ANSC update July 2023 RHW:

Contact details for RHW

Email address for GP enquiries at RHW: SESLHD-RHWGPSCEnquiries@health.nsw.gov.au

Antenatal Shared Care (ANSC) GP Liaison Midwife Chantelle du Boisee workdays are Monday and Tuesday 8.00am-6.00pm. (Please note these days have changed). Email – Chantelle.duBoisee@health.nsw.gov.au

For Clinical GP Advice line call 0417 995 153 (Monday – Friday 8.00-4.30). The mobile phone will be answered by the liaison midwife or the senior in charge midwife.

If you need to speak directly to the Obstetric doctors, please call 9382 6111 and ask the operator to page the on-call Obstetric Registrar for ANSC.

The Obstetric Medicine Physician Registrar can be contacted for advice Monday-Friday during business hours by calling 9382 6111. Advise the operator to page the Registrar.

For more urgent 7 day /24hr advice, contact Delivery Suite on 0439 869 035 or 9382 6100 (from 20 weeks pregnancy).

National Preterm Birth Prevention Collaborative

RHW has joined the National Preterm Birth Prevention Collaborative with the aim to reduce the rate of preterm birth and early term birth in Australia by 20%. Please help RHW to reduce the rate by following the referral guidelines. Dr Antonia Shand is the lead collaborative consultant. Dr Sarah Lyons leads the Monday morning clinic located in maternity OPD. Please see the Referral Guidelines for Preterm Birth Prevention Clinic .

Brochures for parents and health care professionals about the importance of the last few weeks of pregnancy for babies health and development can be found here.

Introducing Midwife Vicky Gay – Preterm Birth Prevention Clinic Midwife

Vicky Gay has been working as a midwife at the Royal Hospital for Women since 2011, with 6 years of experience working in Midwifery Group Practice in a case loading model of care. Since March 2023, Vicky has worked as the Preterm Birth Prevention Clinic midwife, providing continuity of care throughout pregnancy and in the postnatal period, for some of the women that have been identified as high risk for preterm birth.

The clinic offers early obstetric review, triaged according to need, for women that have had a previous premature rupture of membranes or preterm birth under 34 weeks, short cervix identified and on Progesterone or with a cervical cerclage, or who have a history of Cone biopsy or 2 or more LLETZ procedures, uterine anomaly or previous second trimester loss 16-24 weeks. The clinic also aims to review women with a history of a caesarean section at fully and postpartum follow up 4-6 weeks following a spontaneous preterm birth under 30 weeks.

Vicky can be contacted on 0487 072 925 or Victoria.Gay@health.nsw.gov.au for further information and referrals to the clinic.

Updates and reminders

Updated ANSC Protocol Summary and Guidelines (May 2023)

Protocol Guidelines

Protocol Summary

Electronic medical discharge summaries

Electronic medical discharge summaries will be sent to the GP listed on the patient’s medical records. If you have not received the medical discharge summary, contact the RHW Liaison midwife. 

For further information and assistance see the following link:

https://www.seslhd.health.nsw.gov.au/prince-of-wales-hospital/accessing-information-about-your-patient

Pregnancy and Oral Hypoglycaemic (e.g. metformin) use

If a woman is taking an oral hypoglycaemic agent (e.g. metformin) prior to pregnancy for:

Pre-gestational DM and proven impaired glucose tolerance:

• do not screen 
• refer to diabetes team
• continue oral hypoglycaemic agent until reviewed by diabetes team (arrange urgent referral if taking any other oral hypoglycaemic agent other than metformin)

If taking for ovulation induction, insulin resistance and PCOS:

• cease oral hypoglycaemic agent once pregnancy confirmed
• screen with an early OGTT
• cease oral hypoglycaemic one week prior to OGTT      

For more detailed information see the clinical business rule.

Reminder about screening for Thalassaemia at the first antenatal visit

Screen for Haemoglobinopathies in pregnancy if patients have any of the following risk factors:

• High risk ethnicity in women/oocyte donor and biological father (Southeast Asian, Asian, Indian, Sri Lankan, Pakistani, Middle Eastern, Mediterranean, Black African and Pacific Islander)
• MCV<80fL or MCH <27pg
• Known Haemoglobinopathy carrier, family history of haemoglobinopathy in woman/oocyte donor and biological fathers’ family

If high risk request FBC, Haemoglobinopathy screen and Iron Studies (Screen the biological father simultaneously while screening the woman/oocyte donor)

Refer urgently to genetics if both parents are known or suspected haemoglobinopathy carriers

RHW Prenatal Genetic Service:

• PH: 9382 6098 
• FAX: 9382 6098

Refer to this clinical business rule for more information.

