Our approach to the gynaecology service is all about appropriate patient selection, and appropriate operations being done locally.

The procedures typically offered would include the following, but not be limited by this list:

Day case procedures

• Hysteroscopy and IUD insertion

• Suction curettage

• LLETZ

• Endometrial resection

• Local excision of vulval lesions

• Cervical polyp removal

• Bartholins cyst and abscess drainage

• Operative laparoscopy for endometriosis, adnexal surgery, adhesiolysis, sterilisation.

• Ovarian cystectomy

• Diagnostic laparoscopy & dye test

Procedures requiring admission to
Bacchus Marsh and Melton Regional Hospital

• Laparoscopic hysterectomy

• Abdominal hysterectomy

• Vaginal hysterectomy

• Vaginal repair

Rooms based procedures

• IUD insertion

• Skin biopsy

• Colposcopy & cervical biopsy

• Pipell’s sampling

Exclusions

• Known gynaecological cancer

• Complex medical conditions

• Significant obesity (BMI >40)

Maternity Admissions

Please note: Obesity - Booking BMI >35, Term BMI >40 can not be booked at DJHS

Booking Criteria Low Risk
CAN BE BOOKED AT DJHS

• Age between 16 - 40 years

• No current medical disorders

• BMI <35 at booking / early pregnancy

• Singleton pregnancy

• Regular antenatal attendance (1st presentation for ANC must be before 24 weeks (does not have to have been at DjHS))

• Multiparous parity < 5 with history of uneventful pregnancies Grandmulti is a G5P4; See Intermediate Risk

• Primigravida with uneventful pregnancy, no anticipated complications of pregnancy or co-morbidities

Booking Criteria Intermediate Risk 
MIGHT BE ABLE TO BE BOOKED AT DJHS

Patients within this category are regularly discussed at the weekly multidisciplinary "AMBER" meeting to ensure programs proceeds optimally

• Maternal Age 40-44 years multigravida ;Obstetrician review at 28 and 36 weeks

• Grand Multiparous – more than 4 previous births (G5P4) 

• Hypertension (essential). A pre existing diagnosis of hypertension pre conception or before 20 weeks of pregnancy without apparent underlying cause and not on any antihypertensive therapy

• Previous difficult birth (difficult forceps, shoulder dystocia) ;Consider acceptance for booking at DjHS if elective caesarean section planned

• Previous significant Post Partum Haemorrhage >1.5Lt

• Previous Caesarean section. Assessment for suitability for VBAC by Obstetrician in accordance with RANZCOG guidelines

• Previous manual removal of placenta x 2 

• Previous cervical surgery (Not LLETZ or laser)

• Previous uterine surgery (not caesarean section)

• Stillbirth or neonatal death in previous pregnancy

• Well controlled maternal medical disorders such as: Epilepsy, Asthma, Mental Health issues, Thalasaemia, minor Thyroid issues, Idiopathic Thrombocytopenia with platelet count >100

Booking Criteria High Risk
CANNOT BE BOOKED AT DJHS

• Maternal age over 40 years at end of pregnancy -  primigravida

• Maternal age over 44 years at end of pregnancy – multigravida

• Obesity - Booking BMI > 35, Term BMI >40

• Multiple Pregnancy

• Previous Severe Pre-eclampsia BP >= 170 / 110 during previous pregnancy associated with SGA; Abnormal renal function tests; Abnormal liver function tests; Previously required parenteral antihypertensives during management of pre-eclampsia; previously required magnesium sulphate during management of pre-eclampsia

• Insulin Dependent Type 1 Diabetes

• Pre-existing Type 2 Diabetes

• Poorly controlled maternal disorders such as: Epilepsy; Renal disease; Active thyroid disease; Maternal heart disease; Organ transplant; HIV infection; Asthma requiring hospitalization in last 12 months; Latex allergy; ITP with platelet count <100

• Recent or recurrent drug use: Heroin; Methamphetamines; Methadone; Cannabis; Alcohol; Stimulants ; Volatile agents (paint, glue, petrol)

• Previous anaesthetic failure or complication (eg: difficult intubation, failed epidural)

• Malignant hyperthermia or neuromuscular disease

• Established psychiatric disorders which are medicated or Unstable psychiatric illness

• Rhesus iso-immunisation

Referrals to EPAS service

Early pregnancy assessment service (EPAS)

Early pregnancy assessment
clinics will be held every day as needed for pregnancies under 12 weeks.

Phone Reception: 5367 9150 or
contact the on call doctor via switchboard

Fax Referrals to: 9746 0668

Marked clearly "EPAS URGENT"

Referrals to Gynaecology

How to refer

All referrals to be directed through the referral and appointment services

Telephone: 9747 7609

Fax: 9746 0668

All patients require a current referral from their general practitioner or relevant specialist

Antenatal clinics and
CTG bookings:

Bacchus Marsh & Melton 
Regional Hospital: