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GP FAQs – including First Trimester Screening and Anti-D

1. How  can I make urgent referrals to Frankston Hospital for assessment of women with pregnancy complications ?

2. How do I organise Anti-D for Rhesus negative pregnant women routinely and after sensitising events? 

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 ?

It is recommended that GP’s use the new Pregnancy Assessment- When & How to refer chart  to assist with the referral of women to Peninsula Health.

Pregnancy Assessment- When & How to refer March 2014

2. How do I organise Anti-D for Rhesus negative pregnant women routinely and after sensitising events? 

Maternity Services Anti-D Information.

A new Routine Prophylaxis and Sensitising Event Pathway has been developed.

Anti-D Prophylaxis Pathway in the community-Feb 2014

 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:

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

 

Disclaimer

These guidelines have been developed by the Peninsula Health GP Liaison Unit and the Peninsula Health Women's Services as a general guide to the management of women participating in the Peninsula Health Shared Maternity Care Program. They may not be applicable in every clinical case. They should not replace thorough clinical assessment and judgement.

Care should be taken when printing any information or Clinical Guidelines. Updates to these guidelines will take place as necessary. It is therefore advised that regular visits to this Website will be needed to access the most current information.