ANSC July Update: RPA Women and Babies/ Canterbury Hospital

First hospital/ booking in appointment = ~ 12-14 weeks gestation

Please ensure that your patient has booked her "First hospital/ booking in appointment" at either RPA Women and Babies or Canterbury Hospital ASAP. It is important that this visit is scheduled for ~12 - 14 weeks gestation.

All women, regardless of whether referral is for a routine/low risk appointment or a high risk/ urgent consult are required to contact the relevant hospital to book their "first hospital/ booking in appointment". Either a woman herself or her GP may book this appointment at either hospital.

For RPA Women and Babies

This appointment is arranged by completing the online First Antenatal Visit Appointment Form. The form can be submitted online or completed and faxed to 9515 3454. After arranging the first hospital/ booking in appointment, additional information is required:

For a low risk/routine referral:
  • Complete the RPAH obstetrics referral form. The patient is required to bring this form to her first antenatal clinic appointment.
  • Complete antenatal "yellow" record card
  • Hospital staff will contact the woman via mail (within 2 – 3 weeks) with a letter outlining her appointment date and further information required.
  • Advise the woman to take obstetric referral form, completed antenatal card and any additional information requested to the first antenatal clinic appointment.
For a high risk/urgent referral:
  • If urgent contact O&G Registrar via hospital switch on 9515 6111, or contact Clare Jordan, ANSC GP Liaison Midwife on 0425 230 662
  • Complete the RPAH obstetrics referral form and fax to antenatal clinic on 9515 3454. Ensure adequate clinical information is included in the referral so an earlier appointment in the appropriate clinic can be arranged, if required.
    NB Only women who require a referral to a specialist or high risk clinic should have the obstetric referral form faxed.
  • Complete antenatal " yellow" record card
  • Hospital staff will contact the woman via phone with their appropriate specialist or high risk clinic appointment.
  • Advise the women to take any additional information requested and completed antenatal card to the clinic appointment.

For Canterbury Hopsital

This appointment is arranged by contacting the antenatal clinic directly on 9787 0250 or 9787 0560. The patient will be given her appointment date/ time and further information required to be bought to the appointment at time of booking. After arranging first hospital/ booking in appointment, additional information is required:

For a low risk/routine referral:
For a high risk/urgent referral:
  • If urgent, contact O&G Registrar via hospital switch on 9787 0000 or contact Clare Jordan ANSC GP Liaison Midwife on 0425 230 662 or the Midwifery Unit Manager on 97870558
  • Fax GP referral letter to antenatal clinic on 9787 0431 requesting assessment at the Doctors Clinic. After assessment, a woman may be referred to RPAH.
  • Complete antenatal " yellow" record card
  • Hospital staff will contact the woman via phone with their Doctors Clinic appointment

 

NIPT and combined first trimester screening (cFTS) - Update from RPA Women and Babies Fetal Medicine Unit

Non-invasive prenatal screening, based on molecular genomic analysis of cell free fetal DNA has become increasingly available in Sydney and we are now observing that a significant number of women are choosing to go down this route of screening for Down syndrome. The RPA obstetric and maternal fetal medicine groups recognise the potential value of this test – but let’s make sure we don’t throw the baby out with the bath water.


We are seeing an increasing number of women who have chosen to have a NIPT test as an alternative to a first trimester scan. This has included a number of women carrying a fetus with a lethal structural abnormality (such as anencephaly) which was eminently detectable at 12 weeks – but was not identified until the morphology scan at 18-20 weeks.


The value of NIPT lies in its increased performance in detecting trisomy 21. In reality – our current screening program, based on combined first trimester screening, has detected 90% of affected fetuses – so 5,000 NIPT tests will be needed to identify the case of Down syndrome we are missing with our current screening paradigm. NIPT has the potential advantage of defining sex chromosomal abnormalities and microdeletions such as 22q11 – extending the range of aneuploidy that is being assessed within the screening program – but it is important to ensure that women who choose to have these chromosomal abnormalities assessed have appropriate pre-test counselling.


