ANSC November Update: Royal Hospital for Women

New antenatal schedule of visits

In aligning with the Clinical Practice Guidelines: Pregnancy Care, 2018 edition - there has been a change to both the number of visits and the order in which women share their antenatal care between RHW and their GP.  This will be effective from 1 January 2019.

Please refer to list below:

  • 6 - 12 weeks (GP)
  • Booking visit 14 – 16 weeks gestation (RHW)
  • 20 weeks (GP)*
  • 26 weeks (RHW)
  • 29 weeks (GP)*
  • 31 weeks (RHW)
  • 34 weeks (GP)
  • 36 weeks (RHW)
  • 38 weeks (GP)
  • 39 weeks onwards (RHW)
  • 6 weeks postpartum  (GP)

*Please remember to check results and act on them accordingly at these appointments – morphology results and blood results.


RHW antenatal shared care electronic integration of external pathology results

On 30 October 2018, the Royal Hospital for Women will launch a pilot program to allow external pathology results, ordered by General Practitioners to be imported into the Cerner eMR.  At this stage only results from Douglass Hanly Moir (DHM) will be imported.

This Code RHWR/SCP has to be used to enable results to be electronically imported to the Royal Hospital for Women Outpatients Department

The pilot will run until March 2019 and will then be evaluated.

We would appreciate support from all GPs on our Shared Care Program to direct pathology to Douglass Hanly Moir and use the code RHWR/SCP on each order.

Once successful we plan to expand to other external pathology providers.

If you have any enquiries please contact Virginia Spear, Maternity Data Manager on 9382 6079 or email: Virginia.Spear@health.nsw.gov.au


Simple strategies to reduce the risk of cytomegalovirus infection in pregnancy

Cytomegalovirus (CMV) is a common herpesvirus circulating widely in the community. If a pregnant woman acquires CMV in pregnancy, this can result in infection and damage to the developing fetus. Some babies born with congenital CMV will die, have hearing loss, epilepsy, intellectual impairment and/or cerebral palsy.

CMV is a common virus that can be passed from person-to-person without their knowledge, usually via intimate contact. The most common sources of CMV infection are young children, as they are more likely to shed high levels of virus in their saliva, urine or nasal secretions for long periods. Women who catch CMV infection while pregnant may pass the virus to their unborn child. Pregnant women can use simple hygiene strategies to reduce their risk of CMV infection. However most women have never heard of CMV.

The international consensus guidelines in The Lancet ID recommend: “all pregnant women should be provided information on congenital CMV infection…(including)…potential dangers of CMV infection for the fetus, the most likely sources of infection, and steps to prevent infection”.

Universal CMV screening of pregnant women with blood tests is not recommended. Hygiene practices to reduce infection should be recommended to all pregnant women and women trying to conceive, regardless of their CMV serology status. While the greatest risk of fetal harm occurs with maternal primary infection, congenital infection with long term complications occurs with similar levels of severity in primary and nonprimary (reactivation and/or reinfection) maternal infections.

Click here to view a new video outlining these simple messages. Captioned versions of this video, flyers and posters are available through Cerebral Palsy Alliance and CMV Australia.

For additional information please see the 2018 Congenital CMV RACGP Webinar.


Antenatal resources

The following antenatal resources are available to order through Stream Solutions.

Please contact Stream Solutions to set up an account on 1300 786 075 or via email StreamDirectHelpdesk@stream.net.au

  • Having a Baby book (Product Code: KF110001), free of charge
  • Antenatal Yellow Cards (Product Code: NH612060), free of charge
  • Antenatal Referral forms (Product Code: S0741), $24. 26 per pad

Stream Solutions do have a minimum order requirement and will charge a postage and handling fee.


RHW publicly 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 publicly 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 attend the birth, one of whom is 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 2 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


Antenatal blood screening

Antenatal blood screening needs to be done for current pregnancies.  There have been several incidents recently whereby antenatal blood screening had not been ordered by the GP either because:

  1. The woman has gone through IVF and antenatal bloods were done pre-pregnancy; or
  2. The woman has had antenatal blood screening in a previous pregnancy which resulted in a miscarriage but then fell pregnant within 3 months of miscarriage.

Please ensure that all antenatal bloods ordered are for the current pregnancy.


Iron infusion protocol

There have been a few incidents whereby women have been given iron infusions in the GP practice or at private Iron Infusion Clinics when both their Hb and Ferritin level have been within normal range for over 20 weeks gestation.

RHW’s first line of management is oral supplements.  Iron infusions should only be recommended to woman with iron deficiency anaemia unresponsive or intolerant to oral iron supplementation.

GPs on the RHW GPSC Programme need to adhere to the RHW Local Operating Procedures (LOPs).

Please refer to both the Anaemia & Iron Infusion LOPs below:

https://www.seslhd.health.nsw.gov.au/sites/default/files/documents/AnaemiaandHaemoglobinopathiesPregnancy.pdf

https://www.seslhd.health.nsw.gov.au/sites/default/files/documents/ferriccarbo.pdf


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.


Complex pre-conception clinic

RHW have a pre-conception clinic held monthly on Tuesday afternoons in Fertility. This clinic is attended by Dr Amanda Beech, Dr Debra Kennedy and Dr Antonia Shand and Justine Darling (Diabetic Educator).

Referrals will be discussed with the clinic specialists and women, who will organise their appointment.

Referrals can be faxed or emailed to the Mothersafe secretary.

GP referral required. Fax referrals to:(02) 9382 6070 or email to SESLHD-rhw-complexpreconceptionclinic@health.nsw.gov.au (Attention Complex Pregnancy Planning Clinic)

Medicare billing available. See flyer for more information.


Invitation to participate in the Timing of Birth study: Translating evidence into practice in relation to induction of labour and planned caesarean section

This study will capture the experiences and attitudes of GPs in relation to planned caesarean sections (CS) and inductions of labour (IOL) through surveys methods, focus groups and interviews. The aim is to uncover and make sense of the perspectives, attitudes and experiences of GPs in relation to planned birth.

We invite all GPs to participate in this study by completing a survey here: Clinician Survey - for midwives, obstetricians and general practitioners

This study is part of a larger study that is making sense of clinical variation in relation to planned birth at maternity hospitals affiliated with South Eastern Sydney and South Western Sydney Local Health Districts – the Royal Hospital for Women, St George, Sutherland, Fairfield, Liverpool, Campbelltown, Bankstown-Lidcombe, and Bowral.

The Timing of Birth study is conducted by the Maternal, Newborn and Women’s Clinical Academic Group of The Sydney Partnership for Health, Education, Research and Enterprise (SPHERE). This partnership includes SESLHD, SWSLHD, as well as the University of Technology Sydney, University of NSW and Western Sydney University. Ethics approval has been received from SESLHD and SWSLHD, project number 18/169 (HREC/18/POWH/356).


South Eastern Community Connect Services

South Eastern Community Connect offers a range of family services including:

  • Playgroups
  • Toy library
  • Out of school hours care
  • Family support program
  • Parenting programs and information sessions e.g. CPR, programs for dads, Triple P and English classes

Grandparents are also welcome to attend.

For more information visit www.secc.sydney/our-services/family-services/