ANSC May Update: St George Hospital and Sutherland Hospitals

ANSC CPD update

When: 6 July 2017
Location: Hazelhurst Gallery, Gymea
Time: 6:30 pm – 9 pm.
Topics include: Hepatitis in Pregnancy, Get Healthy in Pregnancy Program and Genetic Counselling update.

Check the CESPHN education calendar to register.

Update on NIPT and CPD course details

Non-invasive prenatal testing (NIPT), also known as non-invasive prenatal screening (NIPS) is a new genetic test that uses cell-free circulating fetal DNA in the maternal serum to screen for the more common fetal aneuploidies: trisomy 21 (Down Syndrome), trisomy 18 (Edward Syndrome), trisomy 13 (Patau Syndrome) and monosomy X (Turner Syndrome).

Important counselling points

  • The test is very accurate for detection of Down Syndrome (sensitivity 99.5%) and Edward syndrome (99%). It is less accurate for the detection of Patau Syndrome (79–92%)
  • It is unlikely to give a false-positive result (0.2%) but all positive results need to be confirmed by an invasive test (amniocentesis or chorionic villus sampling)
  • The cost is $500–1400
  • There is a test failure rate of up to 4% (this is higher as body mass index increases: the test failure rate is likely to be 50% at a maternal weight of 160 kg).*
  • Ultrasound to exclude structural fetal abnormalities is still very important; nuchal translucency and morphology ultrasounds are recommended
  • NIPT can also test for fetal sex and some sex chromosome abnormalities.

AFP. Noninvasive prenatal testing. Volume 43, No.7, July 2014 Pages 432-434

*Repeat test failure is associated with an increased risk for fetal aneuploidy and tertiary referral or diagnostic testing should considered.

Reasons to consider diagnostic testing over NIPT include

  • Significantly increased risk for fetal aneuploidy on First Trimester Screening (greater than 1:50 risk)
  • Increased nuchal fold thickness on First Trimester Screening (greater than 3mm)
  • Pregnancies at increased risk for atypical (not 13,18 or 21) chromosome abnormalities due to fetal structural abnormalities, previous affected pregnancy or suggestive family history.

For further advice or to discuss referral please call Dominic Ross (Genetic Counsellor, St George Hospital) on 9113 2581 or email dominic.ross@health.nsw.gov.au

Useful links

Gestational Diabetes Mellitus (GDM)

Women with GDM are to be referred to the Diabetes Education Centre as soon as the results are available. For both hospitals, fax a copy of the results with the referral to 9113 2774.

Women are seen for a first appointment with the dietitian and diabetes educator. Diet changes and HBGM is discussed and equipment is provided. Women are able to email their results to the department for review. This eliminates frequent hospital appointments to the hospital and cuts expenses for women who are not using Medicare.

Thyroid screening

Women with abnormal thyroid results can be referred to the outpatient clinic using the form provided on the CESPHN ANSC ‘Bookings, referrals and contacts’ page. The woman will be contacted and an appointment arranged within two weeks.

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 -referrals are not required. Please bring blood or ultrasound results if available.
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, Ph. 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

  • Women must live in SESLHD.
  • 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 we would like to schedule this appointment between 12-16 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 in ANC.
  • Women with diet controlled GDM may remain on ANSC. Women who are medicated or on insulin must return to ANC for remainder of the pregnancy.
  • Access the ANSC protocol and GP resources via CESPHN website

Breastfeeding Education and Support

Lactation consultants at St George and Sutherland Hospitals are available to provide support and information for GPs and their patients. Click here for lactation consultant contact details and other support services.

ANSC CPD Update

When:                   6th July 2017.

Location:            Hazlehurst Gallery in Gymea

Time:                   6:30 – 9pm.

Topics include: Hepatitis in Pregnancy, Get Healthy in Pregnancy Program and Genetic Counselling update.

Check the CESPHN education calendar and register via the CESPHN portal.

