Direct to an emergency department with a maternity service for:

  • Twin-twin transfusion syndrome
  • Fetal death of a single monochorionic twin. 

Criteria for referral to level 6 public hospital maternity service

  • Pregnancies involving triplets or more
  • Twin pregnancies with any of the following:
    • monochorionic monoamniotic
    • monochorionic diamniotic (MCDA) twins when COGU or CMFM ultrasound unavailable
    • monochorionic diamniotic (MCDA) twins with discordant fetal growth (>25%)
    • fetal anomaly
    • fetal death of a single twin
    • selective fetal growth restriction in a monochorionic twin pregnancy.

Information to be included in the referral

Information that must be provided

  • Ultrasound reports
  • Gestational age
  • Blood group.

Provide if available

Not applicable.

Additional comments

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. 

If there are signs of increased risk in monochorionic twins the level of care needs to be escalated and expert advice should be sought.

Referral to a level 6 public hospital maternity service is not appropriate for

Not applicable.