GP Obstetric Shared Care Newsletter | It’s All About Genetic Screening | November 2023
Latest Updates Just for You!
We’re thrilled to usher in a new edition of our GP Obstetric Shared Care newsletter – your exclusive gateway to all things pregnancy and shared care. Get ready to embark on a journey of insights, updates, and shared experiences that make our shared care family truly extraordinary. So, grab a cuppa, settle in, and let’s dive in!
First-up: Cervical length assessment has transformed our approach to managing preterm birth in singletons where we target those with a short cervix with interventions such as progesterone and cervical cerclage. But the evidence that this works for twin pregnancies is uncertain. Measurement of the length of the cervix at all mid-pregnancy scans is now mandated. Furthermore, no pregnancy should be ended until 39 weeks gestation unless there is obstetric or medical justification. At both our recent Clinical Refresher and Accreditation Seminar, we had the privilege of hosting Dr. Kate Andrewartha, the South Australian Medical Lead for the Preterm Birth Alliance. Kate provided invaluable insights and expertise on this crucial topic, enhancing our understanding and contributing significantly to the depth of knowledge shared during these events.
The SA syphilis epidemic has diversified. Following increases in cases among men who have sex with men (2010 onwards) and Aboriginal and Torres Strait Islander people (2015 onwards), there has also been a significant increase in cases among non-Indigenous heterosexual people (2020 onwards). There is particular concern regarding the increase in cases among females (on track to double during 2023 relative to 2022), due to the risk of harm linked to vertical transmission of syphilis from mother to baby (congenital syphilis).
Syphilis infection during pregnancy is associated with high rates of infant mortality, premature delivery, and congenital abnormalities which can lead to severe, permanent disability. These outcomes are entirely preventable through the prevention or timely diagnosis and treatment of infections. Because of this, congenital syphilis cases are considered a sentinel public health event, a failure of public health interventions and an indicator of gaps in the broader health system requiring urgent attention.
In addition to three cases of congenital syphilis reported in SA since 2017, there have been several ‘near misses’ in recent years, with cases of infectious syphilis detected in pregnancy requiring extensive support to access healthcare and social support and prevent vertical transmission. Furthermore, vertical transmission of syphilis can occur many years after acquisition of infection. For these reasons, even though there have been no notifications of congenital syphilis in SA since the last case in 2020, the risk of a baby acquiring congenital syphilis continues to increase in SA, and remains a significant public health concern.
Dr Alison Ward provided this information at last Saturday’s Accreditation Seminar. The link to the Perinatal Practice Guideline – Syphilis in Pregnancy can be found here.
We will be uploading the presentations from the Clinical Refresher and the Accreditation Seminar to the website in the coming week.
While we have your attention, we are looking forward to seeing you for our final CPD Activity for 2023 on the 29th November at Sunnybrae Estate Function Centre. Don’t miss out as we explore the implications of the new carrier screening rebate.
Vale Dr Amy Moten
Dr Amy Moten, our much-loved colleague, friend and leader in sexual and reproductive health, tragically passed away on Saturday 21 October. We are still coming to terms with this loss while we reflect on the incredible impact of Amy on the lives and wellbeing of so many around her – personally and professionally.
As usual, our newsletters aim to keep you informed about the most recent developments, noteworthy updates, special announcements, and engaging discussions pertaining to all things obstetric!
From my team and myself, keep happy and healthy!
With warmest wishes,
SA Preterm Birth Prevention Project
7 Strategies to safely reduce Preterm and Early Term Birth
The rate of preterm birth (20 – 36+6 weeks gestation) in Australia has remained steady at around 8.3% over the past decade.
Preterm birth (PTB) is one of the leading causes of infant morbidity and mortality. The rate of early term birth (37 – 38+6 weeks gestation) has increased by 6% in Australia over the last decade. Early term birth is associated with increased risk of neurodevelopment delay. Both PTB and early term birth is associated with increased length of hospital stay, and ongoing healthcare and education costs.
The current state of preterm and early term birth in Australia led to the launch of a PTB prevention program in WA, known as the Whole Nine Months. Through implementation of PTB prevention project strategies, preterm and early term birth rates were reduced in participating sites. In 2021, the Australian Preterm Birth Prevention Alliance (APBPA) submitted a project proposal to the Australian Government Department of Health seeking funding to support the implementation of the WA PTB prevention program nationally. Approximately $13 million was allocated nationally to support the implementation of the program over a 3-year period, now known as Every Week Counts. South Australian Health and Medical Research Institute (SAHMRI) has coordinated SA’s involvement in implementation of the program, including contractual arrangements with the Women and Infant Research Foundation (WIRF).
Congenital CMV tackling preventable childhood disability through primary, secondary and tertiary prevention strategies.
✨Dr Natalia Rode, Shared Care GP: ‘CMV education for Midwives and GPs: can eLearning improve knowledge and change practice?’
✨A/Prof Lisa Hui, MFM Specialist: ‘Is antenatal screening and maternal treatment with valaciclovir the solution to congenital CMV?’
✨A/Prof Valerie Sung, Paediatrician: ‘Reducing the impacts of congenital CMV’
The password to access the recordings is Twilight
Dr Jenni Goold
Nominated For a Help Award
More than 120 nominations were received across the awards’ eight categories for 2023, which encompass everything from healthcare efforts to community champions. Two new award categories have been introduced for 2023: the Community Sport Award and the Emergency Services Award, both sponsored by NRMA Insurance.
They have been whittled down to five finalists per category with several – including Paralympian Gabe Lieschke, anti-violence advocate Neil Davis and Medical Director Dr Jenni Goold – in the running for multiple honours.
Our Jenni, a finalist in both the AMP Healthcare Hero and People’s Choice categories, said she was “honoured and humbled” to be included. “It’s recognition for the hard work and dedication of an awesome team,” she said.
Best wishes for a well-deserved victory! Your journey inspires us all!
The Safer Baby Bundle is a national initiative with five evidence-based elements to address key areas where improved practice can reduce the number of stillborn babies.
Saving babies’ lives: Culturally sensitive resources launched to address unacceptably high stillbirth rates
PAL -3 Determining the Optimal Dose of Omega-3 Fatty Acids in Pregnancy for Women with Moderate Status
he omega-3 test, delivered through SAMSAS as a part of the Omega-3 Test-and-Treat Program measures a woman’s omega-3 status.
What we know about omega-3, pregnancy and preterm birth:
• Pregnant women with low total omega-3 status early in pregnancy are at a higher risk of early preterm birth and may benefit from omega-3 supplementation.
• Conversely, women with sufficient total omega-3 status are at a lower risk, and additional omega-3 supplementation might not be advantageous.
What we don’t know about omega-3, pregnancy and preterm birth:
• We lack guidance for women with moderate omega-3 status regarding the appropriate omega-3 dose.
Currently the advice we provide to women in this range is ‘no action required’
You can help recruit for this study.
You do not need to provide any study advice to women. Regardless of whether participants are in the randomised groups or reference groups, they should continue following the usual guidance of the Test and Treat Program. The only difference is that some women in this study will be taking additional supplements.
Send us your Expression of Interest from now!