ANSC March 2022 Update: Royal Hospital for Women

Contact details for RHW

There is a new email for GP enquiries at RHW: SESLHD-RHWGPSCEnquiries@health.nsw.gov.au

For clinical or general ANSC advice, please contact ANSC Liaison Midwife Chantelle du Boisee

Monday and Tuesday 8.00am-5.30pm (Please note these days have changed)

Phone – 9382 6016

Mobile – 0417 995 153 (Monday –Friday 8.00-4.30)

Mobile phone will be answered by senior midwife on remaining weekdays

Email – Chantelle.duBoisee@health.nsw.gov.au

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

For more urgent 24hr advice, contact Delivery Suite ph. 0439 869 035 (from 20 weeks pregnancy).

General Reminders

• Delivery Suite can accept referrals from GPs and women, with urgent obstetric medical concerns in the immediate 14 days following the birth. Delivery suite 0439 869 035 or 9382 6100
• Antenatal Blood tests must be attended at the confirmation of the pregnancy. Any pre-conception bloods cannot be accepted
• Please refer to specialised obstetric ultrasound practices for all pregnancy ultrasounds. RHW ultrasound department accepts referrals for Third trimester ultrasounds
• If a woman’s GP is not available for a routine antenatal visit, please ensure the woman sees another RHW accredited GP at the practice. If an accredited GP is not available, telephone the Liaison Midwife to organise a hospital appointment on 0417 995 153

COVID-19 updates

Women who are hospitalised with COVID 19 in pregnancy and treated with Tocilizumab are advised to delay live newborn vaccinations until the baby is 6 months of age.

Obstetric and Neonatal Clinical Placements have been temporarily postponed due to ongoing COVID-19 restrictions.

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 Obstetrician/and or Medical Physician review, please fax the referral to 9382 6118.

 Please note these important changes with the booking process during COVID-19:

• Booking visits are via telehealth video appointment.
• The GP is NOT required to complete the yellow card as this will be completed by the booking in midwife. The card will be mailed directly to the woman after the booking is completed.
• The GP needs to complete the entire RHW antenatal referral form. Please fax, together with antenatal pathology, ultrasound results and any other relevant results to RHW Outpatients Department prior to the booking visit. Fax: 9382 6118.
• Documents for the booking visit can be emailed to SESLHD-RHWOPDRESULTS@health.nsw.gov.au (please send as one document)

If your patient has NOT been contacted within 2 weeks of lodging their online booking submission, please ask them to follow up on 9382 6206.

Preterm birth prevention clinic

RHW has commenced a weekly preterm birth prevention clinic under the care of Dr Daniel Challis and Dr Laura Gerhardy (MFM Fellow). Please see the attached information on the clinic.

Royal Applause

This column provides recognition of the excellent work performed by RHW ANSC GPs.

This month RHW would like to recognise Dr Zarin Gundevia from Randwick Doctors Medical Centre.  Dr Gundevia has received very complementary feedback from her patient who highlighted that she was thorough and caring during her fertility treatment and then during her pregnancy care.

Ask the Royal

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

Dr Antonia Shand is the lead RHW Maternal Fetal Medicine Specialist and head of the Infectious Diseases in Pregnancy Clinic and has written an article on  Cytomegalovirus Infection in Pregnancy

Gestational Diabetes Mellitus (GDM)

The Diabetes in Pregnancy team at RHW have a provided an ANSC Diabetes in Pregnancy update. There is also a new patient educational letter for women, explaining why screening for gestational diabetes is recommended.

Please be mindful that some pathology labs use different reference ranges for diagnosing GDM. The RHW criteria for diagnosing GDM is as follows:

FASTING >5.1 mmol/L

1 HOUR >10 mmol/L

2 HOUR >8.5 mmol/L

For further information you can review this helpful flowchart for screening, diagnosing and referring GDM and the GDM Screening and Management Policy

Referral Process after a diagnosis of GDM

If you have a patient diagnosed with GDM, please contact the Diabetes Educator within one week of the GDM diagnosis on (02) 9382 6010 or at SESLHD-RoyalHospitalforWomen-DiabetesServices@Health.nsw.gov.au

Please address the referral to Prof. S Lowe/Dr S M Lau/Dr A Beech/Dr T Young and attach the pathology results. You can also fax the referral and results to 9382 6118.

