ANSC GPs are reminded that hospital discharge summaries are available via their patient’s MyHealthRecord. This includes ED presentations, EPAS admissions and well as birthing discharge summaries. These summaries are uploaded to MyHealthRecord within 24 hours of discharge.
If you are having trouble accessing discharge summaries, please contact the GP Shared Care Midwife Melanie Tulloch on 0425 230 662 (Monday to Friday 8.00am-4.30pm).
EPAS Case Study: Management and diagnosis of pregnancy of unknown Location
Harriet is a 37yr old woman who presented to her GP with two day history of per vaginal bleeding one week after a positive home urine pregnancy test. She is unsure of her last menstrual period. She has no abdominal pain and is otherwise well. This is her first pregnancy, and she has no significant past medical history. She is taking pregnancy multivitamins containing folic acid.
GPs are now able to use HealthLink SmartForms from their practice software or the HealthLink portal to launch e-Referrals to the following services:
For GPs without Best Practice, Genie or Medical Director practice systems, referrals can be lodged using the HealthLink portal, or via fax using the new fax coversheet which enables digitisation of your faxed referral.
Women with complex pregnancies can be cared for at Canterbury Hospital
Pregnant women are welcome to choose Canterbury, RPA or Concord Hospitals’ Midwifery Group Practice for their antenatal care, regardless of which part of Sydney Local Health District they reside.
However, there are many advantages in attending their local hospital for their maternity care. These include being eligible for up to two weeks of postnatal home visits by a midwife and having a wider range of antenatal care options available to them. A list of hospital postcode boundaries is available on the CESPHN website.
Women with a wide range of complex medical conditions can attend Canterbury Hospital for their maternity care, including:
Type II Diabetes
Thyroid disease, including Graves Disease
IVF pregnancy/assisted fertility
Previous congenital abnormality
Maternal age ≥40
Vaginal birth after 1 previous caesarean section
A combination of medical conditions
If the woman’s condition requires tertiary level care, Canterbury Hospital will organise transfer to RPA.
Tertiary Ultrasound Services are now available at Canterbury Hospital for second and third trimester ultrasounds.
Specialist services available at Canterbury Hospital include:
Birth After Caesarean (BAC) Midwife and BAC Clinic
Hypertensive/Renal Disorders of Pregnancy Clinic
Antenatal Endocrine Clinic (diabetes and thyroid), including Low Risk GDM Midwife
Midwives specialising in caring for young mothers and those with complex psychosocial needs, including substance use and DCJ involvement
Arabic Midwife Clinic
Midwife Practitioner (coordinates care for women with complex pregnancy, caseloads women with DCJ involvement including those experiencing family violence)
Canterbury Hospital aims to have a named midwife for ALL women. Continuity of Care models of antenatal care available at Canterbury include.
GP Antenatal Shared Care
Canterbury Antenatal Postnatal Service (CAPS), can provide Antenatal Shared Care with the woman’s GP
Midwifery Group Practice
There is a limited range of medical and non-medical reasons which require transfer of care to RPA. These include:
Type I Diabetes
MCDA and MCMA twins, and higher order multiples
Wanting vaginal birth after 2 or more previous caesarean sections
Previous caesarean section with no operation reports available
BMI ≥ 50 or body weight ≥150kg at any stage of pregnancy
Diabetes on insulin ≥170 units
Jehovah’s Witness patient
All women who live in area and birth at Canterbury Hospital receive postnatal care at home for up to two weeks, regardless of their length of stay in hospital.
If you are unsure whether to refer a woman to Canterbury Hospital for maternity care, please discuss her circumstances with SLHD GP Shared Care Midwife Melanie Tulloch (0425 230 662).