The 11-13+6 week ultrasound scan is often referred to as the NT scan but it has many values above and beyond its role in screening for Down syndrome. The scan confirms gestation and viability (recommended before any NIPT test), identifies abnormal placentation (triploidy is missed by most forms of NIPT) and identifies multiples and their chorionicity (and risk of complications such as Twin to Twin Transfusion syndrome). There is limited data on the value of NIPT in twin pregnancies, that represent 1 in 50 conceptions; they need to be clearly identified before cell free fetal DNA screening is performed. First trimester is also of value in identifying structural abnormalities (it will detect >50% of major structural abnormalities) and in identifying women with pregnancies at high risk of pre-eclamspia. The program of pre-eclampsia screening, coupled with prescription of aspirin (150mg PO nocte) to women deemed high risk has seen an 80% reduction in deliveries for this condition <34 weeks gestation – a very significant impact on the quality of obstetric care.


We are happy and able to facilitate NIPT for your patients who are planning to deliver at RPA. The tests we are using (Natera / Panorama and Roche / Harmony) are robust. We are currently able to offer the Panorama test at a reduced rate of $250 – and will ask women if they will take part in a prospective trial to screening for del22q11 if they use this test. The test is not funded by either the state or federal medical systems and consequently women have to pay for this test – payments are made direct to the laboratories and we make no charge for any genetic counselling or for phlebotomy.


If your patient decides to have NIPT we would ask that you ensure that they also have a scan at 11-13+6 weeks. We continue to expand availability of this service within the hospital, but recognise that this is also available through outside obstetric ultrasound providers. NIPT does not replace the need for this scan. Using NIPT in a ‘contingent model’ where women who have an intermediate risk based on cFTS has a high level of sensitivity but reduces the overall added cost for additional detected cases – and this is the model we are currently promoting. As costs of NIPT decrease we may be in a position to add NIPT to the screening process for all women.

Clinical Professor Jon Hyett
Head High Risk Obstetrics RPA Women and Babies

 

Haemoglobinopathy Carrier Testing

Thalassaemia screening is routine for all women attending RPA Women and Babies/ Canterbury Hospital

The SLHD Antenatal Shared Care protocol currently recommends that all pregnant women have haemoglobinopathy carrier testing as part of the routine first trimester blood tests. Screening involves a full blood count and haemoglobin electrophoresis. Iron studies (which include ferritin) are essential for the molecular genetics laboratory to interpret molecular testing results. If screening indicates that the woman is a carrier of a haemoglobinopathy, or screening is inconclusive, her partner should be screened to determine his haemoglobinopathy carrier status. If the woman’s partner is unavailable for testing she should be referred to Medical Genomics/Clinical Genetics for a consultation.

When both the woman and her partner are carriers of a haemoglobinopathy, or they both have inconclusive results they should be referred for genetic counselling so possible implications for the pregnancy and molecular testing can be discussed. As molecular testing for haemoglobinopathies is time consuming it is important that at-risk couples are identified as early in the pregnancy as possible. If you are uncertain about any results you can contact Medical Genomics/Clinical Genetics on.9515 5080 or fax a copy of the results together with referral form to 9515 5490

For further information view Thalassaemia Screening in pregnancy flowchart - ANSC GP Resource Manual pp.62

 

Pregnancy Checklist – New Patient Resource

The ANSC program has developed a Pregnancy Checklist that outlines topics that should be discussed between a woman and her health professional throughout her pregnancy, ensuring that important issues aren’t overlooked.

The pregnancy checklist can be downloaded from the CESPHN website as a resource for your pregnant women.

 

RPA Hospital Annual Clinical Week Symposia - GPs welcome

RPA Hospital will be holding their Annual Clinical Week Symposia 1 - 4 August 2017, Kerry Packer Education Centre Auditorium RPA Hospital. 

This years theme is Genomics in Reproduction with both international and interstate speakers presenting genomics for prediction of adverse obstetric outcome, genomics testing in reproductive medicine and gynaecology oncology.

For further information, please view the event flyer here