ANSC April 2021 Update: Royal Hospital for Women
Contact details for Royal Hospital for Women
For clinical or general ANSC advice, please contact ANSC Liaison Midwife Chantelle du Boisee:
Monday and Thursday 8.00am-5.30pm (Please note these days have changed)
Phone – 9382 6016
Mobile – 0417 995 153 (Monday –Friday 8.00-4.30)
Mobile phone will be answered by senior midwife on remaining weekdays Email – Chantelle.duBoisee@health.nsw.gov.au
If you need to speak directly to the Obstetric Doctors please call ph.9382 6111 and ask the switch to page the on-call Obstetric Registrar.
For more urgent 24hr advice, contact Delivery Suite ph. 0439 869 035 (from 20 weeks pregnancy).
RHW will be running a face-to-face Intake session on the 15 May 2021 for all new GPs requesting to join the ANSC program and for GPs requesting cross affiliation ANSC.
To register interest please contact Kylie Sommerville from CESPHN at k.sommerville@CESPHN.com.au
Preterm birth prevention clinic
RHW has recently commenced a weekly preterm birth prevention clinic under the care of Dr Daniel Challis and Dr Laura Gerhard (MFM Fellow). For information on the referral criteria and the referral process please contact the ANSC Advice line on 0417 995 153.
The antenatal visit schedule is still revised in response to COVID-19. Please review the following documents as guidance for antenatal care with RHW Royal Hospital during this time.
RHW visitor policy has changed as follows:
2 visitors per woman at a time
Only 2 parents/carers to visit babies in Newborn Care
Children – only siblings of a new baby are permitted to visit
Further visitors for compassionate reasons at the manager’s discretion
Obstetric and Neonatal Clinical Placements are still not being held due to ongoing COVID-19 restrictions and this will be reviewed in 2 months.
This is a new column where RHW provides recognition of the excellent work performed by ANSC GPs. This month we have three great examples:
- Dr Kathryn Chae from Green Square Health provided outstanding care by diagnosing and referring promptly, with a new onset of elevated blood pressure in late pregnancy.
- Dr Jill McDonell from Royal Randwick Medical Centre. Wonderful feedback was received by RHW from Dr McDonells patient who highlighted that she was extremely thorough, knowledgeable and caring.
- Dr Maria Opacic from Ocean Medical Practice provided excellent management of a patient who had significant mental health issues.
Ask the Royal
This a new Q&A column with answers from Obstetricians and other Medical Specialists, drawn from regular questions asked by GPs via the GPSC advice line.
A GP asked “My patient has been reported as having a high risk for pre- eclampsia, from the first trimester screening – when should she start Aspirin and what is the correct dose?”
Information to answer this question has been provided by Dr Amanda Beech – Medical Physician and Endocrinologist at RHW.
Guidelines recommend that women at high risk of pre-eclampsia take 150mg of aspirin at night before 16 weeks gestation (ideally 12-14 weeks) and continue this until 36 weeks gestation.
Women we would consider high risk include:
Hypertensive disorders during a previous pregnancy
Chronic kidney disease
Autoimmune disease such as systemic lupus erythematosus or antiphospholipid syndrome
Type 1 or type 2 (pre-gestational) diabetes
Maternal BMI >30kg/m2
First trimester screening for pre-eclampsia risk >1:100
Women with more than 1 moderate risk factor for pre-eclampsia are advised to take 150mg of aspirin at night before 16 weeks pregnant (ideally 12-14 weeks), and continue this until 36 weeks pregnant.
Moderate risk factors include:
Age 40 years or older
Pregnancy interval of more than 10 years
Family history of pre-eclampsia
Chronic kidney disease
Connective tissue diseases
For more information on management of hypertension see the Hypertension management in pregnancy local operating procedure.
Gestational Diabetes Mellitus (GDM) Update
Please be mindful that some pathology labs use different reference ranges for diagnosing GDM. The RHW criteria for diagnosing GDM is as follows:
FASTING >5.1 mmol/L
1 HOUR >10 mmol/L
2 HOUR >8.5 mmol/L
For further information you can review this helpful flowchart for screening, diagnosing and referring GDM and the GDM Screening and Management Policy
Referral Process after a diagnosis of GDM
If you have patient diagnosed with GDM, please contact the Diabetes Educator within one week of the GDM diagnosis on (02) 9382 6010 or at SESLHD-RoyalHospitalforWomen-DiabetesServices@Health.nsw.gov.au
Please address the referral to Prof. S Lowe/Dr S M Lau/Dr A Beech/Dr T Young and attach the pathology results. You can also fax the referral and results to 9382 6118.
