ANSC March 2023 update: RPA Women and Babies/Canterbury Hospital

RPA/Canterbury:

NEW: GP Shared Care CMC

Chauncey Sjostedt has commenced as GP Shared Care Midwife for RPA Women and Babies and Canterbury Hospital.

Chauncey’s work hours are Monday to Friday 8.00am-4.30pm and is contactable via phone or text on 0425 230 662, or email chauncey.sjostedt@health.nsw.gov.au

For urgent clinical concerns please contact the on-call O&G Registrar through switch at the relevant hospital: RPA 9515 6111, Canterbury 9787 0000.

Referrals

RPA is urging GPs to complete eReferrals for antenatal care as early as possible. This will assist in making the women’s first booking in visit as close as possible to 14 weeks.

NEW: CMC Aboriginal Women and Babies:

Krystie Veldkamp is the new Clinical Midwife Consultant for Aboriginal Women and Babies at RPAH.

Krystie’s role involves continuity in the antenatal clinic for identified Aboriginal and Torres Strait Islander women and their families, if they are being assessed in other areas of the hospital and checking in with them in the early postnatal period.

As some Aboriginal women and families can have more complex social, emotional and cultural concerns than non-indigenous families, the role aims to bridge the gap in delivering culturally safe, equitable and effective care to the families.

SLHD is supporting a recent KPI directive from the Ministry of Health aiming to have all Aboriginal and Torres Strait Islander women attending their midwife booking visit before 14 weeks. GPs are reminded to ask their patients and record Aboriginal and Torres Strait Islander status on antenatal clinic referral forms, so women are linked in with Krystie early in their pregnancy.

RPA is currently creating an Aboriginal Midwifery Group Practice model of care. Until fully staffed, this service will operate as an antenatal and postnatal service and will extend to birthing once recruitment has finished.

Non-Invasive Prenatal Testing (NIPT) at RPA

NIPT is offered in the RPA Fetal Medicine Unit from Tuesday to Thursday each week.  

The cost is $350, and a platform called Panorama is used.

Women can be referred for NIPT by emailing a fetal medicine referral form (there is a tick box for NIPT) to rpafmu@health.nsw.gov.au

Elizabeth is the Consultant Midwife available 8am-4:30pm, Monday to Friday to help with clinical questions about genetic screening in pregnancy (including tests taken outside RPA, that may need referral) or if GPs have any questions regarding early pregnancy screening results. Elizabeth may be contacted on 0448 333 516 or Elizabeth.Austin@health.nsw.gov.au.

RPA also welcomes referrals for investigations into high-risk results from external labs.

NIPT Case Study

Key learnings:

1. NIPT remains a screening test for aneuploidy despite low rates of false negative and false positive results. 
2. Abnormally low PAPP-A (<0.2Mom) is associated with an increased risk of atypical chromosomal abnormalities. This includes microdeletion and microduplication that could be smaller than the detectable range of NIPT (<5 Mega base pair).
3. cFTS can provide opportunity for early assessment of structural anomaly screening, pre-eclampsia (PET) screening and assessment of maternal anatomy.
4. PET screening has been widely utilised in both public and private sectors since the publication of the ASPRE trial in the NEJM 2017. The reduction of preterm PET before 36 weeks gestation was 62% by commencing 150mg of aspirin every night from 11- 14 weeks to 36 weeks gestation. The prevention of preterm PET was significant and is based on a robust level I evidence-based medicine. Read the full case study here

Parent education

RPA provides an Early Pregnancy Information Session every 2 weeks. It is a free 60 min ZOOM session providing health and wellbeing information and resources. An experienced midwife will answer questions and provide an introduction to maternity care within SLHD. All expectant families from 0 to 20 weeks pregnancy are welcome.

Bookings can be made via the website, phone (9515 5284) or email.

Carbon Monoxide Monitoring in Pregnancy

RPA will soon be recommending carbon monoxide monitoring at booking and 28 weeks gestation for all women regardless of smoking or vaping status. This will be offered each visit to women who currently smoke or have quit in the last 12months. Additional resources will be made available for your education, and RPA would appreciate you introducing this to your patients when they present for their initial GP pregnancy visit. This is in line with a newly released NSW Health Guideline.

Hyperemesis Gravidarum Resources

Work is underway to raise awareness of the impact of hyperemesis gravidarum on pregnant women and their families through a range of activities with general practice, community pharmacists, hospitals and consumers.

The aim is to standardise care for women with hyperemesis gravidarum across NSW so that women receive high-quality, compassionate care and treatment options best suited to their individual needs.

NSW Health is implementing the new Clinical guideline on the Management of Nausea and Vomiting/ Hyperemesis Gravidarum  to raise awareness and educate healthcare providers, pregnant women, their families, and the broader community on Hyperemesis Gravidarum (HG). This resource provides patients with information on HG to help identify if they might be suffering from the condition, as well as treatment options and further support information. There is also a Pregnancy-related Nausea and Vomiting Health Pathway available. To access Health Pathways Sydney.

Reducing pre-term and early-term births

RPA is participating in the “Every Week Counts” Initiative to reduce rates of preterm and early term births by 20 per cent by 2024.

Please ensure you add cervical length onto each morphology form. It is helpful to advise patients that this may need to be done via a transvaginal scan depending on measurements taken transabdominally.

Any person with a history of preterm birth can be referred directly to our Preterm Birth Clinic.