ANSC November Update: St George Hospital and Sutherland Hospital

Updated Antenatal Shared Care Protocol Summary now available

GPs can now access the latest version of the St George and Sutherland GP Shared Antenatal Care Protocol Summary online on the Central and Eastern Sydney PHN website.

Update of the 'Vitamin D in Pregnancy' protocol

Although routine vitamin D screening for all women is not part of the national antenatal guidelines, St George and Sutherland hospitals have decided to routinely screen due to the incidence and our demographics.

Antenatal

Perform vitamin D level with the booking blood tests
  • Women with a vitamin D level ≤ 15 nmol/L at booking should have a referral to an endocrinologist.
  • Women with a vitamin D level ≤ 50 nmol/L at booking should be advised to take an oral dose of 2000IU of cholecalciferol (e.g. 2 x Ostelin 1000™) daily for the remainder of pregnancy and given an information brochure. Women on Halal diet can take Ostevit tablets instead.
  • If vitamin D level ≤ 50 nmol/L at booking, women should have repeat vitamin D levels checked at 28 weeks. Do not recheck if Vitamin D was normal at booking.
  • If vitamin D level ≤ 25 nmol/L at 28 weeks, women should be referred to an endocrinologist (SGH).
  • Do not recheck vitamin D at any other times.

Postnatal

  • Women who had vitamin D level ≤ 50 nmol/L at 28 weeks should have their babies reviewed by the paediatric medical team and treat their babies with vitamin D - 1000IU per day for three months following discharge from hospital.
  • A letter is given to the mother by the Paediatric Medical Officer (MO) for the GP with instructions to arrange a repeat neonatal vitamin D test level after three months of treatment and further management as required (see letter to GP).
  • Mother to continue to take oral vitamin D at pre-birth dosage until levels rechecked by GP at six weeks postpartum.

Author: Julie Curtis, GPSC Liaison Midwife, St. George Hospital

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Early Pregnancy Assessment Service (EPAS)

St George Hospital has an EPAS service Mon-Fri at 8am sharp. The location is the 1West Gynaecology ward. This is a drop-in service and-referrals are not required. Please ask the patient to bring blood or ultrasound results if available.

At Sutherland Hospital, all women are assessed by the O&G registrar in the Emergency Department.

Maternity Ward Tours

St George

Saturdays at 2.30pm, appointment required

To book, phone 9113 2162.

Meet at Level 1 lifts, Gray St entrance.

Sutherland

Saturdays at 2.30pm, no appointment required.

Meet at Level 3 outside Maternity unit door.

GP reminders for referrals

  • Women must live in the South Eastern Sydney Local Health District catchment. Click pdf here (182 KB) for a map.
  • Complete and sign the back of the referral form and tick the hospital and ANSC. This is all that is required for booking referral.
  • Encourage the woman to phone for her first antenatal booking as soon as she has confirmed her pregnancy. Ideally this appointment should be scheduled between 12-14 weeks of pregnancy.
  • Please discuss/arrange NT and NIPT screening.
  • Ensure the yellow card is completed at all ANSC visits and results are recorded.
  • If a woman presents with an abnormal finding on palpation, ultrasound or blood results, please contact the medical staff in Delivery Suite immediately to establish follow-up care.
  • Women requiring Anti D to be given at 28 weeks need to have a copy of their current red cell antibody screen prior to administration.

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New 'yellow card' patient record

A new version of the yellow card will be available for all ANSC GPs to use with their patients. The new version offers a more comprehensive patient record including the following features:

  • Opportunity to confirm whether the patient identifies as Aboriginal or Torres Strait Islander
  • More information on lifestyle considerations
  • BMI and fields to better monitor weight gain
  • Edinburgh Perinatal Depression Scale (EPDS)
  • Prenatal testing
  • Infectious considerations

Fields relating to the educational background of the patient have been removed and there are a few subtle changes to the format of the yellow card.

Free drop-in service for women with GDM

The Sutherland Antenatal Clinic offers a free drop-in service where women with GDM can discuss relevant topics with midwifery staff.

Topics discussed will include the importance of expressing colostrum from 36 weeks onwards and how to store colostrum. They will also be provided with practical resources such as syringes, labels etc. to assist them in this process.

Eligibility: All women with GDM residing in the local area are encouraged to attend. There is no specific gestation. However, clinic staff would prefer to see women earlier in their pregnancy.
When: First Wednesday of each month
Time: 11:00 am – 12:00 pm. Bookings are not required.
Where: Antenatal Clinic at The Sutherland Hospital, Ground Floor, near Main Entrance
Contact: 9540 7240

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