Canterbury Hospital is now a member of the Children’s Hospital Training network for paediatric registrars. Where there is a known risk that the baby will need tertiary level neonatal care after birth, a multidisciplinary team will make a plan of care during the pregnancy and determine whether birth at Canterbury Hospital is suitable. Where a baby is born at Canterbury <34 weeks or requires tertiary level care, an established system is in place to facilitate safe transfer via the Neonatal Emergency Transport Service (NETS).
Canterbury Hospital Hypertensive/Renal Disorders of Pregnancy Clinic now accepting GP referrals
Canterbury Hospital Maternity has a Hypertensive/Renal Disorders of Pregnancy (HDP) Clinic, run by renal physicians Dr Lucy Wynter and A/Prof Adrian Gillin. The clinic runs weekly on a Friday afternoon in the antenatal clinic area of Canterbury Hospital.
The HDP clinic welcomes referrals from all community settings. Please fax all non-urgent referrals to 9787 0431. Urgent referrals should be discussed with the Birth Unit Obstetric Registrar as per current protocols.
HDP Clinic Referral Criteria
Pregnant women (preferably prior to 16 weeks) with:
preeclampsia in a previous pregnancy
any renal disease including Chronic Kidney Disease (CKD) (with the exception of Transplant patients who should continue to see their transplant physician)
with preeclampsia, gestational hypertension or elevated blood pressure (>140/90) on any antihypertensive medications
Postpartum women who:
had difficult to control hypertension during pregnancy
had preeclampsia during pregnancy (up to max 12 weeks postpartum)
have persistent renal abnormalities (e.g proteinuria, recurrent UTIs or pyuria)
had hypertension or preeclampsia who were transferred to or delivered at RPAH but are local to the Canterbury area and would prefer to return
Women planning pregnancy who have:
a history of preeclampsia or hypertension
a history of any renal disease
Information about referral to the clinic will soon be available on HealthPathways and the CESPHN website.
If you require further information or assistance with referrals, please contact the GP Shared Care Midwife Melanie Tulloch on 0425 230 662 (Monday to Friday 8.00am-4.30pm).
iSEARCH Randomised Controlled Trial has commenced at RPA
A phase III double-blind placebo controlled RCT has commenced at RPA. The iSEARCH RCT aims to determine whether administration of intrapartum sildenafil citrate can safely avert the risks of contraction-induced hypoxia. A pilot study conducted at the Mater Mother’s Hospital in Brisbane found that there was a significant reduction in the relative risk of emergency assisted deliveries (caesarean and instrumental births) by 51 percent, as well as a reduction in the incidence of meconium-stained liquor and pathological fetal heart rate patterns by 43 percent.
The target population for this RCT is pregnant women with singleton or dichorionic twin pregnancies, planning a vaginal birth at term from 37+0 weeks gestation, and are aged 18 years and over. Eligibility requires willingness and compliance with study requirements, and women must provide informed written consent. The study involves taking 1 tablet (50mg sildenafil citrate or matched placebo) every 8 hours (to a maximum of 3 doses) intrapartum.
Turner J, Dunn L, Tarnow-MordiW, FlatleyC, FlenadyV, Kumar S. Safety and efficacy of sildenafil citrate to reduce operative birth for intrapartumfetalcompromise atterm: a phase 2 randomized controlled trial. American Journal of Obstetrics & Gynecology. 2020 May;222(5):401-414. doi: 10.1016/j.ajog.2020.01.025. Epub2020 Jan 21. PMID: 31978434.
SLHD Early Pregnancy Information Session
This free session is available to anyone planning on having a baby at a SLHD hospital. It is a 1 hour ZOOM session covering general health and wellbeing, models of care and useful resources for women up to 20 weeks pregnant.
The Birth Centre is contactable on (02) 95156405 if GPs or families have any questions prior to booking in.
GPs can refer directly to Birth Centre and MAPS via My HealthLink Portal or HealthLink SmartForms. e-Referral functions in Best Practice, Genie and Medical Director software systems. If you’re unable to complete a referral in HealthLink, please fax the referral (using this fax cover sheet) to 9515 3454.
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