Perinatal Loss Service at RHW

The Perinatal Loss Service at the Royal Hospital for Women is a service that supports families experiencing pregnancy loss from 18 weeks gestation. This loss may be a miscarriage, stillbirth, a termination of pregnancy for abnormality or a neonatal death.

The Perinatal Loss team comprises a specialist obstetrician, a bereavement midwife and a named social worker, who coordinate care with genetic counsellors, neonatologists, perinatal mental health, chaplains as required.

The Perinatal Loss Service offers individualised care to these women and families through practical, emotional support and will offer ongoing contact in the early loss period and then follow up in Perinatal Loss Clinic to review results of autopsy, or other investigations and plan subsequent pregnancy management.

The “Living with Loss” program is an online support program offered to parents following a perinatal loss. This evidence based program has been co-designed by parents and the Stillbirth CRE (Centre of Research Excellence) and aims to assist parents in navigating their grief and find coping strategies to help bereaved parents manage the future without their baby.

For further information about the Perinatal Loss Service please contact the bereavement midwife at SESLHD-BereavementRHW@health.nsw.gov.au or by calling 9382 6007

Medical Disorders in Pregnancy Clinic

Referrals to medical physicians at the Medical Disorders in Pregnancy Clinic must be addressed to Professor Sandra Lowe/Dr Amanda Beech. The patient will be contacted directly to arrange an appointment only after the referral has been received. Please fax referrals to 9382 6118.
The clinic is open on Thursday afternoons.  

Accessing Local Operating Procedures

You can access useful clinical policies, procedures and guidelines at RHW here.

Important and helpful policy reminder:

• Thyroid disease in pregnancy: management of women with subclinical or overt thyroid disease in pregnancy

Important Reminder: Please refer to the above policy prior to screening for thyroid disease in pregnancy. Use pregnancy trimester specific ranges for each pathology laboratory. If laboratory does not have trimester specific ranges, then use the following (as per RANZCOG policy statement) If pathology results fall out of the normal range for pregnancy, please refer to the policy above or make contact with the ANSC Liaison midwife for further advice.

Reminder: 20 week GP visit

Click here for a reminder of essential information for the 20 week’s visit.

Genetic counselling

Please ensure that you are familiar with the RHW Genetic Counselling policy. A flowchart at the end of the Genetic Counselling Policy is helpful with navigating the correct referral pathway.

Important reminder: Women referred for a NIPT (from 10 weeks gestation) must also be referred for a Structural NT Ultrasound at 12-14 weeks gestation.

 Any woman who receives an increased risk aneuploidy screening result (cFTS or NIPT) or has a structural anomaly detected on ultrasound can be referred to the Maternal Fetal Medicine Department at RHW. They will be offered genetic counselling, a repeat ultrasound, a consultation with a maternal fetal medicine specialist and prenatal diagnostic testing (such as amniocentesis or chorionic villus sampling), if appropriate. All these consultations will be covered by Medicare.

For GPs to arrange or discuss a referral please call the  ‘Fetus Phone’  on 0437 537 448  (Mon-Fri 9am- 4pm). For patient enquiries the number is ph. 9382 6098

Ferinject infusion at RHW – changes to booking procedure

There has been a recent sharp rise in requests from GPs for Royal Hospital for Women (RHW) to give Ferinject infusion for pregnant mums who have a low ferritin but normal Hb.

RHW protocol recommends that for these women a trial of oral iron is first line therapy. If oral iron has failed or is contraindicated then IV iron infusion may be considered. See the iron deficiency management policy for further information.

How to book an iron infusion at RHW for a pregnant patient over 20 weeks gestation:

Check the levels meet strict criteria of Hb 105 or less and Ferritin <30. 

GP to make the booking by phoning PDSU on 9382 6417 with patient name and MRN hospital number on the yellow card. 

Fax the FBC and ferritin result to PDSU fax 9382 6404

Give the patient a prescription for the Ferinject and remind her to bring the medication to her PDSU appointment.

Give the patient the IV iron infusion information sheet (found in Appendix 2 in the policy.)

Complete the iron infusion checklist with the patient (found in Appendix 3 in the policy) Fax the completed checklist to PDSU

If a patient does not meet criteria but the GP believes that iron infusion is warranted then the GP can phone RHW and ask to speak to Dr Fay or Dr Lee to discuss the case; or arrange the infusion elsewhere. 

As of June 28 patients will no longer be allowed to book directly with RHW. This decision was made due to multiple incidents of verbal abuse of the midwife taking the booking calls.