Relieving GP Liaison Midwife
From the 13th January, Audrey Lee (GP Liaison Midwife – RPAH and The Canterbury Hospital) will be taking long-service leave. Her position will be relieved by RPAH Midwife Clare Jordan. Her contact details are: ph 0425 230 662 (same as before) or email: clare.jordan@sswahs.nsw.gov.au

Further information regarding Postnatal Depression including available support services and resources can be found by visiting some of these websites:

• BeyondBlue
• Gidget Foundation
• PANDA : Post and Antenatal Depression Association Inc

ANSC information regarding Perinatal Mental Health Services and resources can be found by accessing the following information:

• SLHD Perinatal Mental Health Referral Flowchart
• SLHD Psychosocial Referral Form (June 2011):to ensure referral is received phone PMH 9515 5873 or GP Liaison Midwife 0425 230 662
• Edinburgh Depression Scale - Assessment of Perinatal Depressive Illness
• Access To Allied Professional Services (ATAPS) overview : Referral to Perinatal Depression Stream
• Local Perinatal Mental Health Referral Contacts
• St John of God Hospital: Mental Health Services: Mother and baby unit

RPAH has changed the criteria for the diagnosis of miscarriage at early pregnancy scans.

Further information is included in memo from Dr Joanne Ludlow ( Lead Consultant : EPAS Clinic RAPH) as well as the new EPAS Flowchart to reflect these recommendations. 

Access the Journal article: Ultrasound Obstet Gynecol 2011 which has determined the need to change the criteria.

The NSW Ministry of Health has just released new guidelines that provide direction regarding the management of pregnant women who report decreased fetal movements in the third trimester.

Access a) Complete guidelines :Maternity-Decreased fetal movements in the third trimester b) Extract from the guidelines “Summary of strategies for management of pregnant women who present with DFM in third trimester of pregnancy” c) RPA Women and Babies patient brochure “Baby’s movements:One way to check on your baby” ( July 2011)

Based on these guidelines, GPs are reminded to send a woman to the hospital’s Labour Ward or Birthing Unit if she is concerned about her baby’s reduced movements for further assessment, even though a fetal heart may be heard with the Doppler.

RPAH would like to conduct a randomised controlled trial examining the maternal outcomes of treatment versus no treatment with Thyroxine of women with subclinical hypothyroidism detected in the first trimester of pregnancy. Further information regarding the study can be accessed from the Information sheet.

Antenatal Shared Care GPs who have attended the introductory information session through the Central Sydney GP Network on “options of prenatal screening/testing” can refer women directly to the Fetal Medicine Unit at RPA Women and Babies for nuchal transclucency screening.

The next Genetic Counselling session ” First Trimester Screening : its not a routine test” is planned for Thursday 17th November 7.00-8.30pm. If you would like to attend, please contact Karen Wheeler.

Situation update
There is increasing influenza activity in parts of NSW and elsewhere in Australia, and there have been reports of admissions of pregnant women to intensive care in NSW. Because of the possibility of another severe influenza season in 2011, it is important to increase uptake of the seasonal influenza vaccine now, particularly among high risk groups like pregnant women. Below is the release from NSW Health:

• Influenza update for Obstetrician and Maternity Services 21 July 2011
• Mothersafe Factsheet Influenza May 2011
• www.mothersafe.org.au
• NSW Public Health

The National Gestational Diabetes Register has been established within the National Diabetes Services Scheme (NDSS) to help women who have had gestational diabetes to manage their health into the future.

The Register is taking registrations from July 1st, 2011. Patients registered will receive regular reminders for follow-up diabetes screening, information on maintaining healthy lifestyle and access subsidised NDSS products for 12 months.

For your patient to qualify, a Registration form needs to be completed and signed by a doctor. The Registration form and further information can be accessed from www.ndss.com.au/GD/ or contact the Infoline 1300 136588

GestationalDiabetesRecipes.com is a recipe, information and community website aimed primarily at women with GDM.The website provides dietitian reviewed GDM recipes which will help women keep to the GDM diet and therefore improve the birth outcomes for both themselves and their babies. The website has been recommended by RPAH Endocrinologist Dr Glynis Ross

The program - ‘Beyond babyblues: Detecting and managing perinatal mental health disorders in primary care’ - is the first of its kind in Australia and will provide health professionals - including midwives, GPs, obstetricians and maternal, child and family health care workers - with extra training and skills to understand, detect, treat and manage mental health conditions.