Booking in visit
Please advise women to book online via the RHW website at ~ 6 weeks gestation. The booking in visit will generally be attended between 14-16 weeks gestation.
If your patient needs a more urgent Obstetrician/and or Medical Physician review, please fax the referral to 9382 6118.
Please note these Important changes with the booking process during COVID-19:
Booking visits are via telehealth video appointment
A woman who requires an Interpreter or has complex psychosocial issues will now need to attend the hospital in person for the booking appointment.
The GP is NOT required to complete the yellow card as this will be completed by the booking in midwife. The card will be mailed directly to the woman after the booking is completed.
The GP needs to complete the entire RHW antenatal referral form. Please fax, together with antenatal pathology, ultrasound results and any other relevant results to RHW Outpatients Department prior to the booking visit. Fax: 9382 6118. Documents for the booking visit can be emailed to SESLHD-RHWOPDRESULTS@health.nsw.gov.au (please send as one document)
If your patient has NOT been contacted within 2 weeks of lodging their online booking submission, please ask them to follow up on 9382 6206.
Medical Disorders in Pregnancy Clinic
Referrals to medical physicians at the Medical Disorders in Pregnancy Clinic must be addressed to Professor Sandra Lowe/Dr Amanda Beech. The patient will be contacted directly to arrange an appointment only after the referral has been received. Please fax referrals to 9382 6118. The clinic is open on Thursday afternoons.
Complex Preconception Clinic
This clinic is a free specialist service for women planning a pregnancy with a history of complex conditions. The clinic is run once /month via telehealth, and we currently have capacity to review only 3-4 women per month. Waiting periods are commonly 2-3 months. To bill correctly, please direct your referral to Dr Amanda Beech, Dr Antonia Shand and Dr Debra Kennedy. More information is available in the information brochure..
Accessing Local Operating Procedures
You can access useful clinical policies, procedures and guidelines at RHW here.
Newly reviewed local operating procedures include:
Prevention of Premature Birth – Progesterone
Hyperemesis and nausea and vomiting in pregnancy
Hypertension – management in pregnancy
Important and helpful policy reminder: Thyroid disease in pregnancy: Management of women with subclinical or overt thyroid disease in pregnancy:
Reminder: 20 week GP visit
Click here for a reminder of essential information for the 20 week’s visit.
The Women’s Health Physiotherapy department continues to stay open.
Click here for referral form
Click here for flow chart that helps to guide what is appropriate to refer to us.
They continue to see most patients face to face but also offer Telehealth appointments (if appropriate). They will also be delivering group education via PEXIP and an update will be provided when it is available.
Antenatal GP shared care brochures
If you require brochures, please contact the ANSC GP Liaison Midwife on ph.9382 6016. These brochures are also mailed out to the woman in the booking pack when the booking appointment is made.
Please ensure that you are familiar with the RHW Genetic Counselling policy. A flowchart at the end of the Genetic Counselling Policy is helpful with navigating the correct referral pathway.
Important reminder: Women referred for a NIPT (from 10 weeks gestation) must also be referred for a Structural NT Ultrasound at 12-14 weeks gestation.
Any woman who receives an increased risk aneuploidy screening result (cFTS or NIPT) or has a structural anomaly detected on ultrasound can be referred to the Maternal Fetal Medicine Department at RHW. They will be offered genetic counselling, a repeat ultrasound, a consultation with a maternal fetal medicine specialist and prenatal diagnostic testing (such as amniocentesis or chorionic villus sampling), if appropriate. All these consultations will be covered by Medicare. For GPs to arrange or discuss a referral please call the ‘Fetus Phone’ on 0437 537 448 (Mon-Fri 9am- 4pm). For patient enquiries the number is ph. 9382 6098
Maternal discharge summary (this process is under review)
The RHW will be providing two copies of the eMaternity Maternal Discharge Summary to women on their discharge home. A copy will be placed in the blue book and another copy given to the woman for her ANSC GP.
It is important to note that the eMaternity Discharge Summary is a summary of the woman’s antenatal, birth and postnatal care. It is not a medical discharge. Women with medical /surgical complications will be provided with a medical discharge by one of our medical obstetrics team if required.
Medical and Midwifery staff will also endeavour to inform the ANSC GP of any adverse outcomes i.e. Stillbirth/Neonatal Death/Severe Prematurity.