ANSC September 2026 Update: RPA Women and Babies/Canterbury Hospital

This month’s update includes a GP case study on fundal height measurement and fetal growth assessment, guidance on referrals for skin issues in pregnancy, and reminders about the importance of early referral for hospital-based antenatal care.

Case Study: ANSC Palpation

Prepared by the RPA/Canterbury ANSC GP Advisor

Fatima is 39 years old and pregnant with her first baby. Her antenatal serology, baseline bloods and urine tests are normal. She has a BMI of 31 and a family history of gestational diabetes, with two of her five sisters affected.

Due to these risk factors, she underwent early gestational diabetes screening at six weeks’ gestation, with a fasting plasma glucose of 5.2 mmol/L and HbA1c of 5.7%.

Fatima opted for shared care; however, she booked appointments with different doctors in the practice rather than an accredited ANSC GP. At her 25-week appointment, a fundal height measurement of 31 cm was recorded, indicating the fetus appeared large for gestational age.

Clinical Considerations

A fundal height measurement that differs from gestational age by 3cm or more should prompt further assessment with ultrasound to evaluate fetal growth and wellbeing.

Macrosomia is associated with increased risks for both mother and baby, including:

• Higher degree perineal tears
• Shoulder dystocia
• Lower APGAR scores
• Increased special care nursery and NICU admissions
• Neonatal jaundice
• Increased risk of obesity later in life

Key Learning Point

Fundal height should be measured and documented at every antenatal visit from 24 weeks’ gestation. Babies at either end of the growth spectrum require closer monitoring and may require additional obstetric interventions.

Resources

• Fetal Growth Assessment (Clinical) in Pregnancy
• International Symphysis Fundal Height Standards
• Standardised Fundal Height Measurement Technique
• NSW Health Fetal Growth Restriction Guideline

Standardised Fundal Height Measurement Technique

Fundal height measurement is an essential component of antenatal care from 24 weeks’ gestation. GPs are encouraged to use a standardised measurement technique and document findings on the yellow card.

Women who are unsuitable for fundal height measurements, including those with a BMI greater than 40 or large uterine fibroids greater than 10cm, or those with risk factors for fetal growth restriction, should undergo regular growth and wellbeing ultrasounds.

Further information is available in the NSW Health Fetal Growth Restriction Guideline.

Referrals for Skin Issues in Pregnancy

Please note that Canterbury Hospital does not accept dermatology referrals.

Patients birthing at Canterbury Hospital who have complex skin concerns should be referred to either a private dermatologist or the RPA Dermatology Outpatient Clinic.

Further referral information is available via Health Pathways – Dermatology Requests

The Importance of Early Antenatal Referral

Pregnant patients should be referred for hospital-based antenatal care as soon as pregnancy is confirmed and ideally before 14 weeks’ gestation.

Early referral supports timely screening and treatment for conditions such as gestational diabetes and fetal growth restriction.

If financial concerns are preventing Medicare-ineligible patients from accessing hospital-based antenatal care, GPs can contact the GP Liaison Midwife directly:

Melanie Tulloch
Phone: 0425 230 662
Monday to Friday, 8:00am–4:30pm

Please note this phone number is for GPs only and should not be provided to patients.