ANSC September 2025 Update: Royal Hospital for Women

Contact Details for RHW

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

GP Liaison Midwives:  Chantelle du Boisee Monday, Tuesday and Wednesday AND 

Hwee Ling Lim Thursday and Friday. Contact the midwives for non-urgent clinical advice on 0417 995 153 between 8:00am-4:30pm, if no answer, please leave a voicemail or text message.

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 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 the Birth Unit on 0439 869 035 or 9382 6100 (from 20 weeks pregnancy). 

Referring into the Royal Hospital for Women- Antenatal Service

The Royal Hospital for Women (RHW) has noted some confusion when GP’s have been completing the selection of clinicians for RHW Antenatal Outpatient Service via e-referrals. To streamline and assist you with this process, RHW would like to provide a list below of all clinicians as they appear in the e-referral dropdown in HealthLink (in the order they appear for you as the referrer), along with their respective speciality at RHW:

Dr Madeleine Sheppard	Postnatal – Obstetrical Anal Sphincter Injuries Service (OASIS)
Dr Alex Owen	Staff Specialist Obstetrician
Dr Sarah Lyons	Staff Specialist Obstetrician/ Pre-term Birth
Dr Antonia Shand	Maternal Fetal Medicine/High Risk Pregnancy
Dr Louise Fay	Antenatal Shared Care (ANSC) Obstetrician
Dr Willem Gheysen	Maternal Fetal Medicine/High Risk Pregnancy
Dr Wendy Hawke	VMO Obstetrician
Professor Sandra Lowe	Obstetric Medicine
Dr Giselle Kidson-Gerber	Haematologist
Dr Helen Barrett	Obstetric Medicine
Dr Amanda Beech	Obstetric Medicine
Dr Sarah Livingstone	Staff Specialist Obstetrician
Dr Stephen Coogan	Antenatal Shared Care (ANSC) Obstetrician
Specialist – unnamed referral	Please do NOT use this going forward if aware of sub-speciality requirement for your antenatal patient.

When referring women for ANSC pregnancy care at RHW, patients are typically assigned either to:

• Dr. Louise Fay
• Dr. Stephen Coogan
  

If the patient prefers MGP and there is available capacity, please continue to refer to either ANSC obstetrician. Once the referral is received, RHW will assign an appropriate MGP obstetrician internally.

We thank you for your ongoing engagement with the eReferral process. Your commitment to using this system plays a vital role in enhancing communication, streamlining patient care, and improving overall service delivery. Your support is appreciated, and we look forward to continuing to work together to provide timely, coordinated care for our antenatal patients. RHW ANSC Practitioners Flyer

 SESLHD Electronic Referral

• SESLHD Existing services Flyer
• SESLHD Referrals Brocher
• Healthlink Updating Practice Name
• Healthlink Investigation Header Patient Details
  

Updated ADIPS 2025 GDM diagnostic criteria: what has changed, why it changed, and what it means for GPs

Gestational diabetes mellitus (GDM) is defined as hyperglycemia, diagnosed for the first time in pregnancy, but below the threshold for overt diabetes in pregnancy. Hyperglycemia in pregnancy increases the risk of adverse maternal pregnancy outcomes (pre-eclampsia, high infant birth weight, obstetric intervention) and perinatal outcomes (neonatal hypoglycemia, respiratory distress, NICU admission and jaundice).

The Australasian Diabetes in Pregnancy Society (ADIPS) recently updated the guidelines for screening and diagnosis of hyperglycemia in pregnancy in response to concerns around over-diagnosis, and variable benefit for lower-risk women, and recognising changes in contemporary guidelines and major trials.

What has changed?

New diagnostic criteria for GDM using the POGTT at any gestation

o fasting plasma glucose (FPG) 5.3–6.9 mmol/L

o 1-hour ≥ 10.6 mmol/L

o 2-hour ≥ 9.0–11.0 mmol/L

Clarification of the diagnostic criteria for Overt Diabetes in Pregnancy

o fasting plasma glucose ≥ 7.0 mmol/L

o 2-hour ≥ 11.1 mmol/L

o HbA1c ≥ 6.5% (48 mmol/mol)

Women with risk factors for hyperglycemia in pregnancy should have an HbA1c measured in the first trimester

o The risk factors remain unchanged from those used previously

o Fasting plasma glucose levels should NOT be measured in the first trimester

o If HbA1c ≥ 6.5% (48 mmol/mol), treat as overt diabetes and refer for diabetes education

o If HbA1c 6.0-6.4% (42-47mmol/L), treat as GDM and refer for diabetes education

In women with risk factors who did not have an HbA1c in the first trimester, a POGTT should be undertaken before 20 weeks, ideally at 10-14 weeks, using the new diagnostic criteria for diagnosis

There is no change to the recommendation to attend universal POGTT screening between 24-28 weeks gestation for all other women. For primary caregivers, changing to the new criteria and targeting early diagnosis with an HbA1c/POGTT will ideally be straightforward, but the cultural shift and clear, empathic conversation about the risk, benefit and rational for fewer diagnoses is just as important.

