There are two significant changes to the acceptance criteria for urgent obstetric ultrasounds in Counties Manukau.
Suspected Miscarriage
Please note the updated criteria for suspected miscarriage. The HealthPathway should be consulted for detailed guidelines on the management of pain and bleeding in early pregnancy. Here are some key points to consider:
Pain and Bleeding in Early Pregnancy:
Between 20-40% of pregnant women experience bleeding during the first trimester.
Major causes include miscarriage (10-20% of clinical pregnancies) and ectopic pregnancy (1-2%).
Less common causes include cervical and vaginal lesions (such as malignancy, cervical ectropion, polyps, and infections) and uterine infections.
Bleeding may also occur around 4-5 weeks due to placental embedment.
If the patient does not require acute gynaecology assessment, arrange investigations, as appropriate.
Pregnancy test if pregnancy is not already confirmed.
In rural practice, consider the use of the Rural Point of Care Testing Service (R-POCT) if available.
Blood tests:
If less than 9 weeks gestation, consider serial quantitative serum beta hCG, at least two tests 48 hours apart. In rural practice, consider the use of the Rural Point of Care Testing Service (R-POCT) if available.
First antenatal bloods including blood group if not already done.
Midstream specimen of urine (MSU) – test with a dipstick and if any abnormalities send to the lab for a culture.
Vulvovaginal nucleic acid amplification test (NAAT) swab for chlamydia, gonorrhoea, and trichomonas.
High vaginal swab for candida and bacterial vaginosis.
Community ultrasound pregnancy scan. Include beta hCG levels to aid interpretation of the scan.
If the patient is ≥ 6 weeks, arrange a routine ultrasound scan.
If the patient is < 6 weeks pregnant, an ultrasound is unlikely to be of any diagnostic use
If the patient has recently had an ultrasound and further imaging is being considered, check the previous ultrasound report for advice on when any further imaging may be required and/or seek gynaecology advice if a scan is still thought to be necessary.
NOTE: If suspected ectopic pregnancy, discuss with on call obstetric team. If endorsed, refer acutely to POAC for urgent ultrasound https://www.poac.co.nz/radiology-request/
Patient Support:
The initial uncertainty regarding the viability of pregnancy and the grief following a miscarriage can be very challenging for women and their families.
Regular check-ins on how patients are coping and offering counselling services are highly recommended to assist in their emotional processing.
For further details, please refer to the HealthPathway guidelines on the management of suspected miscarriage.
Small for Gestational Age (SGA) Over 34 Weeks Gestation
Where diagnosis of SGA over 34 weeks of gestation, please follow the updated criteria:
If the gestational age is 34 weeks or more, please arrange for an urgent obstetric ultrasound referral via POAC using the urgent scan request form.
If the gestational age is less than 34 weeks, arrange a direct community ultrasound appointment in the normal routine manner.
Reminder on Co-payment Coverage
Where eligible, the co-payment will be covered using the Counties Manukau Maternity Voucher (regardless of whether booked by POAC or direct). Please apply online at https://www.poac.co.nz/maternity-scanning-counties-manukau/.
Accurate Referral Submissions
We request that the referral form is not submitted using incorrect clinical information to override the criteria. Referrals submitted using incorrect criteria or gestational age information will be returned to the referrer and may cause further delay in access to community ultrasound. Unfortunately, no exceptions may be accepted to this revision.
We appreciate your understanding and support with these necessary changes. Please send any concerns or feedback through to Deanna Williams by email deannaw@easthealth.co.nz
Thank you for your attention to this important update.