ANSC September Update: St George Hospital and Sutherland Hospitals

Updated antenatal haemoglobinopathy screening process

The following information has been provided by Dr Giselle Kidson-Gerber, Consultant Haematologist.

The antenatal haemoglobinopathy screening procedure at the Royal Hospital for Women and St George Hospital will be changing following a recent audit of our haemoglobinopathy screening and molecular results.

In summary:

  1. We will using a cut-off of MCV <80fl or MCH <26.5pg to instigate further testing, screening partner or stating that ‘alpha thalassaemia cannot be excluded'.
  2. We have provided an algorithm to help you interpret the test results – the pdf Action following Antenatal Haemoglobinopathy Screen (386 KB) . The first page is for you to use, and the second page states what genetics or haematology will do, subsequent to your referral. The algorithm can also be used when interpreting results from other laboratories.

There is data and consensus to screen for a two gene alpha mutation in the parents in order to predict for Barts hydrops fetalis (four gene deletion) rather than screening for a one gene alpha mutation which would help predict HbH disease (three alpha gene deletion). Of course we are also screening for beta thalassaemia major, sickle cell disease and other ‘major’ phenotypes. With the changing ethnic distribution of our patients, haemoglobinopathy screening will become more important and so my intention is to clarify and streamline the process for you.

As a reminder, please screen any of:

  • High risk ethnicity in patient and partner: South east Asian, Asian, Indian, Sri Lankan, Pakistani, Bangladeshi, Middle Eastern, Mediterranean, Black African, Islander
  • MCV <80fL or MCH <26.5pg
  • Known haemoglobinopathy carrier, family history of haemoglobinopathy in mother or partner’s family

And request:

  • Full blood count
  • Haemoglobinopathy screen
  • Iron studies

If you would like more information, including the results of our study, or to discuss a patient, please contact me (Giselle.KidsonGerber@health.nsw.gov.au, 0402 426 842). Referrals to my Haematology Obstetric Clinic at RHW can be made on 9382 6044 and attached is the pdf genetic referral form (663 KB) .

Gynaecology referrals

St George Hospital has a variety of outpatient gynaecology clinics available for women living in the Rockdale area, Georges River and Sutherland Shire municipalities. Women previously managed through the gynaecology clinic will also be accepted.

All gynaecology referrals to St George Hospital need to be faxed or emailed.

Please see the following for more information:

DV resources

The July ANSC CPD event included domestic violence screening and outlined appropriate referral pathways and advocacy/support services for victims of domestic and family violence.

The importance of early screening and referral to support services was highlighted and GPs were provided with resource pathways. The safety of women and children in the home is a key element of reducing stress during pregnancy.

Reading through the RACGP White Book will guide the GP through screening - asking, responding and counselling strategies, a risk assessment flowchart, phone app for woman to download and other tools and resources.

The Contact and Services List for St George and Sutherland Hospitals provides the phone contact details for the Social Work department.

Another useful link is the Edinburgh Postnatal Depression Scale.

 

Use of anti-D in GP practices

 

In recent months, the St George and Sutherland Antenatal Shared Care Advisory Committee has discussed the potential for administration of Anti-D in GP practices. GP Advisor, Dr Lucy France shares her experience below:

This year at my practice we have trialled supplying Anti-D for our patients. The aim was to avoid the added stress of hospital admission or presentation during sensitising events.

Anti-D can be ordered through the Australian Red Cross Blood Service.

A doctor needs to be registered and be given approval through the National Blood Authority. This registration provides a code for the approved health provider to enable ordering. The code is required on each order form. It is a very easy process to register and they advise within a couple of days of approval.

An order form and information on how to order is sent out once you are approved.

Ordering

Phone: 02 92342442

Customer Service Delivery: 1300 478 348

Delivery is usually within 24 to 48 hours.

Storage

Blood products must be stored in a monitored vaccine fridge at a range of 2 to 8°C.

The fate of the product must be recorded on the delivery form.

Patient details must also be recorded as well as batch number and expiry in the patient’s notes. This is because occasionally blood products are recalled.

We started this process in May and ordered one each of 625iu and 250iu. We have only used the lower dose for miscarriage so far, which has been very satisfying in keeping women out of hospital at a distressing time. In retrospect the higher dose may not have as much indication in general practice and to avoid wastage we will not be renewing this stock.

Further information about the NSW Health guideline is available here (see page 3 for care pathway).

 

HealthPathways

 

The South Eastern Sydney HealthPathways website is now live.

