Resources for general practitioners

The ANSC GP Resource Manual is no longer available as a program resource. All clinical information and advice, can now be viewed on relevant Sydney HealthPathways or resources on this site.

Refer to the following documents as guidance for antenatal care:

• Click here for revised antenatal schedule of visits (updated April 2022) 
• Click here for GP summary (updated April 2022) to use in conjunction with revised antenatal schedule of visits 

These recommendations are for women attending both RPA Women and Babies and Canterbury Hospital for their antenatal care.

GPs participating in the ANSC program will be expected to adhere to the agreed guidelines as outlined in the SLHD ANSC Schedule of Visits when caring for their antenatal shared care patients.

Breaches of the ANSC Schedule of Visits that affect patient outcomes will be recorded for quality assurance purposes. Any investigations requested by the GP for a woman under his/her care must be followed up by the GP concerned. At all times it is the primary responsibility of the provider ordering the test or noting an abnormal finding to ensure appropriate follow-up management and communication, irrespective of whether a copy has been sent to the participating hospital

Pregnancy Checklist – Patient Resource.  A pregnancy checklist that suggests topics your patients should discuss with their GP/ health professional during your pregnancy and following birth.

Refer to Sydney HealthPathways Early Pregnancy Assessment Pathway for information about the RPA EPAS service and referral critiera.

The aim of EPAS is to identify and manage ectopic pregnancies, vaginal bleeding in pregnancy, or miscarriage less than 20 weeks gestation. The service is available to assist you with the management of your haemodynamically stable patient.

If patient is clinical unstable and less than 20 weeks pregancy, arrange immediate transfer to relevant hospital Emergency Department

Urgent review for pregnant patients < 20 weeks gestation, contact relevant hospital on-call Gynaecology Registrar

Contact relevant hospital on-call O&G Registrar for all pregnant patients > 20 weeks gestation.These women should be sent to hospital Delivery Ward.

Fetal movements are a reliable indicator of fetal well-being. Any maternal reporting of a change in fetal movements should be taken seriously and assessment arranged as soon as possible.

Movements matter – comprehensive suite of resources for both health professionals and consumers developed by the Centre of Research Excellence in Stillbirth. Translated information also available
Safer Baby Bundle– online learning module developed by the Centre of Research Excellence in Stillbirth covering 5 elements : Smoking Cessation, Fetal Growth Restriction (FGR), Decreased Fetal Movements (DFM), Side Sleeping and Timing of Birth.
Safer Baby Bundle Handbook and Resource Guide – Handbook developed by the Centre of Research Excellence in Stillbirth covering 5 elements : Smoking Cessation, Fetal Growth Restriction (FGR), Decreased Fetal Movements (DFM), Side Sleeping and Timing of Birth.

Refer to Sydney HealthPathways Hyperglycaemia in pregnancy Pathway for information about the RPA EPAS service and referral critiera.

Early identification of women experiencing psychosocial problems and mental health conditions in the perinatal period it important so they can recieve timely support and care.

Mental Health Care in the Perinatal Period – Australian Clinical Practice Guideline – Centre of Perinatal Excellence (COPE)
COPE Centre for Perinatal excellence – provides resources for both health professionals and consumers
Screening and assessment tools : Including psychosocial risk assessment (ANRQ/PNRQ) , assessment of depression and anxiety (EPDS. Includes D&A and D&FV questions , assessing mother and child interaction
Looking after your perinatal mental health – Information for patients
beyondblue – provides access to a variety of information regarding perinatal mental health

Clinical Services
Psychological Support Services (PSS)

PSS provides FREE short term face-to-face psychological services to people living in the CESPHN region. Priority groups include women experiencing perinatal depression from conception to 12 months after birth.

For more information visit our PSS page

St John of God Medical Centre 
Free Medicare fund Psychiatrist service for women in the perinatal period that cannot afford a consult with a private psychiatrist.
The clinic provides short term assessment, therapy, and treatment plan and the woman is referred back to the GP for ongoing management

For more information and referral processes visit Clinic Information and GP Referral Form

Carrier screening – preconception and early pregnancy 
RACGP provides a number of resources, fact sheets and on-line module regarding carrier screening

Click here to access these resources

Prenatal Screening
All women, regardless of age should be counselled and offered the option for screening for chromosomal anomalies.

