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.

Availability

North South North West Statewide

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
• 12+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.

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.

Tests

• FBE
• Beta hCG
• Blood group and antibodies
• Early pregnancy ultrasound scan for dating
• STI screen

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).

Referral template

For use by health professionals only

• Referral template - Medical Director
• Referral template - Best Practice

Additional information

Tasmanian Health Pathways website

Tasmanian DoH - Termination of Pregnancy website