ANSC September Update: RPA Women and Babies/Canterbury Hospital

Prenatal Screening at RPAH

All women, regardless of age should be counselled and offered the option for screening for chromosomal anomalies.

Women should be given information about the purpose and implications of testing for chromosomal abnormalities to enable them to make informed choices about whether or not to have the tests. Information should be provided in a way that is appropriate and accessible to the individual woman, with particular regard given to language and literacy.

All ANSC GPs can directly refer women to RPA obstetric ultrasound clinic /Fetal Medicine Unit (FMU) for the following tests:

  1. Combined First Trimester Screening (cFTS)
  2. Non-Invasive Prenatal testing (NIPT)
  3. Chorionic Villus Sampling (CVS)
  4. Amniocentesis

Patient Information brochures:

Non-Invasive Prenatal Testing (NIPT)

RPAH can arrange NIPT testing for women who will book at RPA or Canterbury Hospital. The service includes pre and post-test counselling and blood collection (free at point of care). NIPT is not currently covered by Medicare and as such will incur out-of pocket costs to the pregnant woman. RPAH presently offers two commercially available tests with costs of $250 and $390. The patient will be required to pay the testing laboratory directly to perform the test.

At RPAH, the preferred model for NIPT is contingent screening. In this model, women undertake the combined first trimester screening (cFTS) initially and then the risk from this test is used to define a cohort of women at intermediate risk that would potentially benefit most from a second screening test using NIPT. Women with a cFTS risk between one in 50 and one in 2500 are placed in this intermediate risk group.

RPA can also offer NIPT before 11 weeks (and before cFTS) although this is not the preferred model. NIPT tests can be attended at 9/10 weeks gestation. In this circumstance, women should have had an ultrasound scan within two weeks of attending for NIPT. This is to confirm gestation, viability and pleurality. RPA is not in a position to provide these scan appointments due to the pressure on the obstetric ultrasound service – so women need to attend having had the scan performed elsewhere and need to bring a copy of the scan result with them.

GPs should be reminded that, even if women are having NIPT, it is important that they have an 11-13+6 week scan. This scan also picks up a significant proportion of major structural abnormalities, identifies chorionicity (helping management of twin pregnancies) and is used to screen for pre-eclampsia and IUGR. None of these additional values are covered by NIPT.

For any further questions please contact RPA FMU 9515 6042.

New Canterbury Hospital Obstetric Referral Form

Canterbury Hospital has recently introduced a new pdf Obstetric Referral Form (451 KB) for GPs to complete for women electing delivery at Canterbury Hospital. This two-sided form should be complete prior to the woman’s hospital booking in appointment. For a routine/low risk pregnancy, the woman needs to bring this referral form to her appointment. For a high risk or urgent review, please fax to ANC. 9787 0431 for triage.

The form will be available shortly as a template for MD/BP.

Referral to Canterbury Hospital Endocrine Clinic – Reminder

Please remember to complete the Canterbury Hospital Endocrine Referral Form for women you wish to refer for review at this clinic. The form is available as BP and MD templates for your clinical software.

Routine antenatal visit at 20-22 weeks for women electing GP ANSC at RPA Women and Babies

RPA Women and Babies have introduced the phasing out of the obstetric second visit for ‘low risk’ pregnant women. Any woman who is identified at the hospital booking in appointment as being at ‘low risk’ for developing pregnancy complications will no longer require a second visit with an obstetric medical officer (scheduled ~ 20-22 weeks). Women will be triaged by a hospital midwife in accordance with the National Midwifery Guidelines for Consultation and Referral.

Depending on the preferred model of care, women triaged as Category A “low risk” and have opted for GP shared care will now be required to have a routine GP antenatal visit (~20-22 weeks) in place of the second visit and then continue the usual schedule of appointments for antenatal care. In the event that any complications develop, the woman’s category may change and consultation and referral will be required (see document Determining need for second visit Flow Chart (57 KB) )

This antenatal visit (scheduled ~ 20-22 weeks) should include all aspects of routine antenatal care as well as review of the 18 -19 week morphology scan. The ANSC protocol now reflect this change (available shortly).

ANSC GPs will continue to be notified by the hospital of the woman’s preferred option of care and the schedule of antenatal visits. This will occur once a woman’s booking and category have been checked and confirmed.

For women attending Canterbury Hospital for antenatal care and delivery, the second visit obstetric review remains.

Specific indications for discussion, consultation and/or referral for pregnant women

There may be specific indications for discussion, consultation and/or transfer of care when first discussing a woman’s needs during initial visits with a GP. The National Midwifery Guidelines for Consultation and Referral may assist shared care GPs in stratifying risk, providing the best possible care and making decisions about future care arrangements for women at different stages of their pregnancy.

These indications are categorised as Discuss, Consult and/or Refer covering matters such as medical conditions, pre-existing gynaecological disorders, previous obstetric history and indications developed/discovered during pregnancy. The main purpose of the indication list is to provide a guide for risk-selection.

In any circumstances that need clarification, the GP should seek advice from the GP ASC Liaison Midwife or an O&G Registrar.

Prenatal Screening at RPAH

All women, regardless of age should be counselled and offered the option for screening for chromosomal anomalies.

