Referral to emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • acute and uncontrolled pain or bleeding

Please contact the gynaecology on-call registrar to discuss your concerns prior to referral.

For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network

Southern Adelaide Local Health Network

Women's and Children's Health Network

Exclusions

  • routine cervical screening test
  • women undergoing test of cure for non-16/18 human papillomavirus (HPV)

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • oncogenic HPV with liquid-based cytology (LBC) prediction of:
    • possible high-grade squamous intraepithelial lesion (pHSIL)
    • high-grade squamous intraepithelial lesion (HSIL)
    • possible high-grade glandular lesion
    • adenocarcinoma in situ (AIS)
    • invasive cancer – cervical or endometrial
  • glandular lesion of the cervix on cervical screening
  • suspected adenocarcinoma in situ (AIS)
  • possible high grade glandular lesion on LBC
  • atypical glandular cells of undetermined significance on LBC
  • atypical endocervical cells of undetermined significance on LBC

Category 2 (appointment clinically indicated within 90 days)

  • positive HPV 16/18 and
    • normal LBC and/or
    • low-grade squamous intraepithelial lesion (LSIL)
  • positive HPV not 16/18 and
    • persistent positive HPV not 16/18
      • on 3 consecutive yearly tests aged less than 50 years of age
      • on 2 consecutive yearly tests aged 50 to 69 years
      • or in a person who is:
        • two or more years overdue for screening at the time of the initial screen
        • identifies as Aboriginal or Torres Strait islander
    • women aged greater than 70 years
    • women who are immune deficient e.g., solid organ transplant, or human immunodeficiency virus (HIV) positive patient
  • women undergoing a ‘Test of Cure’
    • positive HPV 16/18
  • history of diethylstilboestrol (DES) exposure in utero regardless of HPV or LBC screening
  • post-menopausal women with any unexplained vaginal bleeding including post-coital
  • unexplained persistent unusual vaginal discharge, especially if offensive and/or blood stained
  • past history of excisional treatment for adenocarcinoma in situ and any abnormal result
  • cervical polyps in post-menopausal women with normal cervical screening

Category 3 (appointment clinically indicated within 365 days)

  • abnormal cervical appearances with normal cytology and bleeding patterns
  • cervical polyps in pre-menopausal women with normal cervical screening

Central Adelaide Local Health Network only accept referrals for people greater than 18 years of age.

Due to limitations in infrastructure and resources, the Women's and Children's Hospital cannot accommodate referrals for individuals with a body mass index (BMI) equal to or greater than 45, as well as individuals over the age of 69 years of age.

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

  • past medical/surgical/obstetric/psychosocial history
  • current medications and allergies
  • height/weight
  • BMI
  • onset, duration and course of presenting symptoms e.g. abnormal bleeding (post-coital/intermenstrual)/immunosuppressive therapy
  • menstrual history:
    • cycle day/months
    • days of bleeding
    • blood loss e.g. change of pads or tampons per day/hours
    • previously trialled treatments
  • quality of life concerns including missed work/school/extracurricular activities as a result
  • pelvic examination findings
  • relevant diagnostic/imaging reports including location of company and accession number

Pathology

  • most recent and any previous abnormal cervical screening results
  • sexually active people complete a sexually transmitted infection screen, including:
    • human immunodeficiency virus and syphilis serology
    • chlamydia and gonorrhoea which requires:
      • endocervical swab for culture and
      • endocervical polymerase chain reaction swab or urine sample

Clinical management advice

A single cervical screening test may be considered for women between the ages of 20 and 24 years who experienced their first sexual activity at a young age e.g., before 14 years, or who had not received the human papillomavirus (HPV) vaccine before commencing sexual activity.

All women less than 25 years of age are considered a high-risk group and should be screened for sexually transmitted infections (STIs).

Post-menopausal women should be considered for the use of oestrogen cream prior to completing a cervical Co-Test (is the combination of HPV testing and cervical screening result).

Women with a positive HPV not 16/18, but normal or low-grade squamous intraepithelial lesion (LSIL) on liquid based cytology (LBC) do not require a referral for assessment. Please complete a repeat cervical screen test (CST) at 12 months and 24 months. If the HPV remains positive and/or LBC remains LSIL.

Specific efforts should be made to provide screening for Aboriginal and Torres Strait Islander women. Please refer to the National Cervical Screening Guidelines for further information.

Women undergoing a test of cure should have annual testing until both the LBC and HPV are negative. At this point routine screening can resume. Routine colposcopic assessment is not required for cases where there are fluctuating results of HPV strains other than 16/18 and/or LSIL.

Clinical resources

Consumer resources

Reason for request

  • to establish a diagnosis
  • for treatment or intervention
  • for advice and management
  • for specialist to take over management
  • for a specified test/investigation the General Practitioner cannot order
  • for other reason (e.g. rapidly accelerating disease progression)
  • transfer of care from another tertiary service
  • clinical judgement indicates a referral for specialist review is necessary.

Patient demographic details

  • full name, including aliases
  • date of birth
  • residential and postal address
  • telephone contact number/s – home, mobile and alternative
  • Medicare number, where eligible
  • name of the parent or caregiver, if appropriate
  • preferred language and interpreter requirements
  • identifies as Aboriginal and/or Torres Strait Islander

Clinical modifiers

  • impact on employment
  • impact on education
  • impact on home
  • impact on activities of daily living
  • impact on ability to care for others
  • impact on personal frailty or safety
  • identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

  • Willingness to have surgery, where surgery is a likely intervention.
  • Choice to be treated as a public or private patient.
  • Compensable status, e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.
  • Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
  • Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  • Where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
  • A change in patient circumstance (such as condition deteriorating or pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
  • All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.

Adolescents transitioning from paediatric to adult specialist services require a formal handover from paediatric specialist clinician to adult specialist clinician as well as a formal referral from the referring specialist to ensure initial transfer of care is completed.

The General Practitioners role in this process is to provide support to patients as part of holistic care. All ongoing referrals to specialists can subsequently be provided by the General Practitioner once the transfer of care has occurred.