On completion of the advanced six-hour program, GPs will receive a mental health skills training qualification from the General Practice Mental Health Standards Collaboration (GPMHSC) and other health professionals will receive relevant recognition from their professional bodies.

To find out more about the online training, visit www.thinkgp.com.au/beyondblue

To find out more about depression, anxiety and related conditions during the perinatal period, visit:
beyondblue or www.justspeakup.com.au or call the beyondblue info line on 1300 22 4636.

The RPAH Thyroid Clinic has developed a new GP referral flowchart and clinic process for antenatal women. The flowchart identifies “red light” areas for which referral to the clinic is recommended.

The Fetal Medicine Unit has informed us of new staff appointments and up-coming additions to First Trimester Screening as well as referral protocols for Fetal Echocardiography.

Downloads

• new staff appointments and up-coming additions to First Trimester Screening
• referral protocols for Fetal Echocardiography

The Infants Home Child & Family Services together with the University of NSW are conducting the Changing Life Trajectories Research Project.

The project will offer free parenting education and support to assist isolated mothers in parenting their newborn. The program will include 10 sessions, 4 individual home visits and 6 parent education groups. The program aims to increase maternal responsiveness, increase knowledge and confidence in parenting, decrease social isolation, increase connectedness and use of services.

Further information is outlined in the Information Sheet or contact Nicole Bechard on ph 9799 4844 or nbechard@theinfantshome.org.au.

The beyondblue Clinical Practice Guidelines for women in the perinatal period (during pregnancy and the first year following birth) have been approved by the National Health and Medical Research Council (NHMRC) and are now available.

The Clinical Practice Guidelines draw on the latest high-quality research evidence to provide recommendations and good practice points for health professionals to identify, treat and manage depression, anxiety and related disorders in pregnant women and new mothers.

The Guidelines were prepared by an expert advisory group comprising mental health professionals, people who have experienced perinatal depression and related disorders – and carers.
The Draft Guidelines were released in 2010 for a two-month public consultation period during which submissions were accepted, reviewed and later, incorporated into the final Guidelines which were submitted to the NHMRC for its approval.

The Guidelines are an Australian first and will assist all health professionals working with women – midwives, GPs, obstetricians and maternal, child and family health care workers – to identify, manage and treat women with depression, anxiety, bipolar disorder and puerperal psychosis. 

Research shows women are more at risk of developing mental health disorders during the perinatal period than at any other time in their lives.  Up to 9 per cent of women will experience depression during pregnancy and almost 16 per cent will experience depression in the postnatal period. Early detection and appropriate treatment greatly reduces the risks not only for the mother, but for her baby and other family members.

Health professionals, women and their families will now be informed by quality research about the most effective treatments including which medications are safe to use during pregnancy and breastfeeding.

The development and application of the Perinatal Clinical Practice Guidelines is an integral part in the implementation of the National Perinatal Depression Initiative which has been allocated $85 million in funding by the Federal, State and Territory Governments.

Copies of the Guidelines can be downloaded FREE or ordered at beyondblue – or by calling the beyondblue info line 1300 22 4636. Summary documents for health professionals are in development.

The Canterbury Hospital’s new Maternity referral form is available below and under ANSC : ” Canterbury Hospital Maternity Booking Process”

Canterbury Hospital Maternity Referral Form (Feb 2011)

The Fetal Medicine Department has introduced a new paging system to assist GPs in contacting the Fetal Medicine Department for urgent matters.

Contact RPA Hospital on ph 9515 6111 Pager # 81668

The paging system is to be used to access urgent ultrasound bookings, urgent ultrasound reports, second opinions or if advice is required from a Fetal Medicine Specialist. The service will operate between Monday & Friday from 7.00am-3.30pm. If the pager is not answered please contact the Department on 9515 6042.

 

 

The RPAH Hepatitis C & B referral forms are now available below and under ANSC : Forms

• RPAH Hepatitis C Referral Form (Mar 2011)
• RPAH Hepatitis B referral Form (Mar 2011)

From Monday 7th February 2011, the Early Pregnancy Assessment Service ( EPAS) at RPAH will be offering outpatient medical management of miscarriage.

