ANSC January Update: St George Hospital and Sutherland Hospital

Antenatal management of iron deficiency anaemia in pregnancy

The following is an updated Clinical Business Rule for St George and Sutherland Hospitals.

Full blood count (FBC) to be taken as part of the initial antenatal screening investigations.

Consider thalassemia screening as per Thalassemia CBR if MCV <80fl and/or MCH <27pg. If thalassemia previously diagnosed/ or excluded, do not repeat thalassemia screening.

If MCV >80fl on a previous FBC (e.g. a previous pregnancy etc.), then thalassemia is unlikely and generally should not be tested for.

If MCV >98fl, arrange medical review and consider Vitamin B12 and folate testing.

If Hb >110g/L, no further action is required.

If Hb <110g/L, check ferritin. It is reasonable to commence iron supplementation whilst awaiting results (if thalassemia already excluded or unlikely).

If ferritin <30ug/L, commence or continue oral iron supplementation.

If ferritin >30ug/L, there is no role for iron supplementation and another cause of anaemia should be considered.

If Hb 90-110g/L, commence iron supplementation and recheck FBC at 28 weeks. If poor response to oral iron supplementation at 28 weeks, refer for medical review.

If Hb <90g/L at any time, arrange medical review. Repeat FBC and ferritin in four weeks after commencing iron supplementation to gauge response.

If FBC <90g/L and or ferritin < 15ug/L despite oral supplementation, or non-compliant, obtain medical review and consider iron infusion.

Recommended oral iron dosages

If Hb normal and ferritin 15ug/mL – 30ug/mL, 65mg daily oral iron.

If Hb <110g/L and ferritin <30ug/mL, 100-200mg daily oral iron.

Routinely recheck FBC at 28 weeks gestation for all women.

Note: Compliance with iron supplementation and any adverse effects to be documented in the antenatal record.

For more information, please refer to the pdf SESLHD Guide (343 KB) for the screening and management of iron deficient anaemia.

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New clinic support for ANSC women

Sutherland Hospital is commencing a clinic line for ANSC women when they return for hospital appointments. Appointments will now be longer to allow sufficient time to provide birthing and admission information at these visits. The Antenatal Clinic will allocate women to this line for continuity of the program.

GP reminders for referrals

  • Women must live in the South Eastern Sydney Local Health District catchment. pdf Click here (182 KB) for a map.
  • Complete and sign the back of the referral form and tick the hospital box and ANSC box. 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 the ANSC visit 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 at high risk of GDM are required to have 75gGTTscreening in early pregnancy. Please refer to the GDM flowchart for risk factors.

    Women with diet controlled GDM may remain on ANSC. Women who are medicated or on insulin must return to the Antenatal Clinic for the remainder of the pregnancy.
  • If women are not able to access Boostrix during ANSC visits, it can be administered at the next Antenatal Clinic appointment.
  • 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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Early Pregnancy Assessment Service (EPAS)

St George Hospital has an EPAS service Monday-Friday at 8 am sharp. The service is located at the 1 West Gynaecology ward. Referrals are not required as this is a drop-in service. Patients are asked to bring blood or ultrasound results if available.

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

Postnatal vitamin D treatment

Women with a vitamin D level of ≤50 nmol/L at 28 weeks will have their babies reviewed by the paediatric medical team and will be required to 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. Please refer to this letter addressed to the GP for more information.

The mother is to continue to take oral vitamin D at pre-birth dosage until levels are rechecked by the GP at six weeks postpartum.

For more information, please refer to the pdf SESLHD guideline (472 KB) for the screening and management of vitamin D deficiency in pregnancy and the neonate.

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Weight gain in pregnancy

Target weight gains

Pre-pregnancy BMI (kg/m2)Rate of gain 2nd and 3rd Trimester (kg per week)* Recommended total gain range (kg)
Less than 18.5 0.45 12.5 - 18
18.5 - 24.9  0.45 11.5 - 16
25 - 29.9 0.28  7 - 11.5
Greater than or equal to 30.0 0.22 5 - 9

Available support

The St George and Sutherland Weight Intervention Group (SSWInG) offers treatment and support to women with a high BMI.

Women are provided with collaborative care including:

  • Midwives
  • Dietitian support and advice for healthy eating
  • Physiotherapist support and advice for exercise in pregnancy
  • Pre-admission planning with obstetric and anaesthetic review
  • Lactation advice and support
  • Perinatal mental health advice around depression and education about delivery and postnatal care

SSWInG is held on Mondays at the St George Antenatal Clinic. For further information, please contact: St George Hospital Antenatal Clinic on 9113 2162

For more information on the management of obese women in pregnancy, during birth and the postnatal period, please refer to the pdf SESLHD guidelines (289 KB) .

Antenatal examinations

It is recommended that the examinations at antenatal visits include the following:

  • BP
  • Urinalysis (where indicated)
  • Evidence of oedema
  • The foetal presentation after 26 weeks
  • The engagement of the head after 37 weeks
  • Foetal heart rate - Doppler after 16 weeks
  • Estimation of fundal height – Symphysial - fundal height to be measured after 20 weeks

For more information on antenatal examinations, please see the pdf St George and Sutherland ANSC Protocol (513 KB) .

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Maternity ward tours

St George Hospital

Saturdays at 2.30 pm, appointment required

To book phone 9113 2162

Meet at Level 1 lifts, Gray St entrance.

Sutherland Hospital

Saturdays at 2.30 pm, no appointment required

Meet at Level 3, outside the Maternity Unit door.

Antenatal shared care CPD requirements

There is still time remaining for GPs to obtain the required CPD points to maintain affiliation status in the ANSC program. GPs are required to obtain at least 12 Category 2 or Category 1 points per triennium of approved antenatal training.

GPs who have not yet met CPD requirements will have until 28 February 2017 to acquire the required points for the 2014-2016 triennium.

Online learning options

pdf Click here (106 KB) for more information. GPs can complete any of these online activities as part of the ongoing educational requirements for a recognised ANSC GP.

If you are unsure of your current point status, please contact CESPHN Maternal and Child Health Program Officer Keren David on 8752 4967.

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