RPA Women and Baies/Canterbury Hospital - ANSC newsletter update

9 April 2019 

ANSC GP Liaison Midwife Leave

Clare Jordan, ANSC GP Liaison Midwife is currently on leave from 25/3/19- 6/5/19.
Part-time coverage is being provided by Midwife Jackie Cowan (Mon- Fri: 9.00am-3.00pm)
Ph: 0425 230 662. For urgent clinical concerns, please contact relevant hospital O&G Registrar.

Case study- Reduced fetal movements

A woman with obvious mental health issues presented to a GP with a history of reduced fetal movements. The GP consult was documented but there was no documentation of procedures if concern needed to be escalated or no mention of a plan to organize an U/S. The woman presented to delivery ward thinking she was coming into labour and disclosed a 3 day history of reduced fetal movement. The baby was born by C/S shortly after.

Reminder:

  • All pregnant women should be advised to contact their maternity care provider if they have any concern about decreased or absent fetal movements and be advised not to wait until the next day to report decreased fetal movements (DFM). Maternal concern of decreased fetal movements (DFM) overrides any definition based on numbers of fetal movements.1  

All pregnant women should be routinely provided with verbal and written information regarding normal fetal movements during the antenatal period.

1. NSW Health – Decreased Fetal movements in third trimester

The woman or GP should contact Delivery Suite at either RPA Women and Babies (ph 9515 5420 or 9515 8444 direct line for GPs) or Canterbury Hospital (ph. 9787 0555) for advice and/or arrange assessment. The unit can be contacted 24/7.
Further information:  SydneyHealthpathways -Fetal movements

  • Women with pre-existing mental illness or risk of developing a perinatal mental health concern can be referred for review to the Perinatal Mental Health Team at relevant hospital. RPA (ph 9515 5873) or Canterbury (ph 9787 0488)
    Further information : Sydney Healthpathways – Perinatal Mental Health review
  • All patient consultations need to be documented on antenatal “yellow” record card. This is the only form of written communication with the hospital.
  • If you have any clinical concerns in caring for or a women requires urgent review, please contact relevant hospital O&G Registrar. 

RPA Ultrasound Referral Forms – adequate documentation is required

Please ensure when you refer a woman to RPA Ultrasound Department that the referral form is completed with all the woman’s details. As the Department is very busy and triages all referrals, it is important that the referral form includes details such as EDD, gestational age, relevant clinical information, GP details, what service is requested (tick box) to ensure your patient receives the appropriate service in a timely manner. Incomplete referral forms may not be accepted. 

Early or high risk pregnancy review 

There may be specific indications for discussion, consultation and/or transfer of care when first discussing a woman’s needs during initial visits. The National Midwifery Guidelines for Consultation and Referral may assist shared care GPs in stratifying risk, providing the best possible care and making decisions about future care arrangements for women at different stages of their pregnancy. These are the guidelines followed by the hospital midwives when triaging a woman at her first hospital visit and her chosen model of care.

In any circumstances that need clarification, the GP should seek advice from the GP ASC Liaison Midwife or O&G Registrar at relevant hospital.

If you are referring a women for an early or high risk pregnancy review, please remember you are required to complete the relevant hospital Obstetric Referral Form - RPA Women and Babies or Canterbury Hospital ensuring that adequate clinical information is documented, including:

  • Reason for referral
  • Previous obstetric history
  • Gynaecological disorders
  • Medical conditions including treatment, medications, specialists (name and location) and attach any recent specialist letters
  • Any other issues

These Obstetric Referral Forms need to be faxed to the relevant hospital antenatal clinic. All referrals will be triaged by the antenatal clinic. The hospital will determine the timing and allocation to the specialist clinic/s. This will ensure that all women are booked to commence their antenatal care.

Visit CESPHN website for a step-by-step process on how to "Refer a woman" to each hospital facility. 

Tips for GP appointments and billing for ANSC patients 

Determining the schedule of antenatal visits is based on the individual woman’s needs and clinician’s assessment. Some tips for ANSC appointments and billing for a woman’s ante/postnatal care are listed below:

 First visit: the “first visit” may be spread over two consultations as patients may only book a standard consultation for their initial pregnancy consultation. The initial consult is an ideal chance to establish patient’s feelings about pregnancy, check estimated dating, review relevant past medical/obstetric history, arrange early pregnancy investigations and provide some education about models of pregnancy care available.

The follow up consultation provides the opportunity to review progress, complete examination, check investigation results and arrange relevant referrals. Depending on potential issues identified at the initial consultation, the GP may arrange a longer appointment for this follow up appointment.

20-22 weeks & 24 weeks: routine antenatal visits, standard GP consultation.

