Antenatal Shared Care Update – RPA Women & Babies and Canterbury Hospital

June 2026

This month’s update includes a clinical case study on reduced fetal movements in the third trimester, information on SLHD early pregnancy education sessions, and details on the new Midwifery Shared Care model available across Sydney Local Health District (SLHD).

Case Study: Reduced Fetal Movements in the Third Trimester

Prepared by RPA/Canterbury ANSC GP Advisor

Reduced fetal movements (RFM) in the third trimester are a clinically significant symptom requiring urgent same‑day assessment. This case study highlights the GP’s critical role in recognising, triaging, and escalating care in line with HealthPathways Sydney recommendations.

Patient Profile

• Name: Mrs A (de‑identified)
• Age: 31
• Gravida/Para: G2P1
• Gestation: 34+2 weeks
• Pregnancy: Singleton
• Antenatal care: Shared care (GP + hospital)
• Medical history: Nil significant

Presenting Complaint (GP Setting)

Mrs A reported:

• Reduced fetal movements over 12 hours
• Baby “normally very active in evenings”
• No improvement with rest, hydration or eating

She denied:

• Vaginal bleeding
• Abdominal pain
• Leakage of fluid

Clinical Significance in General Practice

HealthPathways Sydney emphasises:

• Maternal perception is the most important indicator of fetal wellbeing
• Any reduction in movements in the third trimester requires same‑day assessment
• Delays in referral increase the risk of stillbirth

GP Assessment

1. Focused History

Key elements include:

• Onset and duration of RFM
• Change from usual pattern
• Previous episodes
• Risk factors (smoking, hypertension, diabetes, fetal growth restriction)

Findings:

• First episode
• Clear subjective reduction
• No risk factors

2. Maternal Observations

• BP: 118/72 mmHg
• HR: 80 bpm
• Afebrile

3. Abdominal Examination

• Fundal height appropriate
• Longitudinal lie
• No tenderness

4. Fetal Heart Rate (Doppler)

• FHR ~140 bpm detected

⚠️ Important:
A normal Doppler fetal heart does not exclude fetal compromise and must not delay referral for CTG.

GP Clinical Reasoning

Although maternal observations and Doppler were reassuring, the history of reduced movements alone warranted escalation.

Management in General Practice

1. Immediate Action

Urgent same‑day referral for:

• Cardiotocography (CTG)
• Further obstetric assessment

2. Referral Process

• Contact maternity assessment unit directly
• Provide clinical handover
• Advise immediate attendance

3. Patient Advice

Mrs A was informed that:

• RFM is common but important
• Assessment is precautionary but essential
• Attendance should not be delayed

4. Documentation

GP recorded:

• Nature and duration of RFM
• Doppler findings
• Referral details
• Patient understanding

Hospital Outcome

At hospital:

• CTG: Reactive
• Ultrasound: Normal growth and amniotic fluid

Mrs A was reassured and discharged with follow‑up.

Discussion: Key GP Learning Points

1. Maternal concern = action
   RFM must be taken seriously even with normal findings.
2. Doppler is not sufficient
   CTG is required to assess fetal wellbeing.
3. Time‑critical referral
   Same‑day assessment is essential.
4. Avoid false reassurance
   Do not advise “monitor at home” in third trimester RFM.
5. Safety‑netting
   If referral is declined, document and provide strict return precautions.

SLHD Early Pregnancy Information Session

SLHD Parent Education Service offers free face‑to‑face and online sessions for families planning a pregnancy or in early pregnancy (from 4 weeks).

Sessions include:

• Preconception health
• Healthy pregnancy planning
• Birth and parenting resources
• Information on SLHD maternity and child/family health services

Bookings: SLHD Parent Education Booking Form

Shared Midwifery Care in SLHD

SLHD has introduced a new model of antenatal and postnatal care delivered in collaboration with privately practising endorsed midwives credentialed within SLHD public hospitals.

Key Features

• Continuity of care, including up to eight weeks of postnatal home visits
• Women remain booked into an SLHD public hospital for antenatal, intrapartum and immediate postnatal care
• Antenatal visits shared between endorsed midwives and hospital clinicians
• Care frequency determined by clinical needs and risk profile
• Referrals accepted from GPs, hospitals, or self‑referral
• Medicare rebates apply for endorsed midwife antenatal and postnatal care

SLHD is the first district in NSW to establish governance for this innovative model.