This outpatient option will be offered to women who are diagnosed as having a missed/incomplete miscarriage and have no contraindications to such management.

• Guidelines for Medical Management of Miscarriage
• Patient Information : Medical Management of Miscarriage

This information is also located under “Pregnancy Assessment” in the ANSC section of the website.

The RPAH Antenatal Thyroid Clinic has re-developed their GP Referral Form for use when referring women to the clinic. The form can be be downloaded from under the title ” Forms” in the ANSC section of our website and faxed through to the clinic. The clinic will contact the woman with her appointment time.

RPA Women and Babies ambulatory care has recently established a new endometriosis outpatient clinic.

Recent work under the guidance of Professor Ian Fraser at the University of Sydney has demonstrated the exciting prospect of being able to diagnose endometriosis utilising endometrial biopsy rather than laparoscopy. They are currently researching a urine test which will hopefully allow an even less-invasive test for diagnosis. They are currently recruiting patients and would welcome any of patients who may be interested in participating.

Further research projects are being conducted by Dr Gabrielle Dezarnaulds in relation to endometriosis and fertility.

The hospital has developed a significant national reputation in relation to the treatment of complex endometriosis requiring multiple specialty surgical skills under the guidance of Clinical Associate Professor Michael Cooper.

Finally they are hoping to introduce new transvaginal ultrasound imaging techniques to identify endometriosis within the recto-vaginal septum and bowel under the guidance of Dr Joanna Ludlow.

Should you have any patients who you feel may benefit from these services an appointment may be made through the RPA Women and Babies ambulatory care.

RPA Women and Babies have decided to change the timing of the vaginal GBS screen to 36 weeks according to college guidelines. This will be a vaginal/anal swab. The transition will be starting from 5th October 2010.

Downloads

• College guidelines for Screening & Treatment for GBS in Pregnancy
• Collection of a genital swab for detection of GBS ( will be used in clinics )

 

Download

The most recently updated breastfeeding guidelines made available from SSWAHS.

• SSWAHS Breastfeeding Guidelines

Advice to GPs on new Antenatal Shared Care (ANSC) advice.

To be able to book to deliver at RPA Women and Babies the patient must live in the suburbs covered by the RPA Antenatal Clinic available on the websites detailed below.

Some pateients requiring complex or specialised care who may live in Suburbs not covered by RPA Antenatal Clinic may be referred to RPA by their doctor. A letter of request is to be sent to the Director of Obstetrics and Gynaecology at RPA Women and Babies.

First antenatal visit

Women sometimes have difficulty accessing the Appointment Reception by telephone 9515 7101 as this is a very busy line.

For a patient to make her first Antenatal Visit appointment at RPA Women and Babies, she is required to please book either on-line or by fax:

On-line: www.rpawomenandbabies.com.au

• select ‘Information for Pregnant Women’; select ‘Public Patient Bookings’;
• fill in the ‘First Antenatal Appointment Form’ on-line and click ‘Submit’

This is a new website address to facilitate better access.
   
  or

fax to 9515 3454 with the same on-line form.

The First Antenatal Visit booking form is also available on the CSGPN website www.csgpn.com.au go the Antenatal Section on the home page and click on continue, screen down the page and after program clinical requirements are the links, with the RPA link, then click on departments and then Women & Babies.

A copy of the form is accessible as well as Medical Director and Best Practice templates. 

RPA Women and Babies follow up

Hospital staff will contact the woman via mail with an appointment date.

Booking process

All antenatal patients also need to book their bed for delivery after 20 weeks gestation (usually soon after the obstetric review visit). The woman will need to take her yellow card and registration form to the RPA Medical Centre Suite 210, Level 2, corner Carillon Avenue and Missenden Road.

The Booking Office is open from 7.30am till 5.00pm Monday to Friday.

Dr Robert Ogle
Executive Director
RPA Women & Babies
22 December 2009

Booking process for RPA Women and Babies Antenatal Clinic word document.

From Monday 17 August 2009, all maternity units in Sydney South West Area Health Service (SSWAHS) will be offering vaccination with dTpa (Boostrix) to all mothers during the postnatal stay in hospital.

The objective of this policy is to reduce the risk and incidence of pertussis in newborns. As you will see from the 2 attached documents, this has the support of NSW Health and NCIRS. A brochure outlining the role of this injection will be given to each mother.

