Obstetric Shared Care: Late Winter | Early Spring 2019Newsletter 

Obstetric Shared Care:  CPD Updates for GPs

2019 CPD Events

Hahndorf

This year our peri-urban CPD event was held at the Adelaide Hills Convention Centre in Hahndorf on the 28th August 2019 and was titled ‘Let’s Manage 1st Trimester Screening’.

Associate Professor Rosalie Grivell’s presentation was detailed, clear and interactive.

Take home messages include the following:

• Offer screening for fetal anomalies to all pregnant women so that they have options. Prevalence of anomalies 2-3% and in SA 2.8%.
• Currently in excess of 80% women take the option to screen. Screening does not give yes/no answers. Remember low risk does not mean no risk! Likewise, with an increased risk result, 96% of these women will have a normal karyotype.
• To ensure best result, complete ALL the details requested on SAMSAS form.
• Timing is important – bloods 9 to 14 weeks (optimal 10 to 12) and scan 11- 14 weeks (optimal 11-13). Low PAPPA<O.37 MoM and is associated with poorer pregnancy outcomes. NT>= 3 mm is abnormal. The scan is also very good at picking up structural issues.  
• NIPT (Non-Invasive Prenatal Testing) is not a replacement for the MSS – still important to do 11-12 week scan and bloods from 9 weeks.  
• NIPT still considered a screening test. Cost is approximately $460.00, and options are Harmony (via Clinpath, Adelaide Women’s Imaging, Specialist Imaging Partners) or NEST (via Repromed).

We were also very fortunate to also have Edwina Jachimowicz from Shine SA present to our OSC GPs about the Implications and Management of Syphilis in pregnancy.

The most recent Perinatal Practice Guideline – Syphilis in Pregnancy can be accessed here.

5 minute video: ‘SA Syphilis Outbreak – Advice for Clinicians’ 

An important take home message is that our Obstetric Shared Care program is based on the PPGs (South Australian Perinatal Practice Guidelines). They can be downloaded from our GPEx SA website or from the internet.

GPEx – A Day in General Practice

The GP Obstetric Shared Care program has collaborated with GPEx again this year and is participating in a series of workshops designed for Registrars. The aim is to offer the Registrars an insight into becoming an Accredited Obstetric Shared Care GP provider and how to manage that first ante-natal consultation.

A total of four workshops will be held in Adelaide and two have been completed to date.

We have been delighted with the positive feedback and more so with the many enquires and new applications.

Clinical Refresher – Updates for GPs

The GP Obstetric Shared Care Clinical Refresher Seminar was held at the Adelaide Pavilion on Saturday 4^th May 2019 and was repeated as a split evening on the 30^th July and the 6^th August 2019.

We were absolutely delighted with the number of GPs that attended on the day and also both nights and we were treated to a great range of topics and excellent speakers. It was lovely to receive so many emails expressing thanks for such an informative, educational and enjoyable day.

GP Advisor Dr Jenni Goold has prepared this summary of the take home messages from the day.

Current Management of the Bariatric Patient – Dr Elizabeth Beare

• Counsel patient for weight loss prior to pregnancy.
• May need contraception whilst losing weight pre-pregnancy, as with weight loss fertility can rise.
• Hypertension
  • Measure upper right arm
  • Document size of cuff required
• Diabetes
  • Obesity is a major risk factor
  • All women should be screened
  • OGTT Early in pregnancy
  • 28 weeks if early OGTT normal
  • Except in women who have had bariatric surgery…..
• Fetal growth monitoring
  • SFH may not accurately represent fetal growth
  • Regular Ultrasound Scan should be offered to all morbidly obese women
    • 28/32/36 weeks
  • Serial USS better to assess for trends
  • NB – USS may also be inaccurate in the super morbidly obese

Thalassaemia/Haemoglobinopathy – Antenatal Screening – Associate Professor David Ross
Why do antenatal screening?

• Option of antenatal counselling, Prenatal diagnosis (PND) and pre-implantation genetic testing (all require screening and genetic testing prior to these procedures)
• Feto-maternal morbidity
• Lifelong morbidity of child
  • Transfusion dependency and iron overload
  • Sickling crises and significant comorbidities

Screening tests – First line of Investigation

• Complete blood examination – look at MCH, MCV, RDW, Hb, RBC count
• Iron studies – iron deficiency most common cause of microcytic, hypochromic picture
• Hb variant analysis (capillary electrophoresis or HPLC) – for detection of haemoglobinopathies (Note: HbS carriers are normocytic and normochromic unless also carrying alpha thalassaemia)

Updates to the SA GP Obstetric Shared Care Protocols 

Important! Change to the timing of Pertussis Immunisation in Pregnancy.

The Australian Immunisation Guidelines and State Health Department protocols have been updated to recommend women be immunised from 20-32 weeks gestation, rather than from 28 weeks. Women can continue to receive a funded vaccine up until birth; however it takes 2 weeks for antibodies to peak, hence the recommendation for earlier immunisation.

The reasons for the change are simple:

• It provides for protection of premature babies
• There is evidence of similar antibody levels in cord blood from 2nd and 3rd trimester vaccination, with perhaps even higher levels from the 2nd trimester immunisation. Although there is lower transfer initially, there is a longer time to transfer, with the most efficient transfer being from 30 weeks gestation
• The research says it is safe for both mum and bub
• We will now have a broader target to hit.

For simplicity’s sake, we suggest that we change our practice and immunise women when we review their morphology scan. If a woman has received pertussis immunisation before 20 weeks, it does not have to be repeated in the current pregnancy.  The data shows transfer of antibodies as early as 13 weeks. 

