ANSC September Update: The Royal Hospital for Women

RHW publically funded homebirth communication

The Royal Hospital for Women is now ready to offer women with a low risk pregnancy the choice of being able to birth at home. Over the past 18 months we have conducted a comprehensive risk assessment and have prepared in consultation with consumers, obstetric medical staff, midwives, managers and RHW executive.

In July 2018, RHW started offering publically funded homebirth to low risk women who meet the criteria. To date, five women have had a successful homebirth following a risk assessment at 36 weeks and consultant obstetric review. All care for women choosing publicly funded homebirth will be under the care of Midwifery Group Practice (MGP) and will follow RHW guidelines.

Two experienced midwives will attend the birth, one of whom will be our mentor midwife, Sheryl Sidery. All women accessing the RHW homebirth programme are aware that they will need to birth at RHW if we cannot provide two experienced midwives to attend their home.

In the past 10 years there has been a growing body of evidence that states that homebirth is a safe and very enjoyable experience for low risk women. The women of the Eastern Suburbs have been requesting this family centred option and now the Royal Hospital for Women is able to meet their demand.

If you would like further information about the service please contact either Sheryl.Sidery@health.nsw.gov.au or Michele.Pezzutti@health.nsw.gov.au

New medical clinic - Wednesday mornings

We are delighted to be able to offer a further Obstetric Medicine Clinic on Wednesday morning as we expand our service with the appointment of Dr Amanda Beech, Obstetric Physician.

This clinic will review patients who have medical disorders in pregnancy, including hypertension, thyroid disorders, venous thromboembolic disease, autoimmune disorders, etc.

Please send referrals addressed to Dr Amanda Beech, RHW OPD via fax on 9382 6118 for women who may need to be reviewed.

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 (94 KB) .

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

24 hour designated triage service within RHW birthing services

Background / Rationale

We recognised a need for a triage system within our birthing service as we have a large number of women who present for clinical review or telephone for advice. Some of these women will have already been seen in the community and are being referred on for more specialist review; others are self-referrals with clinical concerns. In addition to these women we have labouring women to accommodate.

To safely meet the needs of all these women we require a triage process that allows prioritisation of the most urgent cases. Some women can be seen and assessed and referred to a less acute service, other may require admission. We receive a large number of phone calls for advice and at present there is no designated triage person to take these calls. This can lead to the same women speaking to different staff members if she calls two-three times within a few hours and potentially receiving inconsistent advice.

We also wish to prioritise our labouring women and ensure we have adequate delivery rooms available to manage our delivery suite efficiently. We are aiming for 1:1 midwifery care for women in labour. This will be more achievable if other clinical reviews are under taken by a separate team.

Clinical Care arrangements

  • A designated midwife will be allocated 24/7 to answer calls from pregnant women or other health care providers regarding acute obstetric concerns.
  • This midwife will also assess and triage women on their arrival to Delivery Suite.
  • One extra full time midwife per shift will be allocated for this position. This midwife will carry a mobile phone which will be dedicated to this purpose.
  • Medical staff will see women as required, after initial assessment by the midwife and according to established guidelines.
  • Women who have non urgent reasons for medical or midwifery review may be redirected to an outpatient clinic for review or to their nominated GPSC provider.

Expected benefits

  • Safer care for women through effective triage processes.
  • More efficient flow of women through Birthing Services.
  • Increased opportunity for core staff to provide 1:1 care in labour- including access to Birth Centre for more women.
  • Consistency of advice to women who call DS for clinical advice.

If you have any questions about this process please contact the triage no: 0439 869 035

 

Screening for gestational diabetes

 

Further to the previous newsletters, there still appears to be some confusion about screening for Gestational Diabetes. Women with the following high risk factors need to be screened between 12 – 14 weeks pregnant:

  • Ethnicity: Aboriginal/Torres Strait Islander, Asian, South Asian, Pacific Islander, Maori, Middle Eastern, Non-white African
  • Insulin Resistance (eg. associated with PCOS)
  • Maternal Age ≥ 40 years
  • Medications eg. corticosteroids, antipsychotics
  • BMI ≥ 30 at pre conception or initial booking
  • Previous adverse pregnancy outcome suggestive of undiagnosed GDM eg shoulder dystocia, unexplained stillbirth
  • Previous baby with birth weight >4.5kg
  • Previous GDM
  • Strong Family History Diabetes (1st degree relative with diabetes, sister with GDM).

If the early screening test is negative, the woman will need to repeat it again between 26 – 28 weeks.

If the early screening test is positive, please contact Diabetes Educator as below. The woman does not need to repeat at 26-28 weeks.

Refer within one week of diagnosis to Diabetes Educator email preferred: Justine.Darling@health.nsw.gov.au

OR Fax to: 9382 6118; Phone: 9382 6010

Please include:

  • Copy of 75g OGTT results, weeks of gestation, EDC, relevant medical history, reason for referral
  • patient current phone number
  • Indicate if interpreter required

Diabetes Educator will contact woman within a few days of receipt of referral and will arrange appointments with Diabetic Educator, Dietician and Endocrinologist.

Please click here for the RHW easy to follow Flowchart for Screening, Diagnosis and Referral of Gestational Diabetes Mellitus (GDM).

Please click here for the RHW Guideline for Screening, Diagnosis and Referral of Gestational Diabetes Mellitus (GDM).

 

Pathology results

 

Further to previous notices in ANSC Newsletters, RHW is still experiencing an overwhelming amount of pathology and ultrasound results that are received daily either via mail and/or fax.

Can you please ensure that you do not copy RHW OPD or send via fax and that instead you give the original copies of all test results and scans to the woman to bring to her next antenatal visit at RHW. Do not copy of fax results to RHW.

Any investigations requested by the GP for the woman under his / her care must be followed up by the GP. It is the responsibility of the provider ordering the test or noting an abnormal finding to ensure appropriate follow-up and communication. This eliminates multiple handling of results.