Maternity referrals — Waikato

All pregnant people being referred, or over 14 weeks gestation, require a booking and registration to be completed by the lead maternity carer.

Send an email with the NHI number and surname of the patient in the subject line to:

Email: maternitybookingforms@waikatoDHB.health.nz

Acute

If you need to be seen within 24 hours:

• phone (freephone): 0800 462 411

To contact the on-call obstetric team:

• phone (freephone): 0800 387 9604

Semi acute

If you need to be seen within 24 to 72 hours, send referral and all lab, scan and other results to:

Email: wauacutereferrals@waikatodhb.health.nz

Subject line: NHI number and patient's surname.

Non acute

For planned appointments, send referral and all lab, scan and other results to:

Email: RCC@waikatoDHB.health.nz

Subject line: NHI number and name of the service.

This clinic is specifically aimed at pregnancies up to 16 weeks gestation.

The role of the clinic is to:

• establish a management plan following the diagnosis of a miscarriage (expectant, medical or surgical management)
• establish a management plan where a confirmed presence of retained products of conception (RPOC) exists following a miscarriage in a symptomatic but stable person
• coordinate molar pregnancy management and follow-up care
• coordinate follow-up care for a person who has received methotrexate or expectant management as part of their ectopic pregnancy of unknown location treatment as per Waikato protocol.

People with a confirmed pregnancy demise of less than 16 weeks should be discussed with the gynaecology registrar.

To contact the gynaecology registrar at Waikato Hospital:

• phone: 07 839 8899

Appointments are booked with the patient once the referral form has been triaged and patients can expect to be called within 5 working days. This is not an acute service.

If a clinical picture indicates acute (urgent) assessment is required, the patient should be referred to the acute gynaecology team to be seen urgently in the emergency department, not the early pregnancy treatment clinic.

Criteria

Criteria for referral to the early pregnancy treatment clinic include:

• miscarriage diagnosed by ultrasound up to 16 weeks gestation
• confirmed RPOC on USS in a woman that is symptomatic and stable
• suspected or diagnosed molar pregnancy by upper UUS/histology/blood test
• follow-up care for ectopic pregnancy or pregnancy of unknown location being managed expectantly or with methotrexate as per Waikato protocol.

Referral requirements

Referrals are accepted from:

• GPs
• lead maternity carer
• emergency department
• gynaecology.

All mandatory information must be provided and emailed to the referral centre. Referrals will be returned to the sender if not completed in full and the referral will not be triaged.

Mandatory information (in addition to the standard required referral information):

• confirmed diagnosis
• gravity parity, last menstrual period (LMP), estimated date of delivery (EDD), current gestation
• first antenatal bloods, blood type, serum bHCG
• ultrasound provider name — e.g. Hamilton Radiology, Pacific Radiology
• relevant health history — pain bleeding, co-morbidities, emotional wellbeing, etc.
• eligibility documents for entitlement to funded public healthcare — e.g. passport and visa
• interpreter requirements — state the language required.

To send a referral to the referral coordination centre:

Email: rcc@waikatodhb.health.nz

Subject line: patient NHI and name of the service and clinic.

The pre-term birth clinic is not an acute clinic. It is for people with a pregnancy or medical history that meet the following criteria and have not had a subsequent full term pregnancy.

Medical history:

• congenital uterine or cervical anomaly
• cervical surgery (at least one of the following)
  • LLETZ with depth excision ≥10mm, or if the depth is unknown
  • more than one LLETZ procedure
  • more than one cold knife cone biopsy
  • trachelectomy.

Previous pregnancy history:

• spontaneous preterm birth or pre-term rupture of membrane <36 weeks
• second trimester loss (not intrauterine death)
• pregnancy requiring either ultrasound, or emergency, cerclage
• caesarean at full dilation, or complicated caesarean section with significant uterine or cervical team
• more than two uterine instrumentations — e.g. surgical termination of pregnancy (sTOP) or evacuation of retain products of conception (ERPOC).

Current pregnancy:

• incidental finding of a short cervix on ultrasound
• emergency cerclage insitu.

Referral is ideally made prior to 14 weeks resulting in a consultation by 16 weeks gestation.

