ANSC July 2022 update: RPA Women and Babies/Canterbury Hospital

Discharge summaries on MyHealthRecord

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.

What would you do next? Read the full case study via this link here

E-Referral to RPAH Women and Babies Services

GPs are now able to use HealthLink SmartForms from their practice software or the HealthLink portal to launch e-Referrals to the following services:

• RPAH Fertility
• RPAH Gynaecology
• RPAH Maternity

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
• DCDA twins
• Thyroid disease, including Graves Disease
• High BMI
• IVF pregnancy/assisted fertility
• Previous congenital abnormality
• Epilepsy
• 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
• Fertility Clinic
• 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
• Midwives Clinics

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).

Neonatal care

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

1. Pregnant women (preferably prior to 16 weeks) with:
   1. chronic hypertension
   2. preeclampsia in a previous pregnancy
   3. any renal disease including Chronic Kidney Disease (CKD) (with the exception of Transplant patients who should continue to see their transplant physician)
2. Pregnant women:
   1. with preeclampsia, gestational hypertension or elevated blood pressure (>140/90) on any antihypertensive medications
   2. with pyelonephritis
3. Postpartum women who:
   1. had difficult to control hypertension during pregnancy
   2. had preeclampsia during pregnancy (up to max 12 weeks postpartum)
   3. have persistent renal abnormalities (e.g proteinuria, recurrent UTIs or pyuria)
   4. had hypertension or preeclampsia who were transferred to or delivered at RPAH but are local to the Canterbury area and would prefer to return
4. Women planning pregnancy who have:
   1. a history of preeclampsia or hypertension
   2. 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.

Please invite all your families to register by emailing the SLHD Parent Education office: SLHD-RPAParentEducation@health.nsw.gov.au

RPA continuity models of care update – MAPS and birth centre

Maternity Antenatal and Postnatal Service (MAPS)

• Midwife-led continuity model of care established just over 1 year ago.
• Women and families are cared for by a primary (known) midwife for the duration of their pregnancy, and in their home for up to 2 weeks following the birth.
• During labour and birth, care is provided by the RPA core maternity team.
• The MAPS team has recently expanded to 6 midwives, collectively caring for 540 women per year.
• MAPS midwives provide antenatal care at 7 community outreach clinics across Sydney Local Health District: Balmain, Forest Lodge, Leichhardt, Zetland, Croydon, Homebush and Concord West.

Eligibility

• Suitable for low to moderate risk pregnancies.
• Women with obstetric risk factors (National Midwifery Guidelines for Consultation and Referral Category B and C) will be reviewed by an obstetrician regarding suitability for the MAPS program
• Women must reside within the RPA catchment area.

Birth centre

• Midwife-led model of care for families choosing a physiological, active birth.
• Home-like environment located within RPAH Women & Babies.
• Accepts 40 women per month.
• Provides care during pregnancy, birth and 2-weeks postpartum in the home.

(NOTE:  Postnatal home visits available only for women living within RPAH catchment).

• Women can choose midwife-led care, ANSC or a selected private obstetrician.
• Obstetric and other multi-disciplinary support available, if required.

Eligibility

• Accepts referrals Sydney-wide, regardless of the woman’s geographical location.
• Suitable for low to moderate risk pregnancies. If you are unsure of a woman’s eligibility, you can contact the Birth Centre for clarification.
• 2 weeks postpartum care available for women within RPA catchment postcodes only
• The Birth Centre is contactable on (02) 95156405 if GPs or families have any questions prior to booking in.

Referrals

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.

Further information on referral to RPA Women and Babies is available on HealthPathways and on the CESPHN website.