ANSC February Update: Royal Hospital for Women

Royal Hospital for Women GP Antenatal Shared Care Survey 

You are invited to complete a survey which will provide important information to enhance your experience as partners in this program. Your perspective is vital to continue efforts to maintain an excellent standard of care for women who access the service.

The survey can be accessed here and will conclude on 28th February.

Thank you for your assistance.

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.

ANSC GPs that do not fulfill these educational requirements will no longer be able to participate in the ANSC Program.

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). 

New contact details for becoming affiliated with RHW for antenatal shared care 

All enquiries related to affiliation with RHW to provide shared care should now be directed to:

Jane Miller

Maternal and Child Health Program Officer (Monday and Wednesday)

Central and Eastern Sydney PHN

Ph: 1300 986 991   Direct: 9304 8643

j.miller@cesphn.com.au 

GP antenatal shared care intake meeting dates for 2019 are Saturday 4 May and Saturday 9 November.  

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)ANTI-D GIVEN TO RH NEGATIVE WOMEN
  • 34 weeks (GP)
  • 36 weeks (RHW)ANTI-D GIVEN TO RH NEGATIVE WOMEN
  • 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) 

New email address for RHW Diabetes Service

Please use this new email address to contact the RHW Diabetes Educator:

SESLHD-RoyalHospitalforWomen-DiabetesServices@health.nsw.gov.au

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

RHW MFM fetal referral phone

For suspected fetal anomalies reported on USS, Maternal Fetal Medicine have a Fetus Phone which is available Monday – Friday between 9:00am – 4:00pm. The phone number is 0437 537 448.

THIS IS FOR MEDICAL AND MIDWIFERY REFERRALS ONLY

THIS PHONE NUMBER IS NOT TO BE GIVEN TO WOMEN

Please click here for the RHW MFM Fetus Phone flyer. 

Removal of RHW postcode cap

Please note there is no postcode cap for women wishing to birth at Royal Hospital for Women. Women are accepted for antenatal care and delivery from all postcodes across Sydney.  The postcode cap was lifted in 2017. The Antenatal Clinic can be contacted on 9382 6048. 

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 & handling fee. 

Antenatal blood screening

When ordering antenatal blood screening please follow the RHW GPSC Protocol.

Mumps, Measles & Thyroid Function Tests (TSTs) are not routine antenatal bloods.

Only order TST if indicated, as per protocol summary

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

  1. The woman has gone through IVF and antenatal bloods were done pre-pregnancy; or
  1. 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. 

RHW antenatal shared care electronic integration of external pathology results

On 30th October 2018, the Royal Hospital for Women launched 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 providing antenatal shared care to direct pathology to Douglass Hanly Moir & 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 

MMR vaccines in pregnancy

There have been a few enquiries of late regarding MMR vaccines in pregnancy.   Below please find information regarding MMR vaccinations in pregnancy.

MMR-containing vaccines are contraindicated in pregnant women.

Vaccinated women should avoid pregnancy for 28 days after vaccination.  This is due to the theoretical risk of transmitting the rubella component of the vaccine to a susceptible fetus.  However, there are no reports of vaccine-induced congenital rubella syndrome.

Active surveillance in the United States, the United Kingdom and Germany indicates that no cases of vaccine-induced congenital rubella syndrome occurred among more than 500 women who were inadvertently given rubella vaccine during pregnancy, and whose pregnancies continued.

In an Iranian study performed after mass vaccination with a measles-rubella vaccine, 117 susceptible women were inadvertently vaccinated while pregnant or became pregnant within three months after vaccination.  There were no abnormalities related to congenital rubella syndrome among the infants born to these women. 

Based on this evidence, the vaccine is not considered to be teratogenic.  Women do not need to consider ending a pregnancy after inadvertent vaccination.

See Vaccination for women who are planning pregnancy, pregnant or breastfeeding for further information. 

Breastfeeding women can receive MMR vaccines.  The rubella vaccine virus may be secreted in human breast milk, and rare cases of transmission of vaccine virus through breast milk have been reported. However, symptoms in the newborn have been absent or mild. Post-partum vaccination of women who are not immune to rubella does not need to be delayed because of breastfeeding.

There is no risk to pregnant women from contact with people who have recently been vaccinated.  The vaccine virus is not transmitted from vaccinated people to susceptible contacts.

See Vaccine contraindicated in pregnancy: live attenuated vaccines for more details.  

If you have any further questions relating to infectious diseases in pregnancy please do not hesitate to contact Jannelle on Jannelle.Carlile@health.nsw.gov.au or PH: 02 9382 6339.  

Alternatively please refer Australian Immunisation Handbook. 

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.

Please click here to see flyer for more information. 

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 2-3 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 

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).