Women should be given information about the purpose and implications of testing for chromosomal abnormalities to enable them to make informed choices about whether or not to have the tests. Information should be provided in a way that is appropriate and accessible to the individual woman, with particular regard given to language and literacy.

All ANSC GPs can directly refer women to RPA obstetric ultrasound clinic /Fetal Medicine Unit (FMU) for the following tests

1. Combined First Trimester Screening ( cFTS)

2. Non-Invasive Prenatal testing (NIPT)

3. Chorionic Villus Sampling (CVS)

4. Amniocentesis

Patient Information brochures: NSW Genetic Education Centre : Prenatal testing overview : Special tests for your baby during pregnancy NSW Genetic Education Centre :Non- invasive prenatal testing RPAH : Combined First Trimester Screening RPAH : Non-Invasive Prenatal Testing (NIPT) RPAH : CVS & Amniocentesis.

Non-Invasive Prenatal Testing (NIPT)

RPAH can arrange NIPT testing for women who will book at RPA or Canterbury Hospital. The service includes pre- and post-test counselling and blood collection (free at point of care). NIPT is not currently covered by Medicare and as such will incur out- of pocket costs to the pregnant women. RPAH presently offers two commercially available tests with costs of $250 and $390. The patient will be required to pay the testing laboratory directly to perform the test.

At RPAH, the preferred model for NIPT is contingent screening. In this model women undertake the combined first trimester screening (cFTS) initially and then the risk from this test is used to define a cohort of women at intermediate risk that would potentially benefit most from a second screening test using NIPT. Women with a cFTS risk between 1 in 50 and 1 in 2500 are placed in this intermediate risk group.

RPA can also offer NIPT before 11 weeks (and before cFTS) although this is not the preferred model. NIPT tests can be attended at 9/10 weeks gestation. In this circumstance, women should have had an ultrasound scan within two weeks of attending for NIPT. This is to confirm gestation, viability and pleurality. RPA is not in a position to provide these scan appointments due to the pressure on the obstetric ultrasound service – so women need to attend having had the scan performed elsewhere and need to bring a copy of the scan result with them.

GPs should be reminded that even if women are having NIPT, it is important that they have an 11-13+6 week scan. This scan also picks up a significant proportion of major structural abnormalities, identifies chorionicity (helping management of twin pregnancies) and is used to screen for pre-eclampsia and IUGR. None of these additional values are covered by NIPT.

For any further questions please contact RPA FMU 9515 6042

New Canterbury Hospital Obstetric Referral Form Canterbury Hospital has recently introduced a new Obstetric Referral Form for GPs to complete for women electing delivery at Canterbury Hospital. This two-sided form should be complete prior to the woman’s hospital booking in appointment. For a routine/low risk pregnancy the woman needs to bring this referral form to her appointment. For a high risk or urgent review, please fax to ANC. 9787 0431 for triage.

The form will be available shortly as a template for MD/BP.

Referral to Canterbury Hospital Endocrine Clinic – Reminder Please remember to complete the Canterbury Hospital Endocrine Referral Form for women you wish to refer for review at this clinic. The form is available as BP and MD templates for your clinical software

Routine antenatal visit at 20-22 weeks for women electing GP ANSC at RPA Women and Babies

RPA Women and Babies have introduced the phasing out of the obstetric second visit for ‘low risk’ pregnant women. Any woman who is identified at the hospital Booking In appointment as being at ‘low risk’ for developing pregnancy complications will no longer require a second visit with an obstetric medical officer (scheduled ~ 20-22 weeks). Women will be triaged by hospital midwife in accordance with the National Midwifery Guidelines for Consultation and Referral .

Depending on the preferred model of care, women triaged as Category A “low risk” and have opted for GP shared care will now be required to have a routine GP antenatal visit (~20-22 weeks) in place of the second visit and then continue the usual schedule of appointments for antenatal care. In the event that any complications develop, the woman’s category may change and consultation and referral will be required (see Determining need for second visit Flow Chart)

This antenatal visit (scheduled ~ 20-22 weeks) should include all aspects of routine antenatal care as well as review of the 18 -19 week morphology scan. The ANSC protocol now reflect this change (available shortly)

ANSC GPs will continue to be notified by the hospital of the woman’s preferred option of care and the schedule of antenatal visits. This will occur once a woman’s booking and category have been checked and confirmed.

For women attending Canterbury Hospital for antenatal care and delivery, the 2nd visit obstetric review remains.

Specific indications for discussion, consultation and/or referral for pregnant women

There may be specific indications for discussion, consultation and/or transfer of care when first discussing a woman’s needs during initial visits a GP. The National Midwifery Guidelines for Consultation and Referral may assist shared care GPs in stratifying risk, providing the best possible care and making decisions about future care arrangements for women at different stages of their pregnancy.

These indications are categorised as Discuss, Consult and/or Refer covering matters such as medical conditions, pre-existing gynaecological disorders, previous obstetric history and indications developed/discovered during pregnancy. The main purpose of the indication list is to provide a guide for risk-selection.

In any circumstances that need clarification, the GP should seek advice from the GP ASC Liaison Midwife or an O&G Registrar.