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 Chronic hypertension Previous pre-eclampsia 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:
First pregnancy Age 40 years or older Pregnancy interval of more than 10 years Family history of pre-eclampsia Chronic kidney disease Connective tissue diseases Multi-fetal pregnancy
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:
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.
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