ANSC October Update: RPA Women and Babies/Canterbury Hospital

Obstetric referrals to RPA Women and Babies – Only Fax referrals for high risk women

Please be reminded that only women requiring an early or urgent review should have the Obstetric Referral Form faxed to the antenatal clinic. Low risk women referred for routine care should bring the completed Obstetric Referral Form with them to their first hospital appointment.

The antenatal clinic has been receiving numerous faxed referrals for routine /low risk care. These are unnecessary and time -consuming for hospital staff, delaying the triage of women requiring early or urgent review.

ONLY FAX Obstetric Referral Form for high risk women requiring an early or urgent review.

If you are uncertain as to whether a woman has identifiable risk factors, please contact O&G Registrar or Clare Jordan GP Liaison Midwife ph 0425 230 662 for advice. A guide for risk selection is  outlined in the National Midwifery Guidelines for Consultation and Referral. These guidelines are used by midwife staff to categorize women at first hospital visit.

Click here to access referral forms including Obstetric Referral Form. Templates for BP and MD available.

Testing process for hyperglycemia in pregnancy - high risk women 

Women who have been identified as high risk for hyperglycemia in pregnancy ( including GDM) should have early testing as per SLHD Diagnostic Testing for Hyperglycemia in pregnancy guidelines.

As per guidelines, for women not already known to have diabetes, 75g oGTT is advised from 16 weeks gestation. Several women have been referred by their GP for their 75goGTT too early in their pregnancy ie between 6-12 weeks. First trimester  (<12 weeks) testing for high risk women includes either HbA1c or fasting BGL.

 

If not already known
to have diabetes:

If not already known
to have diabetes:

If not already known
 to have diabetes:

 


1st Trimester
(<12 weeks gestation)

HbA1c or fasting blood glucose level (BGL)


16 to 20 weeks gestation organise 75g oGTT


26 to 28 weeks gestation organise 75g oGTT

HIGH Risk

20191022 Icons tick and cross 98

20191022 Icons tick and cross 98

20191022 Icons tick and cross 98

LOW Risk

20191022 Icons tick and cross 99

20191022 Icons tick and cross 99

 20191022 Icons tick and cross 98


Reference:  SLHD Diagnostic Testing for Hyperglycemia in pregnancy  (2016)

Please note that 50g glucose challenge test (GCT) should no longer to be requested.

Process for iron infusion referrals – RPA

If you are referring a woman for an iron infusion, please ensure the following:  

  • Complete referral letter including reason for iron infusion, gestation, parity and pathology results
  • GP or woman must contact Day Assessment Unit to arrange appointment ph. 9515 8258 or ph. 9515 6042. Message bank is available. NB Appointments are generally in the morning.
  • Complete a script for intravenous iron preparation and give it to the woman.
  • Woman is required to collect intravenous iron preparation from pharmacy and bring to her appointment.

Click here for further information about iron infusions.
 

Discussing models of antenatal care

Regardless of whether a GP has a special interest in obstetrics, he or she will almost inevitably be the first consultation a woman has regarding her pregnancy. During these initial visits, GPs should be responsible for informing women of all options of care, offering balanced information on the full range of options available to them throughout pregnancy, birth, and the postnatal period.

This information should include not only the different models of maternity care available locally but should also cover choices such as antenatal screening tests, antenatal education and information about birth, postnatal care, and infant care and feeding. 1

Click here for models of care at RPA Women and Babies and Canterbury Hospitals

Click here for pregnancy checklist – consumer resource listing suggested topics women should  discuss with their GP during pregnancy and following birth. 

  1. RANZCOG Maternity Care Australia 2017

 

Prenatal screening – timing all important

Please be mindful of the timing for prenatal screening procedures when referring women.

Timing of prenatal screening procedures

Procedure

Gestation (weeks)

Non- Invasive Prenatal Screening (NIPT)

10 weeks onwards

Combined First Trimester Screening (cFTS)

11 +1 – 13 + 6 weeks

Chorionic Villus Sampling (CVS)

11-13 weeks

Amniocentesis

15-19 weeks

As screening is performed early in pregnancy and often prior to first hospital “booking in” visit, it is the responsibility of the GP to discuss and refer women requesting prenatal screening.

Please ensure you have:  
1) Discussed prenatal screening with your patients and arranged referral for women requesting screening. NB The hospital does not arrange prenatal screening. It is the responsibility of the GP to discuss and arrange prior to first hospital visit.

2) Booked requested prenatal screening appointment according to timing of procedure (above). Women should not be attending their appointment earlier or later than the recommended gestation.

For women requesting cFTS, please ensure blood collection is attended from 11 weeks up until 3 days prior to ultrasound. Both the pathology form and ultrasound form should be completed.

All women delivering at RPA Women and Babies or Canterbury Hospital can be referred to RPA Ultrasound & Fetal Medicine for prenatal screening. The hospital has recently modified processes to accommodate more appointments. Please advise your patient to contact FMU ph. 9515 6042.

 Consumer resources:

GP on-line learning resource

Screening for preterm pre-eclampsia – Patient Information brochure

Did you know RPA now has a consumer information brochure available that outlines what is pre-eclampsia, who is at risk, the screening process for early onset and aspirin treatment for those screened as high risk

Click here for screening for preterm pre-eclampsia- Information for patients

Hospital “booking in” appointment: ~ 12-14 weeks gestation

 

It is very important that women schedule their hospital booking in appointment for ~ 12-14 weeks gestation. It is recommended that women arrange this appointment ASAP after their initial GP consultation.

Please ensure that your patient has arranged this appointment and she brings the required paperwork for this visit e.g. Obstetric Referral Form, antenatal record “yellow” card, pathology results, photo identification and Medicare card.

To arrange hospital “booking in” appointment:
RPA Women and Babies – Click here to access online booking form
Canterbury Hospital – ph. 9787 0250 or 9787 0560

All women need to book their first hospital “booking in “appointment regardless of whether a low or high-risk referral. High risk referrals will be triaged by ANC and contacted directly with appointment time. Low risk referrals will receive a letter via mail outlining their appointment time.