Placenta Clinic Referrals

If you are a health care professional and are looking for guidelines to pregnancy management and delivery, as well as wondering about whether to refer a patient to the Placenta Clinic, the following information will help guide you in the care you offer to your present and future patients.

Contents

Clinical practice guidelines
Indications for referral 

Clinical practice guidelines

Below are some guidelines you may find useful in caring for pregnancies complicated by pre-eclampsia, intrauterine growth restriction, placenta previa and vasa previa.

For updated ACOG guidelines on the diagnosis and management of hypertension in pregnancy, click here.
For updated SOGC guidelines on the diagnosis and management of IUGR, click here.
For SOGC guidelines for the management of placenta previa, click here.
For SOGC guidelines for the management of vasa previa, click here.

Indications for referral 

The Placenta Clinic staff is happy to see your referred patients either in their current pregnancies or to provide consultations for any future pregnancies. The following is a list of pointers you may use to decide whether to refer a patient to our Clinic.

Referral for problems in current pregnancy:

 1.     Abnormal FTS/MSS/IPS testing results

–        PAPP-A <0.35 MoM
–        AFP >2.0 MoM (positive risk for neural tube defect)
–        DIA/Inhibin >3.0 MoM
–        hCG>5.0 MoM

Due to the volume of referrals, we are unable to see women with individual marker abnormalities below these thresholds. If your patient has multiple marker abnormalities and relevant medical and/or obstetric histories, we will consider your referral. Please ensure the patient has a standard 18-20 week anatomy scan, and genetic counselling/amniocentesis done, if appropriate.

Alternatively, you can book a placental ultrasound in our Centre for Excellence in Obstetric Ultrasound (CEOU), the referral for which can be found here. This examination should be performed after your patient has had a fetal anatomical ultrasound, because the fetal ultrasound is needed to evaluate the fetal cause in the abnormal biomarker screen results (such as a neural tube or anterior abdominal wall defect or for ultrasound markers of trisomy 21). In CEOU, the ultrasound will be reported directly after the examination either by a Maternal-Fetal Medicine specialist or by a radiologist, and your patient will take home a copy of the report. If the report is abnormal, we will fax a copy to your office with recommendations.

 2.     Background medical risk factors for placental damage, including:

–        Insulin-dependent diabetes
–        Significant obesity (BMI>35)
–        Advanced maternal age (>40 years)
–        Chronic hypertension
–        Previous venous thrombo-embolism
–        Renal disease
–        Auto-immune disease

3.     Previous complex obstetric history suggesting placental damage, including:

–        Prior unexplained/placental loss >16 weeks
–        Stillbirth >20 weeks
–        Delivery <34 weeks due to hypertension/pre-eclampsia/HELLP syndrome
–        IUGR  due to placental disease or abnormal uterine and/or umbilical artery Doppler

  1.  Suspected invasive placenta (placenta accreta/percreta) detected at the 18-20 week fetal anatomical ultrasound (or at a later BPP/growth ultrasound) as an anterior low or previa placenta in a patient with previous Caesarean deliveries, myomectomy, multiple D&C’s, other uterine surgeries  
  2.  Current pregnancy complicated by hypertension or IUGR
  3.  Sonographic abnormalities of the placenta and/or membranes
  4.  Placental/chorionicity/growth problems in multi-fetal pregnancies

Referral for pre-pregnancy consultation:

We welcome requests for a pre-pregnancy consultation for the following specific indications related to placental function:

  1.    Medical risk factors for placental insufficiency
  2.    Previous pregnancy complicated by stillbirth/severe pre-eclampsia, HELLP syndrome, IUGR due to placental insufficiency
  3.    High risk for invasive placenta (3 or more prior Caesarian sections or multiple other risk factors)

Due to the high volume of requests, our waiting time is 4 months. We do divert requests to our general “Pre-pregnancy Counselling Clinic” with a Maternal-Fetal Medicine Specialist in our Special Pregnancy Program. Depending on the circumstances and/or test results, the Placenta Clinic staff may be asked to provide additional advice following your consultation.

Checklist of useful information to receive by fax beforehand:

–        FTS/MSS/IPS test results from current or prior pregnancies

–        Ultrasound reports from the current or index pregnancy

–        Placental pathology report from prior pregnancies

–        Thrombophilia screening results (if already done)

–        Operative reports from previous pregnancies (if relevant)

Special Pregnancy Program

Referrals »

Fetal Medicine: 416-586-4800 x 7756
Fax: 416-586-3216

Maternal Medicine: 416-586-4800 x 7000
Fax: 416-586-5109

Main clinic hours: Monday to Friday, 8am to 4pm

Prenatal Diagnosis & Medical Genetics

Referrals »

phone: 416-586-4800 x 4523
fax numbers:
416-586-4723 or 416-586-8384

Perinatal Mental Health

Referrals »

Phone: 416-586-4800 x 8325
Fax: 416-586-8596