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  • Guidelines For Referral of Antenatal Cases

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    neomunumu34567
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    This document provides guidelines for when to refer pregnant patients to an obstetrics and gynecology specialist. It lists several conditions that should be referred early in the first trimester or before 20 weeks, such as chronic hypertension, gestational diabetes, or a multiple pregnancy. It also indicates that patients should be referred at 28 weeks for conditions like gestational hypertension or diabetes. Any urgent issues requiring hospital admission are outlined, such as preeclampsia, abnormal fetal heart rate, or bleeding. Other cases can be discussed individually with the specialist in-charge.

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    GUIDELINES FOR REFERRAL OF ANTENATAL CASES

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    This document provides guidelines for when to refer pregnant patients to an obstetrics and gynecology specialist. It lists several conditions that should be referred early in the first trimester or before 20 weeks, such as chronic hypertension, gestational diabetes, or a multiple pregnancy. It also indicates that patients should be referred at 28 weeks for conditions like gestational hypertension or diabetes. Any urgent issues requiring hospital admission are outlined, such as preeclampsia, abnormal fetal heart rate, or bleeding. Other cases can be discussed individually with the specialist in-charge.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    6 views1 page

    Guidelines For Referral of Antenatal Cases

    Uploaded by

    neomunumu34567
    This document provides guidelines for when to refer pregnant patients to an obstetrics and gynecology specialist. It lists several conditions that should be referred early in the first trimester or before 20 weeks, such as chronic hypertension, gestational diabetes, or a multiple pregnancy. It also indicates that patients should be referred at 28 weeks for conditions like gestational hypertension or diabetes. Any urgent issues requiring hospital admission are outlined, such as preeclampsia, abnormal fetal heart rate, or bleeding. Other cases can be discussed individually with the specialist in-charge.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    of 1

    WHEN TO REFER TO O&G C.

    Other cases not listed or non-urgent – please


    discuss with specialist in-charge :
    A. Refer early ( 1st trimester ) or < 20weeks POA B. Refer at 28 weeks - AFI < 8 or > 20
    1. Gestational Hypertension - Abnormal lie at or above 37 weeks
    1. Chronic hypertension on treatment 2. GDM / pre existing DM not on treatment - Fetal growth anomaly – FGR/ SGA
    2. GDM on insulin, good control 3. Uncomplicated medical disorders , eg : - Late booking > 20 weeks for date
    3. Pre-existing DM - Syphillis, Varicella zoster infection in verification
    4. Multiple pregnancy current pregnancy - Newly diagnosed asymptomatic Placenta
    5. Ovarian cyst or uterine fibroid in pregnancy - Thalassemia / hemoglobinopathies Previa > 32 weeks
    6. Pregnancy following ART ( IUI, IVF, Clomid - Hepatitis B/ C carries - Poorly controlled DM at any gestation
    induced ) - Asymptomatic moderate anemia not - Anemia with Hb < 8g/dL at any gestation ,
    7. Medical disorders in pregnancy – poorly responding to treatment – Hb 8-9g/dL requiring intervention
    controlled or on treatment - Vulval varicosities - Thrombocytopenia ( plt < 100 )
    - Poorly controlled bronchial asthma - Persistent proteinuria - Rhesus negative with abnormal indirect
    - Asymptomatic moderate to severe - Bronchial asthma on treatment Coombs test
    anemia , Hb < 8g/dL 4. Asymptomatic placenta previa (to be seen
    - Congenital heart disease or any between 28-32w ) D. ALL URGENT ADMISSION TO HOSPITAL
    abnormalities in the patient 5. Grandmultiparity ( Para 5 or more ) 1. Eclampsia
    - Connective tissue diseases and 6. Previous uterine surgeries – Caesarean section, 2. Pre-eclampsia (BP>- 160/100 or high blood pressure with
    thrombophilia , with or without medication myomectomy, cornual pregnancy proteinuria more than 2+)
    - Epilepsy on treatment 7. Maternal obesity ( BMI 30kg/m2 at booking ) 3. BP more or same as 160/110 mmHg
    - Thyroid disease on treatment 8. H/o Low birth weight baby ( <2.5kg at term ) 4. Heart disease with symptoms eg SOB, palpitations.
    - Psychiatric disorders on treatment ( eg 9. H/o Macrosomic baby ( >4kg ) 5. Dyspnoea on exertion
    Schizophrenia, MDD ) 10. Teenage pregnancy < 19 years old 6. Uncontrolled diabetes with capillary glucose level > 11
    - Patients on Warfarin 11. Advanced maternal age > 35yrs old mml/l and urine ketone more or same tan 2+
    - RVD positive mother 12. Rhesus negative with indirect Coombs negative 7. APH
    - Any other medical conditions not 13. Short stature < 145cm 8. Abnormal fetal heart rate:
    mentioned above 14. H/o preterm labour 32-37 weeks a. FHR< 110/min >22/52
    8. H/O recurrent 1st Trimester miscarriages 3 or 15. Involuntary subfertility > 2 yrs b. FHR>160/min >62/52
    more 16. Bad obstetric history 9. Hb < 7 g/dL or symptomatic anemia
    9. H/O VTE Eg – h/o perinatal death, shoulder dystocia, 10. Premature uterine contractions
    10. Recent 2nd trimester miscarriage PPH, 3rd/ 4th degree perineal tears 11. PPROM/PROM
    11. Previous babies with congenital anomalies ie 12. Seizures
    spina bifida, genetic disorders. 13. Fever with signs of sepsis (lethargy, dehydration,
    12. H/O severe Pre Eclampsia / Eclampsia at or tachycardia)
    before 28w in previous pregnancies 14. Suspected dengue cases (fever with headache, joint pain,
    13. Risk factors for cervical incompetence –eg : h/o stomachache,vomiting and diarrhea)
    cervical conization, h/o recurrent preterm births 15. S/sx of DVT and/or pulmonary embolism
    < 34w

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