To send a referral:

• email: rcc@waikatodhb.health.nz

Subject line: patient NHI number and name of the service and clinic

Criteria for referral to the vulnerable unborn forum, for any pregnant or post-partum person (up to 6 weeks postnatal) currently residing in Waikato:

• concerns for care or safety of unborn child
• substance misuse concerns (drug or alcohol)
• family violence concern
• Oranga Tamariki history
• teenage parents
• mental health concerns
• concerns about parenting ability or life choices
• concealed or unwanted pregnancy
• transient lifestyle
• attachment concerns
• poor engagement with maternity services
• recent migrants, asylum seekers, refugees or clients who have difficulty reading and speaking English
• disabilities potentially affecting ability to access or provide care
• cognitive disabilities.

To refer to the vulnerable unborn forum:

• Email: vulnerableunbornwaikato@waikatodhb.health.nz

Subject line: patient NHI number and name of the service and clinic

Waikato Hospital employs midwives, named Whānau Mai, who care for pregnant and recently pregnant people who have not been able to find a lead maternity carer, or for people who have a baby in the NICU but live in another town.  

Whānau Mai is not a lead maternity carer or caseload model. The midwives provide antenatal (pregnancy) and postnatal (following birth) care in the Waikato area. Labour and birth care is provided by the midwives on rostered shifts in the hospital delivery suite. Hauora coordinators support whānau to link in with social supports and community agencies.

All referrals for midwifery care will result in additional efforts to find a lead maternity carer to provide ongoing midwifery care, and the Whānau Mai midwives will provide antenatal and postnatal appointments as needed.

Referral criteria:

• lead maternity carer who is unable to engage a person registered in their care with another lead maternity carer when they are no longer able to provide ongoing care
• people presenting to their healthcare provider at >14 weeks pregnant and report not being able to access a lead maternity carer (via BPAC)
• acute presentation to Waikato Woman's Assessment Unit and Delivery Suite where there is no lead maternity carer
• other health and social agencies when a pregnant person known to them is unable to engage them with a lead maternity carer.

To refer someone to Whānau Mai:

• email: WhanauMaiMidwife@waikatoDHB.health.nz

Subject line: NHI number and surname

Iron infusion is provided on the hospital site when criteria is met. It is an intravenous infusion of Ferric Carboxymaltose (Ferinject). Iron infusion may also be available in Thames and Tokoroa following the same pathway below.

Criteria for referral

Criteria for referral is:

• iron deficiency anaemia
  • Hb <100g/L postpartum and ferritin <30ug/L
  • Gestation ≥36weeks or near planned birth with Hb ≤110 may be considered.

At least one of the following is also required:

• intolerance to oral iron having had an acceptable trial of oral iron therapy
• malabsorption due to a diagnosed condition — e.g. previous gastric surgery, IBS
• confirmed non-compliance, despite explanation of the importance of oral treatment and trialling for at least 2 weeks
• no response after 2 to 4 weeks of oral treatment.

Do not send a referral for an iron infusion in the following situations:

• anaemia not caused by iron deficiency — e.g. thalassemia
• iron overload e.g. hemochromatosis, previous iron infusion within 4 weeks
  • first trimester of pregnancy
  • history of anaphylaxis to any form of parenteral iron preparations
  • hypersensitivity to any of the injection excipients
  • patient with severe inflammation or infection of the liver or kidney
  • history of atopia or multiple allergies are not suitable for infusion outside Waikato Hospital.

Send your referral to:

• email: rcc@waikatodhb.health.nz

Subject line: patient NHI and name of the service and clinic

Referrals for fetal medicine services are sent to Health New Zealand | Te Whatu Ora Auckland.

To contact the fetal medicine team in Auckland:

• email: FetalMedicineScheduling@adhb.govt.nz

For urgent referrals:

• phone: 09 307 4949 (extension 29462)

The goals of the obstetric anaesthetic clinic are:

• planning for and optimisation of significant medical, obstetric, or anaesthetic conditions
• provide information and education to pregnant people and their whānau
• diagnose and manage any potential complications of previous anaesthetic interventions.

