ANSC September 2021 Update: RPA Women and Babies/Canterbury Hospital

New ANSC Schedule of Visits 

The SLHD revised COVID-19 ANSC Schedule of Visits has recently been updated. Please refer to the new schedule for ongoing patient care. The new schedule and supporting resources are available on the CESPHN Maternal Health website and on Sydney HealthPathways. 

• Revised antenatal schedule of visits (updated July 2021)
• GP Summary Guide (August 2021)

SLHD Update: COVID-19 Vaccination for pregnant women

Pregnant women are eligible for the COVID-19 vaccine. At Canterbury Hospital and RPA Women and Babies, midwives and doctors are discussing vaccinations during antenatal clinic appointments and providing relevant information for women to make an informed decision. 

Pregnant women who are interested in receiving the vaccine are assisted in coordinating an appointment at the Canterbury Hospital Vaccination Centre or the Mallet Street Vaccination Clinic (RPA). Appointments are being facilitated either following antenatal clinic appointments or patient details are passed onto the vaccination team who will organise an appointment at the Mallet Street Clinic (RPA). 

GPs are encouraged to discuss the safety of the COVID-19 vaccination with their patients. Refer to the Australian Government COVID-19 vaccination decision guide for women who are pregnant, breastfeeding or planning pregnancy – updated 2 September 2021. 

RPA update: COVID-19 testing

See information below as a guide for COVID-19 testing at RPA Hospital inpatient and outpatient services. Please note that this is a guide, information is being updated regularly with changing COVID-19 situation.

• All patients admitted to the hospital will be tested for COVID-19 
• All outpatients attending for consultation, tests or intervention will need to show evidence of a negative swab in the previous 72 hours
• All antenatal women from 38 weeks gestation are strongly advised to have a third daily swab prior to delivery
• All patients who present in labour will require a rapid swab if it has not been performed in the previous 72 hours.  

Please contact the RPA Women and Babies/Canterbury Hospital GP Liaison Midwife if you or your patients are needing further guidance. 

Strategy for Enhanced GP Communication for Non-Face to Face Consultations

To enhance communication with referring doctors, RPA has developed a strategy for non-face to face consultations. This strategy has been circulated to all hospital staff. GPs are to note step 6 and contact hospital clerk if patient information is not being received. 

1. Regular education of doctors and midwives of the importance of routine and timely communication with referring doctors.
2. Continued use of the Yellow Card for all face-to-face consultations.
3. When a non-face to face consultation occurs, documentation of relevant findings and plan will occur in PowerChart. This information will be automatically transferred into the pregnancy “Summary Report”.
4. The midwife or clinician seeing the patient will confirm contact details of the referring doctor or local GP.
5. A “Healthcare Professions Request Form” is completed and faxed to Medical records requesting the Summary Report +/- other results/ultrasound be sent to the identified GP.
6. Should the GP not receive any patient information, please contact the Release of Information Clerk on 9515 6094, the clerk will fax or electronically send the Summary Report.

Obstetrics and Gynaecology: GP Education series

Specialists from the RPA Obstetrics and Gynaecology Department are providing clinical case studies specifically for ANSC GPs published in each ANSC newsletter.

See latest case study on LLETZ and cervical shortening, and refer to case scenarios from early in the year linked below.

• LLETZ and cervical shortening

Case scenario: Emma Smith, 37yo, Gravida 0 Para 0, presents for preconception planning. She has apast medical history of a previous LLETZ procedure in 2012 for CIN III. Her last pap smear was in 2016 and was normal. She is currently smoking 3-4 cigarettes/day.  

What are issues specific to Emma that should be mentioned as part of preconception counselling? Given she has had a previous LLETZ, how would you manage her pregnancy at this stage? Click on the link to see full case scenario. 

• Hypertension and pre-eclampsia 

Case scenario: A healthy 28-year-old female, Amy, Gravida 2 Parity 1, presents to her GP at 34 weeks’ gestation complaining of a 3 day history of severe headaches and blurry vision. She reports good fetal movements with no vaginal loss. GP took vital signs with BP measuring 160/100. Examination revealed a soft non-tender abdomen with hyper-reflexia with 2 beats of clonus. Urinalysis shows proteinuria 2+. Amy’s GP refers her to the delivery ward for further blood tests and assessment. 

What would you do next if you were Amy’s GP? Click on the link to see full case scenario.

• Decreased fetal movements 

Case scenario: 35-year-old, Maria, Gravida 2, Para 1 presented to her GP with her first episode of decreased fetal movements at 38 weeks gestational age. Her first pregnancy resulted in a ventouse assisted vaginal birth of a 3.0kg baby. Her current pregnancy had progressed well with no antenatal issues. She denied feeling unwell, any vaginal loss or bleeding and reported painless tightenings. Her GP took vital signs and performed an abdominal examination. BP was normal at 112/65. Abdomen was palpated as a cephalic presentation with reduced fundal height of 35cm. Fetal heart rate of 145bpm. 

What would you do next if you were Maria’s GP? Click on the link to see full case scenario