Update on NIPT and CPD course details

Non-invasive prenatal testing (NIPT), also known as non-invasive prenatal screening (NIPS) is a new genetic test that uses cell-free circulating fetal DNA in the maternal serum to screen for the more common fetal aneuploidies: trisomy 21 (Down syndrome), trisomy 18

(Edward syndrome), trisomy 13 (Patau syndrome) and monosomy X (Turner syndrome).

Testing is available through DHM and Genea at a cost of $450.

Table 1. Important counselling points

·        The test is very accurate for detection of Down syndrome (sensitivity 99.5%) and Edward syndrome (99%). It is less

accurate for the detection of Patau syndrome (79–92%).

·        It is unlikely to give a false-positive result (0.2%) but all positive results need to be confirmed by an invasive test (amniocentesis or chorionic villus sampling).

·        The cost is $500–1400.

·        There is a test failure rate of up to 4% (this is higher as body mass index increases: the test failure rate is likely to be

50% at a maternal weight of 160 kg).*

·        Ultrasound to exclude structural fetal abnormalities is still very important; nuchal translucency and morphology

ultrasounds are recommended.

·        NIPT can also test for fetal sex and some sex chromosome abnormalities.
AFP. Noninvasive prenatal testing. 
Volume 43, No.7, July 2014 Pages 432-434

*Repeat test failure is associated with an increased risk for fetal aneuploidy and tertiary referral or diagnostic testing should considered.

 

Reasons to consider diagnostic testing over NIPT include

·        Significantly increased risk for fetal aneuploidy on First Trimester Screening (greater than 1:50 risk)

·        Increased nuchal fold thickness on First Trimester Screening (greater than 3mm)

·        Pregnancies at increased risk for atypical (not 13,18 or 21) chromosome abnormalities due to fetal structural abnormalities, previous affected pregnancy or suggestive family history.

For further advice or to discuss referral please call Dominic Ross (Genetic Counsellor St George Hospital) on 9113-2581 or email dominic.ross@health.nsw.gov.au

 

Useful links

·        http://www.racgp.org.au/afp/2014/july/noninvasive-prenatal-testing/

·        https://www.ranzcog.edu.au/RANZCOG_SITE/media/DOCMAN-ARCHIVE/Prenatal%20screening%20and%20diagnosis%20of%20chromosomal%20and%20genetic%20conditions%20%20(C-Obs%2059)%20Amended%20May%202016.pdf

·        http://www.genea.com.au/my-fertility/i-need-help/genetic-testing/first-trimester-screening

·         http://www.dhm.com.au/media/22055687/harmony_patientbrochure_square_dhm_web.pdf

 

Gestational Diabetes Mellitus (GDM)

Women with GDM are to be referred to the Diabetes Education Centre as soon as the results are available.

For both hospitals, fax a copy of the results with the referral to 9113 2774.

Women are seen for a 1st appointment with the Dietician and Diabetes Educator. Diet changes and HBGM is discussed and equipment is provided. Women are able to email their results to the department for review. This eliminates frequent hospital appointments to the hospital and cuts expenses for non-medicare women.

 

Thyroid screening

Women with abnormal thyroid results can be referred to the Outpatient clinic using the form provided on CESPHN ANSC ‘GP resources and referrals’ page. The woman will be contacted and an appointment arranged within 2 weeks.

 

 

 

 

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 -referrals are not required. Please bring blood or ultrasound results if available.

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, Ph. 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

•             Women must live in the SESLHD.

•             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 1st antenatal booking as soon as she has confirmed her pregnancy. Ideally we would like to schedule this appointment between 12-16 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 in ANC.

·         Women with diet controlled GDM may remain on ANSC. Women who are medicated or on insulin must return to ANC for remainder of the pregnancy.

·         Access the ANSC protocol and GP resources via CESPHN website

 

Breastfeeding Education and Support

Lactation consultants at St George and Sutherland Hospitals are available to provide support and information for GPs and their patients. Lactation consultant contact details and other support services