ANSC March 2023 Update: Royal Hospital for Women

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’s 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 am – 4.30 pm). 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 02 9382 6100 (from 20 weeks pregnancy).

Preterm Birth 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 per cent. Please help RHW to reduce the rate by following the recommendations outlined by Dr Antonia Shand, the obstetrician who is leading the RHW preterm birth initiative.

Infectious diseases in pregnancy clinic

Dr Antonia Shand leads the Infectious Diseases in Pregnancy clinic at RHW.  This clinic sees women with Syphilis, HIV, Hepatitis B and C, Cytomegalovirus (CMV) and toxoplasmosis infections in pregnancy. Obstetrics, midwifery, maternal fetal medicine, adult infectious diseases/virology/Paediatric infectious diseases, and public health work together when required, to ensure best quality care for women and their children. The clinic is on alternative Monday afternoons in outpatients.  FAX all referrals addressed to Dr Antonia Shand to 9382 6118.

Updates and reminders

• 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 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.
• 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.
• 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 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.

Diabetes in Pregnancy Update from Dr Wendy Hawke 

Dr Wendy Hawke has provided a diabetes in pregnancy update containing an updated list of staff involved in the care of pregnant women with diabetes at RHW, information regarding the preconception clinic for women with pregestational diabetes (type 1 and type 2), booking pathways, false negatives, diet controlled GDM and more.

Physiotherapy Update 

The new Antenatal Drop-in Clinic (ANDi) located in the RHW Antenatal Outpatient Department runs sessions designed to address any musculoskeletal, pelvic floor or general concerns a woman may have. The clinic has commenced physiotherapy review and tailored exercise sessions for women at risk or diagnosed with gestational diabetes mellitus. As per the SESLHD GDM management policy, exercise is a key component of care and should be considered as part of routine care.

Read the full update via this link

The ANDi flyer can be accessed here

Next Birth after Caesarean (NBAC) Information session

For over a century, access to and the increased safety of caesarean births has played an important part in improving outcomes for mothers and babies who experience this intervention. As known, the rates of Caesarean births vary from 20-49% across NSW public hospitals. The increasing rate of primary caesarean births has led to an increased proportion of women who have a history of a previous caesarean birth. For these women, there are two options: a Vaginal Birth after Caesarean (VBAC) or Elective Repeat Caesarean Section (ERCS).

The Royal Hospital for Women offers an information session to women/birthing people and families whose last birth was a Caesarean Birth. Midwives from the Antenatal Outpatients Department run a telehealth group session that provides consistent, unbiased, evidence-based information regarding their next birth options. These assemblies offer an opportunity to engage in a balanced discussion of the contraindications, advantages/disadvantages, risks, and safety parameters for both options of birth, answer questions and provide guidance for future clinical visits. 

NBAC information sessions run fortnightly on a Tuesday morning and can be organised by the administration team in RHW OPD.

Homebirth Program

The Royal Hospital for Women offers a variety of Models of Care, aiming to provide a Continuity of Care approach that ensures women/birthing people establish a partnership of knowledge, trust and support for the woman’s/birthing person’s pregnancy and birth journey.

Through The Royal’s Midwifery Group Program (MGP) women are afforded the opportunity for a homebirth as a place to safely birth their baby, whilst remaining under the care of the public hospital system. Their antenatal visits are in partnership with their midwife and a collaboration with our O&G consultants around their suitability for a homebirth are discussed and planned. Our homebirth program is governed by policies and directives of NSW health and all homebirths are attended by two skilled midwives. There is a limited capacity for the homebirth service, so please recommend to women in your care, early contact with the hospital if they are wanting this.

Research at RHW

Current research includes:

• The NADip Study (Nicotinamide adenine dinucleotide in Pregnancy Study) – Nicotinamide adenine dinucleotide (NAD), is a form of vitamin B3. Researchers at RHW are currently recruiting non-pregnant women with a history of two or more miscarriages to the NADip study.
• PreBabe – The University of Sydney is leading the world’s first clinical trial exploring how losing weight prior to pregnancy can improve the long-term health of mothers and babies. Researchers are recruiting women living in Sydney and Newcastle with overweight or obesity (BMI>25), aged 18 to 40 and thinking of becoming pregnant in the near future.
• The Optimum Study – Can a vaccine protect kids against developing allergies? Researchers are currently seeking healthy babies aged 6-12 weeks (born after 32 weeks gestation) who have not yet had their 6-8 week vaccines. 

Read the full research update via this link

Maternity antenatal and postnatal services (MAPS) and GP ANSC

A team of midwives who provide the woman with continuity of care during the pregnancy and in the early postnatal period, in collaboration with an RHW affiliated GP. During labour and birth the care is provided by RHW birth unit midwives.  If you have a woman interested in MAPS please contact the GP Liaison Midwife.

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.

 Please note these important changes with the booking process since 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)

NB: Following on from the booking visit all ongoing results must be 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.

When emailing or faxing patients’ results, please ensure the patient’s name appears on all pages.

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.

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.

Mastitis: It’s not a blocked duct! Update by Katy Hunt RHW Lactation Consultant

On Monday March 6, the Australian Breastfeeding Association (ABA) Professional Seminar Series took place in Sydney. Lactation Consultant Katy Hunt attended the event and has provided an update including the four main changes the ABA have made to the language and advice they offer mothers who report mastitis symptoms in the peer-to-peer setting, as well as updates on when mothers benefit from support from a Lactation Specialist.

Read the full update via this link

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.