Criteria for referral to level 6 public hospital maternity service
- Maternal cardiac, renal, respiratory and neurological conditions that:
- place the mother at such high risk of an adverse outcome that termination would be considered
- are associated with significant risks of preterm birth or severe early-onset growth restriction
- are associated with a significant risk of neonatal compromise requiring NICU-level care (e.g. myasthenia gravis)
- require specialist multidisciplinary care, especially anaesthetics, allied health, to achieve an optimal outcome.
See the additional comments section for a list of conditions.
Information to be included in the referral
Information that must be provided
- Ultrasound report
- Gestational age
- Name of specialists or centres currently responsible for the woman's ongoing management
- Indication of current disease status and copies of correspondence from relevant specialists
- Copies of recent relevant investigation results (e.g. echocardiograms, lung function tests).
Provide if available
The Summary and referral information lists the information that should be included in a referral request.
Referral to a level 6 maternity service should be considered in the context of the local maternity service system. Referring clinicians should contact the closest level 5 maternity service to discuss options.
The cardiac, renal, respiratory and neurological conditions requiring referral to a level 6 service are:
• Modified WHO classification of maternal cardiovascular risk classes II-III, III and IV
• Severe, refractory hypertension
• Ischaemic heart disease (IHD), especially with residual ischaemia / LV dysfunction.
• Significant chronic kidney disease (CKD) where preterm delivery is likely
• Lupus nephritis
• Pyelonephritis if preterm labour
• Acute renal failure.
- Cystic fibrosis
- Severe restrictive or reversible lung disease (due to risks associated with anaesthesia)
- Sarcoidosis, especially if pulmonary hypertension.
- Myasthenia gravis
- Myotonic dystrophy
- Stroke or subarachnoid haemorrhage in pregnancy, although access to neurology/neurosurgery is clearly paramount
- Active Guillain Barré syndrome
- Some brain tumours, if surgery required at an early gestation, or there are risks associated with anaesthesia
- Multiple sclerosis, if refractory
- Spinal cord injury, if risk of autonomic dysreflexia
- Refractory epilepsy, if significantly preterm delivery is likely to be required.
Referral to a level 6 public hospital maternity service is not appropriate for
- If the woman's condition can be managed by the local service.