Termination of pregnancy

Information about outpatient clinics for surgical terminations of pregnancy, as well as for women who are assessed by the referrer as unsuitable for Medical Termination of Pregnancy (MTOP) and can be seen at the clinic within an appropriate gestation (see referral process); for follow up of failed medical termination of pregnancy (MTOP); or for medically stable patients with complications of MTOP.

Emergency care

Scope

These gynaecological clinics do not provide initial counselling regarding unplanned pregnancies. See Pregnancy Choices Information (Women's Health Tasmania) website for links to these services.

Surgical termination of pregnancy

Surgical terminations of pregnancy, as well as for women who are assessed by the referrer as unsuitable for Medical Termination of Pregnancy (MTOP), and can be seen at the clinic at less than:

• 12+0 weeks gestation at Mersey Community Hospital
• 13+0 weeks gestation at Launceston General Hospital
• 14+0 weeks gestation at Royal Hobart Hospital

If the regional hospital is unable to accommodate a referral, the woman will be contacted by the regional hospital and assisted to receive care elsewhere. There will be no out of pocket expenses for clinical care for women eligible for this service after the referral is received.

Complications of Medical Termination of Pregnancy (MTOP)

There are two infrequent situations for which a prescriber (or other medical practitioner) will need to refer a patient despite good planning/procedures. These may be:

1. The stable patient where the MTOP has failed and the uterus still contains the foetus. See referral process.
2. The unwell/unstable patient who may have excessive bleeding, pain or infection. See referral process.

Emergency Referral Criteria

Criteria for Emergency include: 

• Ectopic pregnancy 
• Ruptured haemorrhagic ovarian cyst 
• Ovarian torsion 
• 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 
• Any molar pregnancy 
• Inevitable and/or incomplete miscarriage 
• Hyperemesis gravidarum 
• Ascites, secondary to known underlying gynaecological oncology 

If you, or someone else, are experiencing a serious and life-threatening injury or illness call triple zero (000) immediately or go to the nearest Emergency Department.

Learn more about when to access emergency care and non-emergency care options if the injury or illness is not serious or life-threatening.

Statewide Referral Criteria (SRC)

Criteria for referral to public hospital specialist clinic services

? Red flags are clinical indicators of possible serious underlying conditions requiring further medical intervention. They may or may not indicate an emergency.

Urgent (Category 1)

• Termination of pregnancy (Surgical or complicated)  

This meets criteria for URGENT referral - please ensure URGENT referral is ticked and ensure relevant regional pathway/protocols are followed. 

Review Termination of pregnancy (Surgical or complicated) HealthPathways Tasmania 

Information to be included in the referral

(Referral may be returned without this)

Essential supporting information

Pathology

• FBE 
• quantitative BhCG 
• blood group, and antibodies 
• Sexually Transmitted Infection screen (inc. chlamydia, gonorrhoea, HIV, syphilis) 

Imaging

• **MUST HAVE** Ultrasound dating scan and location of scan 

Investigations/other

• Any relevant

Additional information

• At least 2 methods for contacting the patient 
• Gestation estimate by scan (weeks) or date ultrasound was performed and last menstrual period (LMP) 
• Relevant past gynaecology, obstetric, and medical history, e.g. presence or absence of asthma, heart disease, hypertension, or chronic illness. 
• Confirmation if the patient has received termination of pregnancy counselling (for clinic awareness). 

Interim/GP management

To refer a patient with this condition, please see the Gynaecology clinic page for the full referral process and templates.

For more information, please view:

Termination of pregnancy (Surgical or complicated) HealthPathways Tasmania 

Referral process

Prior to referral the referrer should ensure the woman has had appropriate counselling, including consideration of the option of MTOP.

Referral for surgical termination of pregnancy

A referral with all requested results included is required. All referrals should comply with referral standards and the referrer should:

• Provide clinical information:
  • LMP
  • relevant past gynaecological, obstetric and medical history
• Preferably provide at least 2 methods for contacting the patient.

Referral for complications of MTOP

1) The stable patient where the MTOP has failed and the uterus still contains the foetus:

• In this situation the prescriber/GP is to refer the patient to the Gynaecology clinic. Phone and fax the clinic coordinator in your region (see Clinic Details) and mark the fax URGENT and clearly stating it is a Failed MTOP.
• Provide explanation and all appropriate information: scans, medications given, dates, Beta hCG etc., vital signs. The woman will be assessed in clinic and a suitable time for surgery booked in subsequent days.

2) The unwell/unstable patient who may have excessive bleeding, pain or infection:

• The prescriber/GP is to provide explanation and refer the patient to the Emergency Department for assessment. The gynaecology registrar will be contacted by ED when/as required.
• Either fax the ED or provide a letter with the appropriate information already to hand: scans, meds given, dates, Beta hCG, vital signs.

Consider referral to clinicians who provide counselling and who provide Medical Terminations of Pregnancy in the community (see Pregnancy Choices Information (Women's Health Tasmania) and Tasmanian Health Pathways).

Additional resources

• Tasmanian Health Pathways
• Termination of Pregnancy

Availability

North

All referrals and queries are to be directed to:

Clinic Coordinator
Phone: 1300 977 694
Fax: 03 6777 5214
Email: [email protected]

North West

All referrals and queries are to be directed to:

Phone: 1800 636 455
Fax: 6441 5928

South

All referrals and queries are to be directed to:

Clinic Coordinator
Phone: 03 6166 0000
Fax: 03 6173 0473