ANSC September 2021 Update: St George and Sutherland Hospitals

Updated contact details

The contact list for St George and Sutherland Hospitals has recently been updated.

COVID-19 update

Please review the attached document for current updates and resources in response to COVID-19 antenatal care at St George and Sutherland Hospitals.

Changes to St George Early Pregnancy Assessment Service (EPAS)

To try to minimise unnecessary face-to-face contact, the St George EPAS service is now recommending phone consultation for most visits.  Patients should be advised to call to register their details between 7:30 and 8:00am and have their medicare card handy, along with any recent investigation results (these can be faxed to 9113 3183 if possible).  

For women with pain or heavy bleeding, or who require urgent medical attention they should proceed for a face-to-face EPAS appointment as usual (Reception at 1W in the St George Tower Block).  Unfortunately partners and support people are not able to attend in person given the current circumstances and we would be grateful if you could please let your patients know this in advance.  If clinical circumstances allow, they should have a covid swab within 72 hours of presentation it they are likely to require an admission.

If you require any further information on this new arrangement, please email kristina.king@health.nsw.gov.au or for urgent clinical advice please contact SGH on 91131111 and page #898 for the on call registrar.

Early Referral of an antenatal woman with risk factors of hypertension or renal disease

Pregnant women with risk factors of hypertension or renal disease need an early referral to the antenatal service at St George Hospital. This includes women that develop early-onset pre-eclampsia, or have a history of one of the following conditions:

• Chronic hypertension or white-coat hypertension
• Chronic kidney disease or other chronic medical disorder
• Previous early onset pre-eclampsia delivered < 32 weeks
• Established pre-eclampsia in this pregnancy
• High risk PE ratio detected from early NT/NIPT screening

If appropriate, the woman is to be commenced on Solprin 150mg at night as soon as possible. A low dose aspirin in pregnancy brochure is available for women. 

Please send the referral by: 

• Email to the clerical booking service SESLHD-STGANC@health.nsw.gov.au for escalation; or
• Fax to St George Hospital 9113 3765

Please advise the woman to complete the online Antenatal Appointment form and include a comment of the risk factor for escalation of an early antenatal booking.

Assessing whether a woman may need low-dose aspirin treatment

Low dose aspirin (150mg nightly) should be commenced as early as possible for women who meet the following criteria: 

• History of pre-eclampsia in a previous pregnancy 
• Pre-existing diabetes (Type 1 or 2) 
• Antiphospholipid syndrome 
• Chronic kidney disease 

Low-dose aspirin treatment should be considered if there are at least two other risk factors such as: 

• Nulliparity, multiple pregnancy, family history of preeclampsia, obesity, age > 40 
• Chronic (pre-existing) hypertension 
• 12-week ultrasound shows high risk for pre-eclampsia 

If in doubt, err on the side of commencing aspirin as it is safe and associated with few side effects, and early commencement is important. These women will often be seen in the high risk clinic and may be excluded from the ANSC program. 

Listeriosis

St George Hospital recently had a pregnant woman admitted with Listeriosis.

Please read the information sheet and discuss with all pregnant women how important it is for safe food choices and hygiene in the home and when in the community.

Consideration of suitability for antenatal share care 

Please consider the below criteria when assessing suitability for antenatal share care (ANSC) and caring for women during pregnancy.

Women not suitable to book for ANSC: 

• Multiple pregnancy 
• Presence of significant maternal disease:
• Clinically significant cardiac disease (Class II, III, IV) 

• Renal disease with impaired renal function 
• Rhesus disease 
• Severe respiratory disorder 
• Poorly controlled epilepsy 
• HIV infection 

• Type 1 diabetes mellitus 
• Poorly controlled or unstable Type 2 diabetes mellitus 

• Pre-pregnancy BMI ≥ 35 
• Women who decline blood products 

Women whose booking history requires assessment by a specialist obstetrician: 

• Asymptomatic cardiac disease 
• History of significant postpartum haemorrhage 
• History of epilepsy – no seizures for past 2 years 
• History of previous stillbirth 
• Consanguinity in couple 
• Excessive alcohol and/or chemical use in pregnancy 
• Primigravida aged 40 years and over at booking 
• Previous caesarean section 
• Women to be managed through SGH Next Birth after Caesarean (NBAC) with review at 20wks and 34wks

Women who require transfer to St George Hospital during pregnancy: 

• Significant hypertension before 36 weeks gestation 
• Pre-eclampsia at any gestation. 
• Preterm labour (32-34 weeks) 
• Major anterior placenta praevia (once confirmed at 32 weeks gestation, or sooner if antepartum haemorrhage). 
• Significant intrauterine growth restriction and/or oligohydramnios 
• Women with BMI > 35 and/or who gain more than 9kg in weight 
• Significant hypertension before 36 weeks gestation 
• Pre-eclampsia at any gestation. 
• Preterm labour (32-34 weeks) 
• Major anterior placenta praevia (once confirmed at 32 weeks gestation, or sooner if antepartum haemorrhage). 
• Significant intrauterine growth restriction and/or oligohydramnios 
• Gestational hypertension after 36 weeks gestation 
• Polyhydramnios 
• Fetal chromosomal abnormality detected after prenatal screening