Central and Eastern Cheshire primary care trust withdrew from a Greater Manchester-wide review of children's and maternity services when it became obvious that Macclesfield Hospital would lose maternity services.
Protestors, who had gathered thousands of signatures opposing any cuts, were delighted. But the PCT now wants to review services it commissions from Macclesfield and Leighton Hospital in Crewe, run by Mid Cheshire Hospitals trust, which was not part of the review.
PCT chair Professor Pauline Ong said the Making it Better review had set a 'gold standard' for maternity services, and the challenge was to see if other hospitals could match it.
But there were safety arguments for units delivering 3,000 or more babies a year, substantially more than at either of the two hospitals.
'We have to think of some sort of network arrangement,' said Professor Ong. 'It is about the PCT as a commissioner saying we know what the model of safe care is and this is the challenge we put to other providers. If it can't be delivered then hard decisions have to be made.'
She warned that small obstetric units could 'bleed to death', with doctors deserting them for larger ones.
A spokesperson for East Cheshire trust, which runs Macclesfield Hospital, said: 'We will be working closely with the PCT to draw up a service model which ensures we can continue to provide 24/7 inpatient children's and maternity services locally.'
East Cheshire Healthcare Alliance chair Brendan Murphy said the proposed review was 'a cloud on the horizon'.
'If you lose maternity and paediatrics, then you lose other surgery, then accident and emergency, you've lost your hospital. We see it as being about the whole hospital rather than just mothers and babies.'