ANSC September 2022 Update: Royal Hospital for Women

Contact details for RHW

Email address for GP enquiries at RHW: SESLHD-RHWGPSCEnquiries@health.nsw.gov.au

ANSC Liaison Midwife Chantelle du Boisee work days 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 8.00-4.30). 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 ph.9382 6111 and ask the operator to page the on-call Obstetric Registrar for GP Shared Care

For more urgent 7 day /24hr advice, contact Delivery Suite ph. 0439 869 035 or 9382 6100 (from 20 weeks pregnancy).

Upcoming intake session

RHW will be running a face-to-face Intake session on the Saturday 5 November 2022 for all new GPs requesting to join the ANSC program and for GPs requesting cross affiliation with the RHW ANSC program. 

To register interest please contact Kylie Sommerville from CESPHN at k.sommerville@CESPHN.com.au

Updates and reminders

• Obstetrician Consultant Dr Sarah Lyons is now leading the Preterm Birth Prevention clinic, OASIS and Mondays Obstetric Diabetes Clinic: Please refer to Dr Sarah Lyons when referring to these clinincs and fax to 9382 6118
• Perinatal Mental Health has a new email address. Email all referrals to: SESLHD-Mentalhealth-referral-RHW@health.nsw.gov.au
• Updated MFM referral form is available on the RHW website Maternal-Fetal Medicine | South Eastern Sydney Local Health District (nsw.gov.au)
• Contact the Fetus Line on 0437 537 448 to discuss the referral, with the MFM midwife. Complete all details on the referral form and include relevant ultrasound and blood results (including blood group).
• Patient results: Prior to faxing and emailing results please ensure that the patients name appears on all pages.
• Please do not CC RHW into any results. This will avoid wastage of paper and double handling.
• Fax ALL Gynaecology OPD  referrals to 9382 6246 (please do not fax to the antenatal outpatients)
• 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.
• Delivery Suite can accept referrals from GPs and women, with urgent obstetric medical concerns in the immediate 14 days following the birth. Contact Delivery suite on 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 Specialized 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, telephone the Liaison midwife to organize a hospital appointment on 0417 995 153.

Updated GP shared care protocol summary and ANSC guidelines

A reminder that the RHW Antenatal Share Care Guidelines and RHW GP Shared Antenatal Care Protocol Summary have recently been updated. 

Physio update – introducing embody classes 

Empowering Mothers toward Better health Outcomes During the childbearing Years (EMBODY) is a NSW Public Health Service first maternal health and wellbeing virtual program lead by the team of physiotherapists at the Royal Hospital for Women.

The RHW physiotherapy team have tailored both prevention and treatment solutions for a more comfortable pregnancy, a more active birth and a speedier recovery after birth. The team provide 4 antenatal and 4 postnatal virtual health sessions tailored to women’s needs at different stages of their pregnancy and postnatal recovery.

For more information about the program please read the brochure.

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 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)

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 patients 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 the ANSC advice line.

Recent questions have been asked by GP’s about COVID-19 and pregnancy.  In the attached document, Dr Amanda Beech RHW Obstetric Medicine Consultant and Endocrinologist has answered the following questions:

1. What are the risks to the pregnancy if the woman is triple vaccinated and develops COVID-19?
2. Are there differences to the risks depending on what trimester of pregnancy a women develops COVID-19?
3. A general update on the mRNA COVID-19 vaccine and pregnant women?
4. Should women over 30 have the 4^thvaccine?

Get Healthy in Pregnancy service are looking for referrals from GPs

All GPs and practice staff can refer patients to the Get Healthy in Pregnancy service. It’s a free NSW Health service that provides positive outcomes for pregnant women and their newborns.

South Eastern Sydney Local Health District, Health Promotion Service staff can provide your practice with:

• tailored training for practice staff
• best referral pathways for your practice
• feedback on number of referrals

Refer to the attached brochure.

Get Healthy in Pregnancy Participant testimonial  

Get Healthy in Pregnancy midwife testimonial  

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 service

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 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

You can access Clinical Business Rules at RHW here.

Recently reviewed Clinical Business Rules:

1. Cervical Screening for Pregnant or Postnatal Women

2. Fetal Growth Restriction and Small for Gestational Age – screening and management for Singleton pregnancies;

3. Estimating Due Date (EDD)

4. Influenza vaccination in Pregnancy

Other important and helpful Clinical Business Rule reminders:

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

• NOTE: 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.

Fetal Movement: Identification and Management of Reduced Patterns

• The RHW Fetal Movement patient brochure (Fetal movement: what is normal?) has been updated. It is important to discuss and educate women about fetal movement at all antenatal visits.

Iron infusions at RHW – booking procedure

There has been a recent sharp rise in requests from GPs for RHW to administer Ferinject infusions for pregnant women who have a low ferritin but normal HB.

RHW protocol recommends that for these women a trial of oral iron is the first line therapy. If oral iron has failed or is contraindicated then an IV iron infusion may be considered. See the link to the relevant policy

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

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

The GP can discuss and arrange an Iron infusion by phoning the Pregnancy Day Stay Unit (PDSU) on 9382 6417.   Please note bookings will not be accepted by the patient directly.

Fax the referral, 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.)

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.