Antenatal Shared Care GPs can refer women directly to the Fetal Medicine Unit (Phone: 9515 6042) for the following tests:

• Combined First Trimester Screening (cFTS)
• Non-Invasive Prenatal Screening (NIPT)
• Chorionic Villus Sampling (CVS)
• Aminocentesis

A referral form (Feb 2022) is required to be completed for referral for these tests. Women should contact FMU to arrange appointment Ph: 9515 6042. GPs can contact service i.e follow-up results etc via email SLHD-RPAHFetalMedicineUltrasound@health.nsw.gov.au

Timing of procedures 

The Fetal Medicine Unit (FMU) at RPA Women and Babies routinely offers Combined First Trimester Screening (cFTS): ultrasound scan (nuchal translucency and nasal bone) plus biochemistry to pregnant women booking for delivery at RPA Women and Babies and Canterbury Hospitals

Referral for cFTS:

• Complete FMU Referral form (Feb 2022)
• Complete RPAH First Trimester Screening Pathology Form – advise woman that blood can be collected from 11 weeks until at least 3 days prior  to ultrasound appointment. It should be collected at either RPAH or Canterbury Hospital Pathology Department
• Provide woman the First Trimester Screening Patient Information Sheet which outlines screening test procedure
• Provide relevant Patient Information Brochures  cFTS, RPA cFTS Patient Brochure, NIPT, CVS & Amniocentesis, Pre-term preeclampsia
• Advise woman that her results will be available at time of U/S appointment (ensuring that blood has been collected prior )

Access to Non-Invasive Prenatal Testing (NIPT) will be as a second line screening tool for women at high or intermediate level of risk after cFTS. The NIPT test is not available through Medicare and women will have to fund this test themselves. For further information contact the RPA Genetic Counsellors ph 9515 5080 or Fetal Medicine Unit ph 9515 6042

Resources

GP Information Sheet – First trimester screening for prediction and prevention of preterm preeclampsia
NSW Health:  Centre for Genetics Education
Patient Brochures- RPA Women and Babies including Screening for preterm pre-eclampsia, cFTS, NIPT, CVS
Patient Brochure- Prenatal testing booklet – NSW Health : Centre for Genetics Education
RACGP – Genomics in general practice
RACGP – Reproductive carrier testing
First Trimester Sceening Learning Module: NSW Centre For Genetics: On-line education module
Search for Certified Operators to perform Nuchal Translucency – RANZCOG Nuchal Translucency: Ultrasound, education and monitoring program

Translated material regarding genetics, prenatal testing and pregnancy are located at the Multicultural Health Communication Service – NSW Health.

Please refer to the following resources to guide clinical management : Referral Flowchart (below) and Sydney Healthpathways – Thyroid Disease in pregnancy

For any clinical concerns, please contact Dr Ash Gargya or Julie Hetherington in the Endocrinology and Metabolism Clinic ph. 9515 7225.

Thyroid Disease Guidelines and referral flowchart: Who to screen, Thyroid Function Test Reference ranges in pregnancy, referral criteria

Antenatal Thyroid Clinic Referral Form (April 2020)

Get Healthy in Pregnancy ( NSW Health) – Free telephone-based service to support all women about eat healthily, getting active and maintaining a healthy weight during pregnancy

Eat For Health ( Australian Government) – Healthy eating during pregnancy – Consumer brochure

Pregnancy and alcohol  (Australian Government)

Tobacco smoking and pregnancy ( NSW Health)

GBS screen should be collected at 34-36 week GP visit. It needs to be collected PRIOR to hospital review at 37 weeks.

The GBS screening LVS can be attended as a patient self-collection

Identifying women who are at risk of having a baby with GBS enables treatment to be given intrapartum to prevent transmission of infection to the baby. Discussion about GBS should take place at around 35 weeks gestation so that women have received information about preventive treatment before they go into labour.

• SLHD Breastfeeding Policy
  NHMRC Infant Feeding Guidelines