with a detailed past history in the referral form or included with an attached letter.
- Any test results received after referral please FAX to 9788 1879
- If you have clinical concerns about a woman you are referring, please call the Antenatal Clinic PH: 9784 2626.
2. Calculate BMI1
BMI measurements affect clinical care for pregnant women.9
BMI > 50 at referral (and >43 if out of area) are not accepted at Peninsula Health. Please refer to Monash Health1,9
BMI >30
- High dose folic acid (5mg) recommended from three months before conception and at least for the first trimester of pregnancy.9
- Iodine (150mcg) supplementation for duration of pregnancy1
- Vitamin D supplementation is advised (1000 IU per day).1
- Low dose aspirin (LDA) 150mg nocte prior to 16 weeks to 36 weeks if level 2 or 3 risk of Fetal Growth Restriction unless contraindicated2. If low dose aspirin is started before 16/40 in high risk women, the rate of FGR can be halved.2,4.
- Consider Calcium supplementation 1500-2000mg daily if low calcium intake in diet as this can reduce the risk of pre-eclampsia and fetal growth restriction.10
- Early Oral Glucose Tolerance Test (OGTT) should be arranged for 14-16 weeks. If normal or not attended all women have should have the Glucose Tolerance Test (GTT) at 26 weeks to exclude Gestational Diabetes.1
BMI 35–39:
- As above for BMI > 30 and also consider baseline investigations of renal function in early pregnancy to assist in diagnosis and management later in pregnancy.1,9
BMI 40 or more:
- As above for BMI > 30 and also test for baseline renal function (presence of proteinuria, serum creatinine and urea) and liver function.1,9
ULTRASOUNDS and high BMI
- Where possible mid trimester fetal morphological assessment should be performed at 20-21 weeks rather than 18-20 weeks and maternal obesity should be highlighted on Ultrasound request form.1,9
3. BP and Estimated Due Date essential for Referral
- Hypertension in pregancy3
- Estimated Due Date6
4. Start Supplements and Aspirin early if indicated
RANZCOG Vitamin and Mineral Supplementation and Pregnancy
- Folic acid 400mcg daily three months prior to conception and for first trimester4
- High Dose folate 5mg 9 for women with Diabetes, BMI>30, PHx Gestational Diabetes, or PHx Neural Tube Defect.
- Iodine 150mcg daily for duration of pregnancy11
- Vitamin D supplementation should be discussed with women identified as being at high risk of vitamin D deficiency 7
- Calcium supplementation assists with women who are at risk for pre-eclampsia 1500-2000mg daily if low calcium intake in diet10
- Low dose aspirin (LDA) 150mg nocte prior to 16 weeks to 36 weeks if level 2 or 3 risk of Fetal Growth Restriction unless contraindicated2. If low dose aspirin is started before 16/40 in high risk women, the rate of FGR can be halved.2,4.
- See Routine Pregnancy Care Clinical Practice Guideline
5. Standard investigations
Recommended at around 9-10 weeks2
- Blood group and Antibodies
- FBE, ferritin
- Hepatitis B, Hepatitis C, HIV, Rubella, Syphilis
- Midstream Urine for MC&S
- Prenatal Screening5
Combined First Trimester Screening or Non-invasive prenatal testing (NIPT) (cfDNA) or, if not done offer Second Trimester Maternal Serum Screening5
Some women need more tests to be done in first trimester
- Chlamydia and Sexually Transmitted Infection (STI) screening
Offer testing to at risk populations (women 25 years or younger, multiple sexual partners)
- Early OralGlucose Tolerance Test (OGTT)2
- Increased risk of Gestational Diabetes (GDM), BMI > 30
- Family history of diabetes (1st degree relative with DM with GDM)
- Previous GDM or previous macrosomia (>4500gm or >90th centile)
- Elevated booking BGL
- Multiple Pregnancy
- Polycystic Ovarian Syndrome (PCOS)
- Maternal age of 40 years or over
- Corticosteroid or antipsychotic medication
- Previous perinatal loss
- Women with ethnicity of increased risk (Asian, Indian subcontinent, Aboriginal, Torres Strait Islander, Pacific Islander, Maori, Middle Eastern, African)
- Maternity Services Consumer Page – helpful information for women
Healthy eating in pregnancy including foods to avoid8
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References
Note Peninsula Health CPG references can be viewed at our CPG page