28 weeks: a longer consultation is helpful for this visit to include a routine antenatal check with additional time for review of pregnancy care, mental health screening and discuss pertussis vaccination. If the GP is providing shared antenatal care for the patient, MBS item number 16591 may be appropriate for this longer visit provided the criteria are met (see below).

32 weeks, 34 weeks & 36 weeks: routine antenatal visits, standard GP consultation

38 weeks, 39 weeks & 40 weeks: routine antenatal visits, standard GP consultation

10-14 days postnatal: baby health check, may require a longer consultation

6 weeks postnatal: longer consultation for maternal health check including physical check and psychological review as per protocol, in addition to a consultation for baby health check and immunisation

For details of recommended assessment at each visit please view the ANSC Protocols (ANC or Birth Centre) or the relevant sections of Sydney HealthPathways. Time allocated for each routine GP antenatal visit should be such that a comprehensive assessment can be undertaken to monitor maternal and fetal wellbeing and protocol tasks completed.

Please ensure that your practice staff are aware of these time requirements when booking a woman’s ANSC appointment.

MBS Item number 16500 is for each routine antenatal attendance.

MBS Item number 16591 is for management of pregnancy >28/40 by shared care GP who is not planning to perform the delivery. A condition of this item number is that the GP must be offer a mental health assessment of the patient including screening for drug and alcohol use and domestic violence. If the patient chooses not to undertake the assessment, this does not preclude a rebate being payable for these items. This item number is payable once only for a pregnancy.

MBS Item number 16407 is for a postnatal attendance lasting at least 20 mins between 4-8 weeks after birth. Mental health assessment needs to be offered to every patient including screening for drug and alcohol use and domestic violence. This item number can only be claimed once per pregnancy.

MBS Item number 4001 is for non-directive pregnancy support counselling services provided to women who are concerned about a current pregnancy, or a pregnancy that occurred in the preceding 12 months. GPs providing this service through Medicare must have completed mandatory training in non-directive pregnancy support counselling. Rebates for up to three non-directive pregnancy support counselling services per patient, per pregnancy, may be claimed. Services can address all pregnancy-related issues for which non-directive counselling is appropriate.

Group B Streptococcus (GBS) screening

Reminder that the GBS screen is not attended at the hospital. It should be collected at the 35-37-week ANSC GP visit ( as per protocol) so results are available for discussion at the scheduled 37 week hospital visit. The screen can be attended as a patient self- collection.

Blood results to hospital 

If you are cc’ing patient blood results to hospital, please ensure all results are sent to the relevant hospital antenatal clinic (ANC). Results are collated at the ANC and sent through to relevant unit. Please do not send results directly to RPA Birth Centre. 


RPA Women and Babies Fax 9515 7452, Canterbury Fax 9787 0431

Documentation of previous birth history

For women that have had a previous C/S at another hospital, please ensure that a copy of the operation report is included with the Obstetric Referral Form and bought with the woman  to her first hospital appointment

GP ANSC Resources – Available as e- copies ONLY

Please note in an endeavour to be environmentally friendly and to ensure GPs are viewing current ANSC information, all ANSC resources e.g. ANSC protocol summary, GP Resource Manual will only be available as e- copies. Visit CESPHN website and/or Sydney Healthpathways to view these resources. If you are unable to access these e- resources, please contact Maternal Health Project Officer.

SLHD Child health Information link 

Looking for child health services within SLHD? The Child Health Information Link (CHIL) connects parents, carers and health professionals with child and family services, information and resources on child health and development in Sydney Local Health District. Find out more on how to access the right service for your patients including nutritional services, hearing and vision.


Child Health Information Link (CHIL)
Ph. 9562 5400 
Monday- Friday 8.30am - 4.00pm 
If interpreter service required ph. 9515 0030 


Visit SLHD Child & Family Health to find out information about its services and location including breastfeeding support, developmental and well-being checks.

Well Child Health Program - Online learning program for GPs and practice nurses 

Did you know that the SLHD Community Paediatric Services provides an online learning program aimed at primary health care professionals caring for families with children aged between 0-5 years.The program has been written by an expert advisory team which provides training about the comprehensive use of the Child Personal Health record (Blue Book) for health and developmental surveillance for all children (child health checks) under five years.

The program is divided into five modules covering examination of the infant and young child, screening for hearing, vision and growth, anticipatory guidance for parents, developmental surveillance and putting it all together.The modules are brief and allow you to sign in and out as needed.


Visit The Well Child Health Program for further information about the program and additional resources.

Expectant Parents Breakfast

A FREE community event for expectant parents for couples living in Canada Bay or Inner West Area. The event will provide information about local parenting and child services and opportunity to connect with local parents . pdf Click here (373 KB) for flyer. 

 

 

 

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