The influenza vaccine, as we would all know, can be administered at any gestation and provides additional protection for the first six months of an infant’s life.

Click here for more information.

Vitamin D Status in Pregnancy
Routine Vitamin D supplementation for all women is now recommended.
Supplementation of infants at risk based on the post-natal maternal serum Vitamin D level recommended.

Chlamydia Screening
Screening for Chlamydia is recommended for all women under the age of 25 years.

Gestational Diabetes
A reminder about the changes with regard to gestational diabetes and overt diabetes and a reminder to arrange an early GTT for women at risk between 12 and 16 weeks ideally.

Click here for more information.

First Trimester Screening
A reminder that nuchal translucency greater than 3.5 is now considered abnormal rather than 3.0

Mental Health
The Women’s and Children’s Hospital has implemented a screening tool for mental health referrals and many women who are struggling will now not meet this criteria. Consequently women will now be referred back to their GPs for their guidance and for completion of Mental Health Plans.

A number of Guidelines have been published on both the SA Health website (available at www.sahealth.sa.gov.au/perinatal and www.sahealth.sa.gov.au/neonatal) and web-based app (available at https://extapps.health.sa.gov.au/PracticeGuidelines).

We are excited to announce that we have recorded a further Shared Care Podcast with Associate Professor Chris Barnett.

A/Prof Barnett has dual fellowships in neonatal/perinatal medicine and clinical genetics and is the head of the Paediatric and Reproductive Genetics Unit at the Women’s and Children’s Hospital in Adelaide. He is the clinical lead of the NHMRC funded Genomic Autopsy Project and on the expert advisory committee of the Genomics Health Futures Mission, the Australian government’s $500 million research investment in the future of genomic medicine in Australia. A/Prof Barnett’s neonatal training was done in Adelaide at the University of Adelaide and Women’s and Children’s Hospital and in Toronto, Canada at the University of Toronto and The Hospital for Sick Children.

He was a consultant neonatologist at the Women’s and Children’s Hospital from 1997-2002 and then in private neonatal/paediatric practice from 2002-2007. A/Prof Barnett is a past president of the SA branch of the Perinatal Society of Australia and New Zealand (PSANZ). A/Prof Barnett’s clinical genetics training was undertaken at University of Toronto and The Hospital for Sick Children, Toronto and at the Women’s and Children’s Hospital in Adelaide.  He has research interests in prenatal genetics, fetal pathology and rare childhood diseases and has over 80 publications in peer-reviewed journals and has written multiple book chapters.

He talks with host GP Advisor Dr Annie Lin about the very topical Pre-Pregnancy Genetic Screening.

This podcast will be available via our GP Partners website early September 2019.

Our earlier podcast featuring Associate Professor David Ross is now available via the GP Partners website.

Up and Coming

Pregnancy Diagnosed—What’s Next? & All You Need to Know About Vaccinations, Supplements, Medications and Lifestyle in Pregnancy – Cat 2

Your opportunity to attend the FPAA National Certificate in Reproductive & Sexual Health FREE!

Australian Medical Placements is offering one VR GP (or GP Registrar GP3 or above) the opportunity to attend with the registration fee fully sponsored (conditions apply) 

Contact carlym@australianmedicalplacements.com.au for details.

5 Day nationally accredited course.

Doctors with a minimum of one year’s experience in general practice or obstetrics & gynaecology can register for this 5 day nationally accredited theory course.  (Suitable also for GP Registrars GP3 or above)

Eligible for 40 category 1 QI&CPD points.

Click here for more info including prices

To provide Obstetric Shared Care in South Australia over 20 weeks, GPs must be accredited in the GP Obstetric Shared Care program.

CLICK HEREto download an application form to join the program

CLICK HEREto order the latest version of the SA Pregnancy Record – Version 11

Retirement

We would like to thank Jenny Niven for her valuable contribution to the GP Obstetric Shared Care Program. Jenny was the Midwife Coordinator and managed the GP Obstetric Shared Care Program at the Lyell McEwin Health Service/Modbury Hospital for a great number of years and will be very much missed.

Congratulations on your retirement Jenny!

New Midwife Coordinator
Lyell McEwin Health Service | Modbury Hospital

We are pleased to announce that the new Midwife Coordinator at the Lyell McEwin Health Service  and Modbury Hospital is Siobhan Lucas.

Siobhan can be contacted on (08) 8182 9000.

Siobhan is pictured (centre) here with Dr Jenni Goold, GP Advisor and Janie Glynn, Midwife Coordinator from the Women’s and Children’s Hospital at the recent SA OSC Clinical Refresher in August.

EMPOWER PARENTS, ENABLE BREASTFEEDING

Now and for the future!

WABA WORLD BREASTFEEDING WEEK

World Alliance for Breastfeeding Action (WABA) is a global network of individuals and organisations dedicated to the protection, promotion and support of breastfeeding worldwide.

Annually, WABA coordinates and organises the World Breastfeeding Week (WBW) between Aug 1-7. WABA WEBSITE

We are listening to your feedback… 
In 2019 we are continuing to offer you CPD Events, Podcasts and Webinars with greater relevance and interactive opportunities!

All CPD events with GP Partners Australia are free of charge and accredited with RACGP and ACRRM

Join Us Soon!

Please Update your Details

It is important and a mandatory requirement to maintain your accreditation that you advise the Program of your current up-to-date details.

Please contact Leanne, Obstetric Shared Care Program Manager if your details have changed or you can click on the link below to complete an up-date form.

Forms can be emailed to Leanne.March@gpex.com.au