Referrals are accepted from a range of healthcare providers:

• midwives (community and hospital-based)
• obstetric doctors (SMOs and RMOs)
• anaesthetic doctors
• other medical specialists — e.g. haematology, maternal fetal medicine
• general practitioners.

Recommended referral criteria

Obesity:

• BMI > 45

Significant coagulation disorders:

• thrombocytopenia with platelets < 100 (e.g. idiopathic, gestational)
• platelet function disorders (e.g. von Willebrand's disease)
• haemophilia
• other inherited bleeding disorders or coagulopathy
• taking antiplatelet medications or anticoagulants (NOT aspirin)
  • If the bleeding condition is not investigated/diagnosed, refer to haematologist first.

Significant neurological or spinal disease:

• multiple sclerosis
• paraplegia
• cerebral palsy
• neuromuscular conditions — e.g. myasthenia gravis, muscular dystrophy, motor neuron disease
• intracerebral conditions — e.g. tumour, aneurysm, hydrocephalus, Chiari malformation
• poorly controlled epilepsy or seizure disorder
• spinal abnormality — e.g. spina bifida, spinal stenosis
• severe back pain
• previous spinal surgery.

Significant cardiac disease:

• valvular disease (including rheumatic heart disease)
• ischaemic heart disease
• cardiomyopathy (e.g. HOCM, peripartum cardiomyopathy)
• arrhythmias requiring cardiologist input
• congenital heart disease
• severe PET (often seen by the acute team)
• previous cardiac surgery or pacemaker/defibrillator
• pulmonary hypertension
  • Patients with well-controlled essential hypertension do not require referral.

Significant respiratory disease:

• severe or poorly controlled asthma — e.g. repeated oral steroid courses, previous hospital/ICU admissions
• significant obstructive sleep apnoea
• cystic fibrosis
• other lung disease — e.g. sarcoidosis, interstitial lung disease, severe kyphoscoliosis
  • Patients with well-controlled respiratory disease do not require referral.

Significant obstetric bleeding risk:

• abnormal placentation — e.g. placenta accreta spectrum, complete praevia, vasa praevia
• high risk of significant APH or PPH
• higher order multiples — triplets and above
• those refusing blood transfusion — e.g. Jehovah's Witnesses

Previous or potential anaesthetic difficulties:

• previous difficult intubation
• airway mass — e.g. large goitre or tumour
• previous difficult epidural or spinal, or complication related to this
• significant allergy or reaction to local or general anaesthetic agent
• malignant hyperthermia —personal or family history
• suxamethonium apnoea — personal or family history
• those refusing or with strong views about labour analgesia or anaesthesia
• severe needle phobia.

Traumatic birth experience:

• traumatic birthing experience involving anaesthesia care
• possible regional analgesia/anaesthesia complications — e.g. neurological symptoms
• possible awareness under general anaesthesia.

Other:

• connective tissue diseases — e.g. rheumatoid arthritis, scleroderma, SLE, Marfan's
• renal failure
• significant congenital conditions — e.g. dwarfism
• poorly controlled diabetes — especially if affecting other organs
• other poorly controlled or significant endocrine conditions — e.g. thyrotoxicosis, Addison's disease, phaeochromocytoma
• previous organ transplant
• communication difficulties — e.g. intellectual impairment, psychiatric conditions, cannot speak any English
• other conditions that the referring clinician is concerned about.

Send your referral to:

• Email: rcc@waikatodhb.health.nz

Subject line: patient NHI number and name of the service and clinic.

For urgent reviews, call Waikato Hospital and ask for the delivery suite anaesthetic:

• phone: 07 839 8899

This clinic is for pregnant people with diabetes, either pre-existing or gestational diabetes. The aim is to manage the glycaemic control of pregnant people with diabetes during the antenatal, intrapartum and post-partum periods to minimise the pregnancy complications of diabetes.

Referral criteria:

• at confirmation of gestational diabetes
• pregnant people with pre-existing diabetes at 12 weeks gestation.

Send a copy of the referral each to:

• email: RCC@waikatoDHB.health.nz
• email: DiabtetesinPregnancy@waikatoDHB.health.nz

Subject line: patient NHI number name of the service and clinic.

