Routine Pregnancy Pathway

ALL WOMEN should visit Hospital at;

  • Booking In Clinic (around 12 weeks). Referral Form- Antenatal Clinic
  • Either 34 OR 36 weeks. The 34/36 week hospital appointment is made during the Booking In clinic visit. The patient can also book phone 9784 2600.
  • Advanced Pregnancy Clinic. All uncomplicated post-date pregnancies are booked for induction of labour between 41 weeks 3 days and 42 weeks.
    Appointments for the Advanced Pregnancy Clinic (weekly) can be made by calling 9784 2600.

TESTS & RESULTS:

  • GP SMCAs (Shared Maternity Care Affiliates) are responsible for following up results of tests ordered in general practice.
  • SMCAs should record test results in the Victorian Maternity Record (VMR) AND SEND COPIES to Frankston Hospital Antenatal Clinic- Outpatient Area 1- Building D
  • Significantly ABNORMAL results should be discussed with Obstetric Registrar or Consultant via hospital switch PH 9784 7777.
  • Medical Clearance: A physical examination confirming a woman is suitable for low risk pathway care (GP or Midwife); BP, CVS , BMI ( ≥18 or ≤35) , pap smear (if due, no cytobrush).

First Trimester

Visit 1 - Confirmation of pregnancy

Supplements

Supplements 2014

Folic acid

  • Standard- 400mcg daily
  • High risk dose 5mg daily (includes BMI >30, DM, PHx of Neural Tube Defect)
  • 1 month preconception and for 1st Trimester

Iodine

  • 150mcg daily

Dietary Advice

Dietary Advice 2014  includes list of foods to avoid

Lifestyle Advice

Lifestyle Advice 2014

Immunisations

Immunisations 2014

Refer to Booking In Clinic

Referral Form- Antenatal Clinic

Discuss Screening


Visit 2 - Around 10 weeks

General History & Examination

  • Medical, reproductive, obstetric, family/genetic, medications, alcohol and drug, nutritional, psychosocial and demographic
  • Physical Exam (Medical Clearance): BP, CVS ( Heart murmurs), BMI (BMI ≥35-40 follow High BMI pathway , BMI ≤18 or ≥40 high risk not for Shared Care)

Establish Estimated Due Date

Supplements 2014

Dietary advice

Dietary Advice 2014 includes list of foods to avoid

Discuss Screening

Early Oral Glucose Tolerance Test (OGTT) for high risk GDM (high BMI or PH GDM)

Standard First Trimester Antenatal Investigations

  • Blood group, Rhesus status Antibody Screen
  • Serum ferritin
  • FBE
  • Hepatitis B surface antigen
  • Hepatitis C Antibodies
  • Rubella Antibodies
  • RPR
  • HIV
  • Serum Vitamin D • MSU- microscopy and culture
  • Pap smear- if required (*cytobrush not to be used)
  • Discuss and/or organise Maternal Serum Screening Test (MSST)
  • Consider ; OGTT
  • Chlamydia, TSH, Varicella Screening


Visit 3 - Around 16 weeks

Obstetric Assessment

Confirm Estimated Due Date

RH Negative

Maternal Serum Screening Test (MSST)

18-20 weeks Fetal Morphology Scan discussed/ organised

 

Second Trimester

Visit 4 - Around 20 weeks

Obstetric Assessment

Fetal Morphology Scan results discussed

OGTT 24-28 weeks

  • Discuss/Organise


Visit 5- Around 26-28 weeks

Obstetric Assessment

RH Negative

Standard Antenatal Investigations at 26-28 weeks

  • HB
  • Serum Ferritin

OGTT

  • For ALL women at 24-28 weeks (unless already confirmed at earlier test)
  • If ABNORMAL refer to GDM Clinic (fortnightly review see GDM pathway)
  • GDM Clinic referral form 2015

 

Third Trimester

Visit 6- Around 30 weeks

Obstetric Assessment


All women must visit Hospital at either 34 OR 36 weeks to allow time for consultant review, discussion of previous results, a routine antenatal check and for an opportunity to discuss issues and ask questions on preparation for labour and birth. This appointment is usually made during the Booking In clinic visit or the patient can phone 9784 2600.
 

Visit 7- Around 34 weeks

Obstetric Assessment

RH Negative

Discussion Points

  • Preparation for labour including timing of birth and VBAC (if appropriate)
  • Breast Feeding Information


Visit 8- Around 36 weeks

Obstetric Assessment

Standard Antenatal Investigations at 36-37 weeks

  • Hb
  • GBS swab- low vaginal (37 weeks)
  • Routine weight

Discussion Points

  • Preparation for labour including timing of birth and VBAC (if appropriate)
  • Breast Feeding Information 


Visit 9- Around 38 weeks

Obstetric Assessment

GBS swab result

 Book Advanced Pregnancy Clinic Appointment (Ph 9783 8324)

Visit 10- Around 40 weeks

Obstetric Assessment

 Confirm 41 weeks appointment for Advanced Pregnancy Clinic booked

 

Post Partum

Visit 11- Postpartum 4-6 weeks

Maternal Check

  • Debrief of labour
  • Follow up of any pregnancy complications eg hypertension, gestational diabetes
  • Signs of anaemia
  • Blood pressure
  • Breast and nipple examination
  • Breastfeeding
  • Perineum – check symptoms eg urinary and faecal continence, dyspareunia and signs eg wound/episiotomy check
  • LUCS wound check
  • Uterine fundus, vaginal loss
  • Contraception
  • Post-natal depression
  • Parenting support and services
  • Settling and sleep

Consider:

  • FBE
  • Iron Studies
  • Coagulation Studies
  • TSH
  • Vitamin D
  • MSU
  • Glucose Tolerance Test if gestational diabetes
  • Pap Test (6-8 weeks postpartum only)
  • Appropriate vaccinations: MMR, Varicella, Pertussis (“Boostrix”for parents, consider immunization of grandparents)

       Immunisations 2014

 Baby Check

  • Enquire about parental concerns (including vision and hearing)
  • Follow up tests and complications (including Vitamin D supplementation if mother was vitamin D deficient )
  • Feeding, breast feeding issues
  • SIDS
  • Immunisation
  • Passive smoking
  • Height, weight, head circumference, growth charts
  • Developmental assessment including smiling at 6 weeks
  • General Physical examination including
  • Jaundice
  • Tone
  • CDH/ clicky hips
  • Fontanelles
  • CVS/murmurs
  • Hernias
  • Testes
  • Squint/ red reflex
  • Primitive reflexes

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.