If you have any questions, contact the RHW Diabetes Education Team on SESLHD-RoyalHospitalforWomenDiabetesServices@health.nsw.gov

Clinical Business Rules (CBRs) – RHW Guidance for GPs

It is the responsibility of all ANSC General Practitioners (GPs) to utilise and adhere to the Royal Hospital for Women (RHW) Clinical Business Rules (CBRs) to ensure safe patient care and evidence-based clinical decision-making.

Access all the RHW CBR’s here:

Royal Hospital for Women Policies | South Eastern Sydney Local Health District

Please advise and refer to the Cross-Cultural Worker at RHW, for women from CALD backgrounds.

Please see directory here

Please see flyer for Cross Cultural training for baby and infant CPR here

Clinical Update: Symphyseal Fundal Height (SFH) Monitoring

To support best practice in antenatal care, please see the following update on SFH assessments and referral guidelines.

SFH Assessments from 24 Weeks

All pregnant women should have their Symphyseal Fundal Height (SFH) measured at each antenatal visit from 24 weeks gestation. SFH assessment is a key tool in identifying abnormal fetal growth.

Watch a short video demonstration on SFH technique available from the Centre of Research Excellence in Stillbirth. https://vimeo.com/363966677?share=copy

When to Refer for a Growth Ultrasound:

• SFH is 3cm above or below the expected measurement for gestational age, OR
• Slow or static growth is observed across two consecutive visits
  

Refer to the RHW Ultrasound Department or a specialised Obstetric Scanning service.

Following the scan, review results promptly and refer to the obstetric team if clinically indicated.

For Further Information:

Refer to the RHW Clinical Guidelines on Fetal Growth Assessment in Pregnancy

Clinical Update: Referral to the Preterm Birth Prevention Clinic (PTBPC)

The PTBPC provides specialist care for women at increased risk of early birth. Timely referral and accurate clinical information are essential to ensure appropriate triage and early intervention.

Important Reminder: A recent audit of electronic referrals (eReferrals) has identified instances where women with a history of cervical procedures—such as cone biopsy or LLETZ—did not have this information documented in the referral details section of the eReferral.

Accurate and complete documentation of relevant clinical history is essential to ensure appropriate triage and management. We kindly remind all referring clinicians to include any history of cervical procedures in the referral narrative, where applicable.

Thank you for your attention to this matter and for your ongoing commitment to high-quality patient care.

Who Should Be Referred to the PTBPC

• Previous spontaneous preterm birth or PPROM under 34 weeks
• Previous second trimester loss (16 -24 weeks)
• Previous cervical cerclage
• 2 or more LLETZ procedures, cold knife cone biopsy or trachelectomy
• LLETZ with histological evidence of >10mm depth specimen
• Congenital Uterine Anomaly (unicornuate, bicornuate or septate uterus)
• History of Asherman’s syndrome
• Short cervix in current pregnancy ≤25 mm at <24 weeks on transvaginal ultrasound
• Post partum 4-6 week follow up after spontaneous PTB <30 weeks
  

Women with any of these risk factors should have a TV cervical length measurement at their mid trimester morphology ultrasound.

• Including women who have had a caesarean section at full dilatation
  

Please contact the PTBPC Midwife Vicky Gay- email victoria.gay@health.nsw.gov.au to discuss all referrals and arrange a review.

Antenatal Lactation Support

Update here

RHW Clinical Placements 2025

RHW Birth Unit Tours and Classes for pregnant women

The RHW antenatal education classes have been updated to align with current evidence and NSW Health policies and frameworks including First 2000 Days, Safe Start, Women-Centred Care, and the Safer Baby Bundle. The contemporary approach to education and facilitation is designed to keep couples interested and engaged with the content.

Birth and Transitions to Parenthood is a 12-hour antenatal education course designed for expectant parents to gain the knowledge, skills, and confidence to navigate pregnancy, labour, birth, and the early weeks of parenthood. Delivered by registered midwives trained in group facilitation, the course uses adult learning principles to ensure content is relevant, practical, and personalised to each family’s needs.

Participants explore topics such as birth planning, labour stages, pain management options (medical and non-medical), newborn care, postpartum recovery, breastfeeding, partner support, and early parenting. The course fosters a supportive, inclusive environment where couples can share experiences, reflect, and prepare together for their unique journey into parenthood.

More information here

“General Practitioners’ perspectives on universal screening for cytomegalovirus (CMV) infection in pregnancy”

• Please see invitation to participate here
• Please see plain language statement here.