3. How do I organise First Trimester Maternal Serum Screening?
4. What should be done if the First Trimester Maternal Serum Screening Test is abnormal?
5. What are the standard antenatal investigations women should have during their pregnancy?
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1. How can I make urgent referrals to Frankston Hospital for assessment of women with pregnancy complications ?
Women’s Health Ambulatory Care Clinic
New clinic that provides timely and appropriate care for women experiencing pregnancy related problems such as suspected or confirmed pregnancy loss or decreased fetal movements without the need for them to attend ED.
- Referrals can be made by phone on 0417 340 535. GPs are requested to send patients in with a referral letter. There is no out-of pocket expense.
- Exclusion criteria include eclampsia, haemodynamically unstable patients, patients requiring fluid resuscitation, likely ectopic pregnancy and general gynaecology complaints. These pateints should be referred to the Emergency Department
Other Condition Specific Referral Options
Symptom |
Urgency |
Referral pathway |
Decreased fetal movements |
Urgent | Women’s Health Ambulatory Care ClinicPhone 0417 340535 |
Rupture of membranes |
Urgent | Women’s Health Unit (Labour Ward)Phone 9784 7959 |
Regular contractions |
Urgent | Women’s Health Unit (Labour Ward)Phone 9784 7959 |
High blood pressure |
Urgent | Contact Obstetric Registrar on call via switchboardPhone 9784 7777 |
PV bleeding > 1tspn(haemodynamically stable) |
Urgent | Women’s Health Ambulatory Care ClinicPhone 0417 340535 |
Fundal height deviation +/- 3cm
|
Urgent | Contact Obstetric Registrar on call via switchboardPhone 9784 7777 |
2. How do I organise Anti-D for Rhesus negative pregnant women routinely and after sensitising events?
Maternity Services Anti-D Information.
Patient journey flow charts (please note these are specific to Peninsula Health patients)
- Anti- D patient journey flow chart- 28 weeks
- Anti- D patient journey flow chart -34 weeks
- Anti- D patient journey flow chart sensitising event 1st trimester
- Anti- D patient journey flow chart sensitising event 2nd trimester
Anti-D Immunoglobulin Patient Consent Trial Medical Record Form This form is being trialled for use at Peninsula Health and your patients may bring it to you to have the administration of their Anti-D documented. Alternatively you can initiate use of this form for your patients. Feedback on how this form works for you and your patients would be appreciated.
Additional resources and Patient Information from CSL & Australian Red Cross:
- Guidelines for the use of Rh(D) Immunoglobulin
- You and Your Baby – Important Information for Rh(D) Negative Women
- Important information for Rh(D) Negative Women-Prevention of Haemolytic Disease of the Newborn
- Frequently Asked Questions
3. How do I organise First Trimester Maternal Serum Screening?
- Process
1) Ensure patients are given adequate information and pre-test counselling.
2) The pregnant woman has a serum screen at 10 weeks (most pathology providers will do this blood test with the appropriate referral form).
3) This is followed by a Nuchal Translucency Ultrasound between 11 weeks 1 day and 13 weeks 6 days.
4) Ideally a pregnant woman should receive her results in person at 13 weeks.
5) If the test is abnormal please see FAQ 4.
- Pre-test counselling
- Women can find ‘A guide to tests and investigations for uncomplicated pregnancies’ on the 3 Centres website, or download fom this link A guide to tests and investigations for uncomplicated pregnancies
Referral Forms, Patient Information and Counselling Guidelines for antenatal Maternal Serum Screening can be found at www.vcgspathology.com.au
Information on genetic testing can be found at Genetic Health Services Victoria, www.genetichealthvic.net.au
4. What should be done if the First Trimester Maternal Serum Screening Test is abnormal?
Women who are identified as ‘Increased Risk’ after results of Maternal Serum Screening should be referred immediately to Frankston Hospital Obstetric Clinic (phone 9783 8324) or private obstetrician for counselling and discussion regarding further investigations.
Patients referred after an ‘Increased risk’ may be considered for Chorion Villus Sampling (usually between 11 and 13 weeks), Ultrasound or Amniocentesis (usually 15-16 weeks) as applicable in keeping with the patient’s wishes after full discussion of the risks associated with further testing.
5. What are the standard antenatal investigations women should have during their pregnancy?
The following is a list of the required basic investigations for all women booking at Peninsula Health – with discussion and consent.
First Trimester
- Blood Group, Rhesus status and Antibody Screen
- Serum Ferritin
- FBE
- Hepatitis B surface antigen
- Rubella antibodies
- RPR
- HIV
- Hepatitis C Antibody
- Serum Vitamin D
- MSU – microscopy and culture
- Pap smear (if not performed in previous two years) – Cytobrush not to be used
Other investigations to consider in the first trimester but not performed routinely
- Chlamydia screening
- TSH
- Varicella screening
- Dating ultrasound
First Trimester Maternal Serum Screening:
Serum screen at 10 weeks followed by Nuchal Translucency Ultrasound between
11 weeks 1 day and 13 weeks 6 days
OR
15 – 18 weeks: Quadruple Test (second best option)
Second Trimester
18 – 20 weeks: Ultrasound Scan
Third Trimester
28 weeks
- Glucose Challenge Test –follow up Glucose Tolerance if serum Glucose > or =8 mmol/L
- Haemoglobin
- Serum Ferritin
- Rhesus antibodies (if Rh negative)
- Rh immunoglobulin given to Rh -ve patients
34 weeks
- Rh immunoglobulin given to Rh -ve patients
36 weeks
- Haemoglobin
37 / 38 weeks
- Vaginal swab for Gp B Strep
41 weeks
- Review in Advanced Pregnancy Clinic for discussion of postdates management