Out of area patients

Reminder – there is no boundary for out of area patients for Obstetrics at RHW.

Smoking Cessation Support for Pregnant Women at the POWPH Stop Smoking Clinic

Breech presentation and Breech Clinic information

Small Group Obstetric Clinical Placements

Small group Obstetric Clinical Placements to re-commence at RHW. Contact the Liaison midwife to register your interest – Chantelle.duBoisee@health.nsw.gov.au

Cytomegalovirus (CMV)

All women who are pregnant or are trying to conceive should receive information about CMV prevention as part of their routine antenatal care or pre-pregnancy practice.  Further information can be found in the ‘Management of Perinatal Infections’ 2022 Guidelines at the Australasian Society of Infectious Diseases (ASID). Helpful educational information for your patients can be found at www.cmv.org.au and http://www.cerebralpalsy.org.au/cmv/ 

Infectious syphilis

Infectious syphilis is increasing in the general population and has led to an increase in congenital syphilis cases in NSW.  NSW Health now recommends all pregnant women be screened for syphilis at least twice in the pregnancy, at the first antenatal visit and again at 26-28 weeks gestation.   See the Safely notification from NSW Health on this matter.  

Reminder for 20 week GP visit.

Please give blood request referrals for 26-28 week bloods at the 20 week visit. See reminder of activities and considerations at the 20 week GP visit. 

Creatine

Normal Creatinine values in pregnancy are 30-70 mmol/L. If the Creatine values are abnormal please contact the GP advice line or the Obstetric Registrar for advice. 

Pregnancy Ultrasounds

Please refer to Specialised Obstetric Ultrasound Practices for all pregnancy ultrasounds. RHW ultrasound department accepts referrals for Third trimester ultrasounds. The RHW Ultrasound Practice phone number is 9382 6080.

GP antenatal visits

If a woman’s GP is not available for a routine GP antenatal visit, please ensure the woman sees another RHW accredited GP at the practice. If an accredited GP is not available, call the GP Liaison Midwife to organise a hospital appointment on 0417 995 153. 

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 Obstetric/and or Obstetric Medicine Physician review, please fax the referral to 9382 6118. 

From the 1st of June 2023 all Hospital Booking in visits have returned to face-to-face appointments.

–              The GP is NOT required to complete the yellow card as this will continue to be completed by the booking in midwife.

–              The GP needs to complete the entire RHW antenatal referral form. Please give the referral, antenatal pathology, ultrasound results and any other relevant documentation to the woman to bring to the first booking appt. It is no longer necessary to fax or email the results.

NB: Please ensure that All RESULTS for the entire pregnancy are given to the woman to bring to their next hospital visit. Please do not fax, mail, or CC in any results unless you have urgent clinical concerns.

Ask the Royal 

The information contained in this column is written by Obstetricians, Medical Specialists and other Health Clinicians and is drawn from regular questions asked by GPs via ANSC advice line.

Maria Lohan (CMS-MFM MGP) and Anita Maitra (Patient Safety and Quality Manager -CPIU) have commenced a QI project at RHW.  The project is aiming to improve the treatment of iron deficiency/iron deficiency anaemia in pregnancy using oral iron. Please see the results and documents from the QI project below.

Iron deficiency Anaemia

Increasing Dietary Iron in Pregnancy

Oral Iron Treatment in Pregnancy

Medical Disorders in Pregnancy Clinic 

Referrals to Obstetric Medicine Physicians at the Medical Disorders in Pregnancy Clinic must be addressed to Professor Sandra Lowe/Dr Amanda Beech/Dr Helen Barrett. The patient will be contacted directly to arrange an appointment only after the referral has been received. Please fax referrals to 9382 6118. 

Hyperemesis Gravidarum (HG) Initiative 

New Policy released from NSW Health on Nausea and Vomiting in Pregnancy. See attached link

Nausea and Vomiting in Pregnancy and Hyperemesis Gravidarum (nsw.gov.au) 

Accessing Local Operating Procedures (LOP’s) NOW KNOWN AS Clinical Business Rules (CBRs) 

Updated CBRs: 

Thyroid disease in pregnancy (nsw.gov.au) 

Referral to the Department of Maternal Fetal Medicine – Fetal Indications (nsw.gov.au) 

High order multiple pregnancy – antenatal care (nsw.gov.au) 

You can access Clinical Business Rules at RHW here.