ANSC July Update: St George Hospital and Sutherland Hospitals

Gestational diabetes

St George Hospital has started an Antenatal Endocrine Clinic on Tuesdays. We have an endocrinologist and dietician from the Diabetes Centre seeing women in the antenatal clinic. This reduces the amount of appointments women with GDM require as they can combine appointments on the same day.

Referrals to the Diabetes Centre remain the same - fax a copy of the blood results with a referral letter to 9113 2690. Appointments will be allocated through this service.

Women at high risk for GDM need to be screened with the booking bloods. Attached is the pdf GDM screening flowchart (275 KB) to refer to for high risk factors.

Sutherland Hospital has an antenatal GDM clinic on Wednesdays with an endocrinologist and dietician. This clinic commenced approximately one year ago. The initial referral is the same as for St George.

Pregnant women with a history of bariatric surgery should have an HbA1c at booking and at 28 weeks. An HbA1c result >5.3 per cent requires referral to endocrinology. An HbA1c>6.5 per cent at booking is highly suggestive of pre-existing diabetes. These women are to be managed at the hospital ANC regardless of their BMI.

Calculating EDB

With the introduction of the eMaternity program used in SESLHD, the algorithm logic used will auto calculate the EDB.

  1. At the initial consultation, ascertain the LMP and cycle length, check for regularity of cycle lengths and determine if a dating US has been done. Give an estimated date and explain that the date may vary by a few days once the eMaternity system auto calculates.
  2. Ultrasounds conducted between 8+0 and 13+6 weeks gestation are more accurate for prediction of birth date than the last menstrual period.
  3. If LMP is unknown or dating US not available, refer the woman for an Obstetric US.
  4. For an IVF pregnancy, use the date given by the fertility centre.
  5. Do not alter dates with subsequent ultrasounds - changes are representations of fetal growth not an altered EDB.

Early Pregnancy Assessment Service at St George Hospital

The service is available Monday to Friday between 7.30 am - 8.30 am, at 1 West Gynaecology Ward, Gray St, Kogarah.

Please advise women to be on time and bring blood and US results if available (especially blood group).

GP reminders

Pregnant women must live in the SESLHD region (i.e. Georges River Council and Rockdale area).

Encourage the woman to phone for her first antenatal booking as soon as she has confirmed her pregnancy or to book this online (St George or Sutherland). Ideally we would like to book this appointment for 12-14 weeks of pregnancy.

Please discuss/arrange NT and NIPT screening.

Please ensure all bloods are requested at booking, including: Vit D, Ab screen for Rh positive women (and repeat at 28 weeks), HIV (informed consent only required for testing), and VZ IgG if uncertain.

Ensure the yellow card is completed at all ANSC visits and results are recorded.

If a woman presents with an abnormal finding on palpation, ultrasound or blood results, please contact the medical staff in Delivery Suite immediately to establish follow-up care.

Women requiring Anti D to be given at 28 weeks need to have a copy of their current red cell antibody screen prior to administration in ANC.

Women with diet controlled GDM may remain on ANSC. Women who are medicated or on insulin must return to ANC for remainder of the pregnancy.