HealthPathways:

  • Is an online information portal for general practitioners and other health professionals, providing localised clinical management and referral pathways.
  • Supports primary care clinicians to plan patient care through the primary, secondary and tertiary health care systems within a local health district.
  • Provides locally agreed information on how to assess and manage medical conditions, and how to refer patients to local services.

HealthPathways empowers clinicians with locally agreed information to make the right decisions, together with patients, at the point of care.

What's different about HealthPathways?

The Pathways is designed and written for use during a consultation. Each pathway provides clear and concise guidance for assessing and managing a patient with a particular symptom or condition. Pathways also include information about making requests for services to specialist clinicians or to the local health system.

Content is developed collaboratively by general practitioners, hospital clinicians, and a wide range of other health professionals. Each pathway is evidence-informed, but also reflects local reality, and aims to preserve clinical autonomy and patient choice. HealthPathways serves to reduce unwarranted variation and accelerate evidence into practice.

The South Eastern Sydney HealthPathways has more than 50 completed pathways and another 100 in development and nearing completion (including pregnancy-related HealthPathways).

To access South Eastern Sydney Health Pathways, visit:

http://www.sesydney.healthpathways.org.au

Username: sesydney

Password: healthcare

 

Hospital bookings - online antenatal appointment form

 

St George and Sutherland Hospitals now have an online ‘Antenatal Appointment Form’ for women to book for their pregnancy. Women should be encouraged to book as soon as their pregnancy is confirmed.

St George: https://www.seslhd.health.nsw.gov.au/contact/antenatal_appointment_form

Sutherland: https://www.seslhd.health.nsw.gov.au/contact/antenatal_appointment_form_suthe

The current Centralised Booking System is still available on 9113 2162 or 13 14 50 for interpreter support.

This is a queuing telephone system so wait times may apply.

 

Reminders

 

  • Pregnant women planning to deliver at St George or Sutherland Hospitals must live in the SESLHD Referral Postcodes ie. Georges River Council and Rockdale area.
  • Women should be encouraged to book online (St George or Sutherland) or phone (9113 2162 or for interpreter 13 14 50) for their first antenatal booking as soon as she has confirmed her pregnancy. Ideally this appointment should be scheduled 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 rpt at 28wks), HIV (informed consent only required for testing), 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 antenatal clinic.
  • Women with diet controlled GDM may remain on ANSC. Women who are medicated or on insulin must return to antenatal clinic for remainder of the pregnancy.

UPDATED ANTENATAL HAEMOGLOBINOPATHY SCREENING PROCESS

The following information has been provided by Dr Giselle Kidson-Gerber, Consultant Haematologist.

The antenatal haemoglobinopathy screening procedure at the Royal Hospital for Women and St George Hospital will be changing following a recent audit of our haemoglobinopathy screening and molecular results.

In summary:

1. We will using a cut-off of MCV <80fl or MCH <26.5pg to instigate further testing, screening partner or stating that ‘alpha thalassaemia cannot be excluded.’

2. We have provided an algorithm to help you interpret the test results – the ‘Action following Antenatal Haemoglobinopathy Screen’.

The first page is for you to use, and the second page states what genetics or haematology will do, subsequent to your referral. The algorithm can also be used when interpreting results from other laboratories.

There is data and consensus to screen for a 2 gene alpha mutation in the parents in order to predict for Barts hydrops fetalis (4 gene deletion) rather than screening for a 1 gene alpha mutation which would help predict HbH disease (3 alpha gene deletion). Of course we are also screening for beta thalassaemia major, sickle cell disease and other ‘major’ phenotypes. With the changing ethnic distribution of our patients, haemoglobinopathy screening will become more important and so my intention is to clarify and streamline the process for you.

As a reminder, please screen any of:

And request:

If you would like more information, including the results of our study, or to discuss a patient, please contact me (Giselle.KidsonGerber@health.nsw.gov.au, 0402 426 842). Referrals to my Haematology Obstetric Clinic at RHW can be made on 9382 6044 and attached is the genetic referral form.

GYNAECOLOGY REFERRALS

St George Hospital has a variety of outpatient gynaecology clinics available for women living in the Rockdale area, Georges River and Sutherland Shire municipalities. Women previously managed through the gynaecology clinic will also be accepted.

All gynaecology referrals to St George Hospital need to be faxed or emailed.

