ANSC December 2021 Update: St George and Sutherland Hospitals

COVID-19 updates

Covid 19 restrictions continue as follows:

– Antenatal Clinic bookings are face-to-face for high risk or late bookings; and telehealth for the remainder

– From 36wks, the woman and partner are to have weekly Covid 19 swabs. For patients attending St George Hospital, one of these must be done at the screening clinic in Kensington St, Kogarah.

– One support person in Birth Unit

– Two visitors for Postnatal ward

– All must have a recent negative swab

Antenatal Booking investigations

As listed in the ANSC protocol, a reminder to complete the following routine investigations at the first visit:

· FBC

· Blood group and antibody screen

· Haemoglobin EPG (please refer to flowchart on CESPHN website and refer to partner testing)

· Rubella serology

· Syphilis screening

· Hepatitis B (surface antigen)

· Chlamydia <25yrs or high risk

· Varicella VZ IgG (if not sure of previous exposure)

· HIV antibody and Hepatitis C antibody screening (with informed consent)

· MSU for M/C/S

· 75g 2 hour Pregnancy OGTT (based on GDM high risk factors)

· Cervical screening test if due (safe at any time in pregnancy)

· Offer seasonal flu vaccination at any gestation

· Vitamin D – screen and treat

Screening and Diagnosing Gestational Diabetes

Please refer to the flowchart for screening, diagnosing and referring of Gestatoinal Diabetes Mellitus (GDM).

All diabetes screening is by 75gOGTT unless the woman has had gastric sleeve surgery.

These women can attend Diabetes Centre for HbA1c and 1 week of HBGM. A 50g GCT is not accepted.

High risk factors for GDM

• Ethnicity: Aboriginal/Torres Strait Islander, Asian, South Asian, Pacific Islander, Maori, Middle Eastern, Non white African
• Insulin Resistance (eg. associated with PCOS)
• Maternal Age ≥ 40 years
• Medications eg corticosteroids, antipsychotics
• BMI ≥ 30 at preconception or initial booking
• Previous adverse pregnancy outcome suggestive of undiagnosed GDM eg shoulder dystocia, unexplained stillbirth
• Previous baby with birth weight >4.5kg
• Previous GDM
• Strong FHx Diabetes (1st degree relative with diabetes; sister with GDM)

Thyroid Screening and Management

Consider thyroid screening and management using the pregnancy reference ranges as listed in this Thyroid Screening Table. St George Hospital has a thyroid clinic if the woman requires endocrine review. The referral form can be found on the CESPHN website

First 2000 Days Care Connect

Child, Youth and Family Service (CYFS) in partnership with UNSW has received Translational Research Grants Scheme (TRGS) funding for their project First 2,000 Days Care Connect (FDCC)

This research will compare the current model of care for women from migrant and refugee backgrounds transitioning from maternity to CYFS, with a model where women and families are linked with a local child and family hub towards the end of their pregnancy and actively followed up until their child is 12 months of age.

The research aims to increase the number of children completing their NSW Health growth and developmental early childhood development checks (blue book) and address other support needs to increase maternal and family wellbeing.

Eligibility criteria:

• Pregnant (> 20 weeks gestation)
• 16 years of age or older
• birthing at St. George Hospital
• from a non-English speaking background and lived in Australia for less than 5 years or  refugee living in Australia for  less than 10 years

If you have any patients who meet the above eligibility criteria and are interested, please contact Mona Asghari (South Eastern Sydney LHD), on (P): 0400 390 859 (E): mona.ashgari@health.nsw.gov.au

Models of care

There are many models of care available at St George and Sutherland Hospitals to support woman during pregnancy, depending on their specific needs. This brochure outlines the different models of care available for your patients.