ANSC October Update: Royal Hospital for Women

Contact details to become affiliated with RHW ANSC

All enquiries for affiliation for RHW GPSC are now to be directed to Jane Miller of Central and Eastern Sydney PHN.  Jane’s details are:

Jane Miller
Maternal and Child Health Program Officer (Monday and Wednesday)
Central and Eastern Sydney PHN
PH: 1300 986 991   Ext:  8643
j.miller@cesphn.com.au

Contact details for RHW

For clinical or general ANSC advice at RHW contact:

ANSC Liaison Midwife Chantelle du Boisee:
Monday 8am-5.30pm, Tuesday 8am-12.30pm and Thursday 8am-12.30pm
Phone - 9382 6016
Mobile - 0417 995 153 (Monday –Friday 8.00-4.30)
Email - Chantelle.duBoisee@health.nsw.gov.au

If you need to speak directly to the Obstetric Doctors please call 9382 6111 and ask switch to page the on-call Obstetric Registrar. For more urgent 24hour advice contact Delivery Suite on 0439 869 035 (from 20 weeks pregnancy).

GP reminders for 20 week visit

pdf Please view this document (159 KB) for a reminder of essential information for the 20 week’s visit.

Antenatal schedule of visits

In alignment with the Clinical Practice Guidelines: Pregnancy Care, 2018 edition - there have been changes to the number of visits and the order in which women share their antenatal care between RHW and their GP.  These 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

Reminder to auscultate the fetal heart rate at all obstetric visits after 14 weeks gestation. 

New antenatal GP shared care brochures and updated GP shared antenatal care protocol summary

The mail out is now complete for the new brochures and summaries. If you have not received these documents, contact the ANSC GP Liaison Midwife on 9382 6019. Please click here for the Protocol Summary.  

Reminder: screening for gestational diabetes

Further to the previous newsletters, there still appears to be some confusion about screening AND diagnosis for Gestational Diabetes.   Women with the following high-risk factors need to be screened between 12 – 14 weeks pregnant:

  • Ethnicity: Aboriginal/Torres Strait Islander, Asian, South Asian, Pacific Islander, Maori, Middle Eastern, Non-white African
  • Insulin Resistance (e.g. associated with PCOS)
  • Maternal Age ≥ 40 years
  • Medications g. corticosteroids, antipsychotics
  • BMI ≥ 30 at preconception or initial booking
  • Previous adverse pregnancy outcome suggestive of undiagnosed GDM e.g. shoulder dystocia, unexplained stillbirth
  • Previous baby with birth weight > 4.5kg
  • Previous GDM
  • Strong Family History Diabetes (1st degree relative with diabetes, sister with GDM)

If the early screening test is NEGATIVE, the woman will still need to repeat the 75gm GTT again between 26 – 28 weeks.

If the early screening test is POSITIVE, please contact Diabetes Educator as below.  The woman DOES NOT need to repeat at 26-28 weeks.

Refer within 1 week of diagnosis to Diabetes Educator - email preferred contact:

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

OR Fax to: 9382 6118; Phone: 9382 6010

Please include:

Copy of 75g OGTT results, weeks of gestation, EDC, relevant medical history, reason for referral,

patient current phone number and indicate if interpreter required

Diabetes Educator will contact the woman within a few days of receipt of referral and will arrange appointments with Diabetic Educator, Dietician and Endocrinologist.

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

Please click here for the RHW Guideline for Screening, Diagnosis and Referral of Gestational Diabetes Mellitus (GDM).

Genetic counselling and fetus phone

There have been several women who have NOT been referred appropriately to the Genetic Counsellor, after high risk Combined First Trimester Screening. Please ensure that you are familiar with the RHW Genetic Counselling policy as listed below. There is a flow chart at the end of this policy which is helpful with navigating the correct referral pathway.

Any woman who receives an increased risk aneuploidy screening result (cFTS or NIPT) or has a structural anomaly detected on ultrasound can be referred to the Maternal Fetal Medicine Department at the Royal Hospital for Women. They will be offered genetic counselling, a repeat ultrasound, a consultation with a maternal fetal medicine specialist and prenatal diagnostic testing (such as amniocentesis or chorionic villus sampling), if appropriate.

All these consultations will be covered by Medicare. General practitioners, specialists and midwives wanting to make a referral or discuss whether a referral is indicated can call the ‘fetus phone’ on 0437 537 448 (Monday to Friday 0900-1600 hrs). Patients should be advised to call 9382 6098. 

  pdf Please view this flyer (46 KB) for more information about the ‘fetus phone’.

ANSC pathology pilot

Please be advised that the Antenatal Shared Care Pathology Pilot with Douglas Hanly Moir and the Royal Hospital for Women has now ceased. You will no longer be required to include the pathology code (RHWR/SCP on pathology order forms)

The pilot has been superseded by plans for private pathology providers to upload pathology to the My Health Record. Public hospitals across Australia have been doing this for some years but the vast bulk of testing is carried out in the private sector.

Recent communication with one of the Sonic Health Care Subsidiaries - Douglass Hanly Moir suggests that this will commence toward the end of the year which will streamline access to private pathology in the public sector.

Maternal discharge summary

The Royal Hospital for Women will be providing two copies of the eMaternity Maternal Discharge Summary to woman on their discharge home. A copy will be placed in the blue book and another copy given to the woman for her ANSC GP.

It is important to understand that the eMaternity Discharge Summary is a summary of the women’s antenatal, birth and postnatal care. It is not a medical discharge.

Women with medical /surgical complications will be provided with a medical discharge by one of our medical obstetric team if required.

Medical and Midwifery staff will also endeavour to inform the ANSC GP of any adverse outcomes i.e. Stillbirth/Neonatal Death/Severe Prematurity.

Antenatal resources

The antenatal resources listed below 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.