Additional information

For those recently diagnosed (before being seen by the specialist service) with gestation diabetes, or any person unable to have a GTT — e.g. bariatric surgery — provide a prescription for:

• Rx: CareSens N blood glucose meter kit
• Mitte: 1 OP

and

• Rx: CareSens blood glucose diagnostic test strip
• Sig: Pregnancy exemption. Gestational diabetes testing up to 8 times daily. ‘Pregnant, please provide education’
• Mitte: 3 months.

Referral criteria

• If gestation has exceeded 40 weeks and the person consents for their labour to be induced (IOL) following a discussion with their lead maternity carer.
• Send the referral between 40+3 and 40+6 weeks gestation.
• Referrals are graded within 72 hours. The referrer will be notified of the IOL booking or the requirement for the person to attend a postdates consultation.

Obstetric recommendation is that a cardiotocography (CTG) and scan is arranged for 41+ weeks for assessment of fetal wellbeing including AFI.

If the ability to have a 41+ week ultrasound scan is restricted due to financial constraints, indicate this on the referral so a scan and consultation can be booked within the hospital.

Send referrals to:

• email: wauacutereferrals@waikatodhb.health.nz

Subject line: patient NHI and name of the service and clinic

Support is available for mothers with babies, provided by Wai Ū Waikato Lactation Consultants.

Lactation consultants cover Waikato, Hauraki, Thames, Matamata-Piako, Waipa, Ōtorohanga, Waitomo and South Waikato. Coromandel and Taumarunui will predominantly have an audio-visual service with the option of face to face visits as needed.

Referrals are accepted from:

• lead maternity carers
• GPs
• Plunket/Tamariki Ora nurses
• Whānau Ora, Pasifika providers or maternal/baby hub.

Lactation consultants provide:

• early intervention for breastfeeding issues
• assessment and care planning in conjunction with the primary practitioner
• education and support, including pregnancy breastfeeding classes
• mostly home visits
• support by phone, text, or email
• tongue tie assessment with referral to the tongue tie service if needed.

Referral information required:

• mother's details: name, NHI, DOB, address and contact number
• baby details: name, NHI, ethnicity
• presenting issue:
• background: parity, pregnancy summary, gestation at birth, birth events, Vitamin K
• relevant medical history
• alerts: allergies, dogs on the property, FV etc.
• management to date
• urgency: urgent, semi urgent, non urgent.

Send referrals to:

• email: waiuwaikato@waikatodhb.health.nz

Subject line: locality

All referrals will be triaged, and a referral is not guaranteed of acceptance. Call or text if not sure:

• phone or text: 027 247 9379
• phone or text: 021 761 935

Process from detection on antenatal ultrasound scan

During the antenatal period ensure that the pregnant person is enrolled with a GP and predetermine the GP that the newborn will be enrolled with.

Provide access to written information to the family.

During pregnancy refer all A2 and A3 to maternal fetal medicine (MFM).

Following birth A1

Lead maternity carer sends a notification of birth to the GP following birth.

Lead maternity carer sends a referral for antenatal detection of A1 RPD.

GP arranges ultrasound scan in line with the national pathway.

National antenatal renal dilation guideline — Starship (external link)

Following birth A2

Lead maternity carer sends a referral within 24 hours of birth to Waikato paediatric surgical services to:

• email: rcc@waikatoDHB.health.nz

Subject line: patient surname, NHI number, Paediatric Surgery.

Lead maternity carer continues with normal requirements of notifying the GP and Well Child Tamariki Ora provider of the birth.

Following birth A3

If an ultrasound is required, the lead maternity carer:

• calls the paediatric surgical registrar within 24 to 48 hours of birth
• sends a referral to Waikato paediatric surgical services within 24 hours of birth

The paediatric surgical registrar responsible for review and arranging an urgent ultrasound referral.

To contact the paediatric surgical registrar:

• phone: 021 382 640

If an ultrasound is required within 7 days of birth, the lead maternity carer sends a referral within 24 hours of birth to Waikato paediatric surgical services to:

• email: rcc@waikatoDHB.health.nz

Subject line: patient surname and NHI number, paediatric surgery.

Lead maternity carer continues with normal requirements of notifying the GP and Well Child Tamariki Ora provider of the birth.