Urgent fetal-surgery referral: timing, records, and triage

Urgency in fetal surgery usually means that specialist review should occur before a condition deteriorates or a gestational window closes. It does not mean that an operation has already been decided.

Examples that may need prompt triage include suspected twin-to-twin transfusion syndrome, a severe congenital diaphragmatic hernia being assessed for FETO, an open neural tube defect within a prenatal-repair pathway, rapid fetal deterioration, hydrops, abnormal Doppler, or a clinician who believes delay could remove an option.

What to send

The referral should include:

• confirmed gestational age and dating method;
• the precise clinical question and suspected diagnosis;
• original ultrasound images, cine loops, and DICOM data where possible;
• longitudinal measurements rather than only the latest value;
• chorionicity in twins, fluid, bladder, growth, and Doppler findings;
• placental position, cervical length, and membrane status when relevant;
• fetal MRI, echocardiography, genetic, infection, or laboratory results;
• maternal conditions, medicines, previous uterine surgery, and obstetric history;
• a direct number for the referring clinician and the patient.

A photographed report can start triage but may not contain the image that determines diagnosis or access.

Referral is not emergency treatment

Online forms are not continuously monitored and should not be used for heavy bleeding, severe pain, fluid loss, reduced fetal movements, collapse, breathing difficulty, severe headache with visual symptoms, fever with maternal illness, or another acute concern. Those symptoms require immediate assessment through the nearest appropriate maternity emergency service.

The dated programme-status panel gives the current pathway classifications. The team may direct a request to diagnostic assessment, multidisciplinary review, intervention, or another appropriate pathway according to the individual case.