Please see the following for more information: * Letter to GPs

* Gynaecology referral form

* Gynaecology clinics information sheet

DV RESOURCES

The July ANSC CPD event included Domestic Violence screening and outlined appropriate referral pathways and advocacy/support services for victims of Domestic and Family Violence.

The importance of early screening and referral to support services was highlighted and GPs were provided with resource pathways. The safety of women and children in the home is a key element of reducing stress during pregnancy. Reading through the RACGP White Book will guide the GP through screening- asking, responding and counselling strategies, a risk assessment flowchart, phone app for woman to download and other tools and resources. The Contact and Services list for St George and Sutherland Hospitals provides the phone contact details for the Social Work department. Another useful link is the Edinburgh Postnatal Depression Scale.

USE OF ANTI-D IN GP PRACTICES

In recent months, the St George and Sutherland Antenatal Shared Care Advisory Committee has discussed the potential for administration of Anti-D in GP practices. GP Advisor, Dr Lucy France shares her experience below.

This year at my practice we have trialled supplying Anti-D for our patients. The aim was to avoid the added stress of hospital admission or presentation during sensitising events.

Anti-D can be ordered through the Australian Red Cross Blood Service.

A doctor needs to be registered and be given approval through the National Blood Authority. This registration provides a code for the approved health provider to enable ordering. The code is required on each order form. It is a very easy process to register and they advise within a couple of days of approval.

An order form and information on how to order is sent out once you are approved.

Ordering

Phone: 02 92342442

Customer Service Delivery: 1300 478 348

Delivery is usually within 24 to 48 hours.

Storage

Blood products must be stored in a monitored vaccine fridge at a range of 2 to 8°C.

The fate of the product must be recorded on the delivery form.

Patient details must also be recorded as well as batch number and expiry in the patient’s notes. This is because occasionally blood products are recalled.

We started this process in May and ordered one each of 625iu and 250iu. We have only used the lower dose for miscarriage so far, which has been very satisfying in keeping women out of hospital at a distressing time. In retrospect the higher dose may not have as much indication in general practice and to avoid wastage we will not be renewing this stock. Further information about the NSW Health guideline is available here (see p.3 for care pathway).

HEALTHPATHWAYS

The South Eastern Sydney HealthPathways website is now live.

HealthPathways:

* Is an online information portal for general practitioners and other health professionals, providing localised clinical management and referral pathways.

* Supports primary care clinicians to plan patient care through the primary, secondary and tertiary health care systems within a local health district.

* Provides locally agreed information on how to assess and manage medical conditions, and how to refer patients to local services.

HealthPathways empowers clinicians with locally agreed information to make the right decisions, together with patients, at the point of care.

What's different about HealthPathways?

The Pathways is designed and written for use during a consultation. Each pathway provides clear and concise guidance for assessing and managing a patient with a particular symptom or condition. Pathways also include information about making requests for services to specialist clinicians or to the local health system. Content is developed collaboratively by general practitioners, hospital clinicians, and a wide range of other health professionals. Each pathway is evidence-informed, but also reflects local reality, and aims to preserve clinical autonomy and patient choice. HealthPathways serves to reduce unwarranted variation and accelerate evidence into practice.

The South Eastern Sydney HealthPathways has more than 50 completed pathways and another 100 in development and nearing completion (including pregnancy-related HealthPathways).

To access South Eastern Sydney Health Pathways, visit: http://www.sesydney.healthpathways.org.au

Username: sesydney

Password: healthcare

HOSPITAL BOOKINGS - ONLINE ANTENATAL APPOINTMENT FORM

St George and Sutherland Hospitals now have an online ‘Antenatal Appointment Form’ for women to book for their pregnancy. Women should be encouraged to book as soon as their pregnancy is confirmed. St George: https://www.seslhd.health.nsw.gov.au/contact/antenatal_appointment_form Sutherland: https://www.seslhd.health.nsw.gov.au/contact/antenatal_appointment_form_suthe

The current Centralised Booking System is still available on 9113 2162 or 13 14 50 for interpreter support.

This is a queuing telephone system so wait times may apply

REMINDERS

* Pregnant women planning to deliver at St George or Sutherland Hospitals must live in the SESLHD Referral Postcodes ie. Georges River Council and Rockdale area. * Women should be encouraged to book online (St George or Sutherland) or phone (9113 2162 or for interpreter 13 14 50) for their first antenatal booking as soon as she has confirmed her pregnancy. Ideally this appointment should be scheduled 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 rpt at 28wks), HIV (informed consent only required for testing), 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 antenatal clinic.

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