As General Practitioners usually take on the overall responsibility for vaccination records for their patients, it would be helpful if you ensure that your pregnant women are aware of this initiative and the implications of the new program.

Also could you please check with your postnatal patients whether they have been given the vaccination and ensure that there is a record of the vaccination being given as well as answer any questions they may have.

Dr Andrew Child AM
Clinical Director, Women’s Health and Neonatology
12 August 2009

Ph:   9515 8416
Fax:  9565 1595
Executive Unit
RPA Women and Babies

• Pertussis fact sheet
• Pertussis vaccination flyer
• Pregnant women info dtpa

Three Key points for GPs

1. The pertussis epidemic continues in NSW. Babies who are too young to be fully vaccinated are most at risk
2. For a limited time, dTpa vaccine will be provided free for all new parents, grandparents and any other adults who regularly care for infants
3. DTPa (Infanrix-hexa) can be given to babies from 6 weeks of age

Timely immunisation of infants is important because unvaccinated infants are at highest risk of infection and are also at high risk of complications. Because pertussis immunity wanes over time, many older children and adults are susceptible to infection and can be the source of new infections in infants.

For a limited time, FREE dTpa vaccine will be available for all new parents, grandparents and any other adults who will regularly care for infants less than 12 months of age.

GPs should advise all new parents to:
• Vaccinate their baby on time.
• Keep their baby away from anyone with a cough.

For new parents, GPs should:
• Check the immunisation status of new parents and other children and provide catch-up vaccination.
• Offer FREE dTpa vaccine to new parents, grandparents and any other adults who regularly care for infants.
• Consider vaccinating infants at 6 weeks if the opportunity arises. Infanrix-hexa, Prevenar and Rotarix are all licensed for use in infants from 6 weeks of age. The next scheduled vaccines should be given at 4 and 6 months of age.

Who is eligible for the FREE dTpa vaccine?
• Couples who are planning a pregnancy (both parents).
• New parents (mothers should be vaccinated as soon as possible after childbirth).
• Grandparents and other adults who will regularly care for the infant.

Ordering FREE dTpa vaccine for adults
Fax order form to the NSW Vaccine Centre on 1800 041 528. Download:
Pertussis outbreak response order form.
Additional guidelines for ordering free dTpa vaccine

For further information, GPs can call the Public Health Unit at Camperdown on 9515 9420.

Central Sydney GPs will shortly be able to refer eligible patients for free psychological therapy to our selected Access to Allied Psychological Services (ATAPS) providers with expertise in PND
Recent studies show that 1 in 7 women in Australia experience postnatal depression. The aims are to provide better care, support and treatment for expectant mothers, new mothers and their families.

Our current ATAPS and Antenatal Shared Care projects will be combining forces to run this project in our area. Key activities of this project include the following:

• establishing linkages and relationships with local child and maternal health services and primary mental health care services to ensure that women experiencing perinatal depression and their families have the necessary resources available to them;
• as appropriate, promoting the use of other pathways to care for women experiencing perinatal depression and their families;
• ensuring that women experiencing perinatal depression and their families are able to receive treatment under ATAPS; and
• promoting and disseminating materials and resources to GPs and allied health professionals to support professional practice in respect of perinatal depression treatment and support;

Discussions are being held with the key SSWAHS service providers as well as Karitane and Tresillian on how best to ensure this program meets the needs of the most at risk women.

Karen Frost (ATAPS) and Dianne Deschamps (ANSC) are interested in speaking to GPs who care for large numbers of women from Culturally and Linguistically Diverse Backgrounds to see how this initiative would assist the women you care for.

Do not hesitate to contact either Karen Frost on 8752 4910 or Dianne Deschamps on 8752 4923 for further information or advice regarding this program.

This clinic will run on Friday mornings in the Women’s Health Ambulatory Care area on level 5 and will be led by Dr Kirsten Black, a consultant gynaecologist and clinical academic. Access will only be by GP referral or referral from other RPAH specialty units. The clinic is for women with complex medical conditions requiring contraceptive advice and management and for women requiring intrauterine device insertion that is not able to be undertaken in the community setting. Gynaecology appointment forms, presently available on the SSWAHS website and used by GPs for faxing requests for appointments, will be updated to include this new clinic.