ANSC February Update: St George and Sutherland Hospitals

Simple strategies to reduce the risk of cytomegalovirus infection in pregnancy

Cytomegalovirus (CMV) is a common herpes virus 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.  

ANSC educational requirements – final year of triennium 

ANSC GPs are reminded that 2019 is the final year of the current RACGP triennium and therefore the final year to fulfill ongoing educational requirements. 

GPs undertaking antenatal shared care are expected to maintain recognition as an ANSC GP provider and be familiar with ANSC guidelines and protocols. This requires each ANSC GP to accrue at least 12 Category 2 points in antenatal or postnatal specific education over each RACGP triennium.

At the end of 2019, GPs without the 12 CPD points required will be notified and their name will be removed from participating in the ANSC program. Exceptions are only for newly registered ANSC GPs within this triennium.

CESPHN educational activities are posted on our events calendar and in Sydney Health Weekly. Please contact the Maternal Health CPD Program Officer Lauren Thomas (l.thomas@cesphn.com.au) to clarify your CPD point status and to forward copies of completion certificates or RACGP CPD credit statement (for events conducted outside CESPHN). 

Early Pregnancy Assessment Service (EPAS)

Mon-Fri 7.30 am - 8.30 am (excluding public holidays) 
Located in 1 West Gynaecology ward 
Level 1, main building 
Fax:9113 3183

Women can be seen in EPAS for:

  • Bleeding in early pregnancy less than 20 weeks’ gestation
  • BHCG follow-up blood tests
  • To assess viability or monitor pregnancy of unknown location
  • Ectopic pregnancy, which is treated conservatively as an outpatient if stable and meets criteria (Needs repeat BHCG day 4 & day 7 then weekly following methotrexate until BHCG levels reach zero; Follow up in EPAS day 5 & day 8)
  • Follow up for ectopic and gestational trophoblastic disease
  • Management of mild - moderate hyperemesis
  • Non-viable pregnancy on ultrasound scan (Miscarriage, either threatened, missed or complete treated expectantly, medically or surgically)
  • Advice regarding exposure to infective agents or radiological procedures.

Referrals come from GPs, ED STG or TSH, and self-referrals.

It is preferable for women to bring copies of blood results, such as blood group and BHCG levels, as well as all ultrasounds attended with reports, and any significant medical history. 

Most importantly women must be stable - if there is heavy bleeding, uncontrolled pain or feeling unwell women should present to ED, before presenting to the EPAS service. 

It is advised that GPs give the woman a copy of these results prior to referring the woman to attend, or fax directly to the clinic with a referral note (contact details above). 

Completion of antenatal record card “yellow card”

Please be reminded that completion of the antenatal record card is a requirement of the SESLHD ANSC Protocol and is an important aspect of the communication process between the GP and the hospital. Good communication is essential for successful antenatal care.

Please remind your woman to bring the card to every antenatal visit. 
 
At each visit, this card should be updated with routine findings and examinations and be sufficient to meet the care provider’s duty of care. Entries should be clear, concise and legible.  
 
If using clinical software, please print out each visit and include this with the hand-held record. GPs should stamp their details on the top right-hand corner of the card. It is helpful to note the external pathology provider to access results. 

Hospital Booking In Appointment ~ 12-14 weeks gestation

Women should be attending their hospital booking in appointment at ~ 12-14 weeks gestation. Please ensure that your patients has arranged this appointment and brings the required paperwork for this visit e.g. antenatal record card, pathology results, photo identification and Medicare card. 

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. 

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 

If the link above does not work, try copying the link below into your web browser: 
https://redcap.research.uts.edu.au/surveys/?s=HRD3L3DC87

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).