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Home // Health Professionals // General Practice Liaison Unit // Women’s Health & Antenatal Care

Women’s Health & Antenatal Care

 

Antenatal Referrals and Contact Information

A GP referral is required for all women booking in at Peninsula Health

E-referral is preferred

If a GP has an URGENT pregnancy concern, please contact the obstetric registrar via switchboard on 9784 7777. 

If a GP has a clinical concern about a woman you are referring, please call the Antenatal Clinic PH: 9784 2626 to speak with the clinical staff

If women want to enquire if their booking referral has been received call clerical staff PH 9784 2643

Key Points for referral

  1. Refer Early (before 12 weeks if possible)
  2. Calculate BMI essential for referral
  3. BP and Estimated Due Date essential for referral
  4. Start Supplements and Aspirin (if indicated level 2 or 3 risk) early
  5. Order Standard Investigations (some women need more tests in first trimester)
  6. Patient Information – click here for helpful patient information about Maternity Services

For more information including recommended supplements and prenatal screening see Further Referral Information tab below. 

Further Referral Information, Supplements and Screening

1.  Refer

  • Refer before 12 weeks. We are aiming for women to have their Booking-In visit at the hospital around 10-14 weeks and their first Obstetric visit by 14-16 weeks.
  • Use E-referral or the paper-based Antenatal Clinic Referral Form  with a detailed past history in the referral form or included with an attached letter.
  • Any test results received after referral please FAX to 9788 1879
  • If you have clinical concerns about a woman you are referring, please call the Antenatal Clinic PH: 9784 2626.

2. Calculate BMI1

BMI measurements affect clinical care for pregnant women.9

BMI > 50 at referral (and >43 if out of area) are not accepted at Peninsula Health. Please refer to Monash Health1,9

BMI >30

  • High dose folic acid (5mg) recommended from three months before conception and at least for the first trimester of pregnancy.9
  • Iodine (150mcg) supplementation for duration of pregnancy1
  • Vitamin D supplementation is advised (1000 IU per day).1
  • Low dose aspirin (LDA) 150mg nocte prior to 16 weeks to 36 weeks if level 2 or 3 risk of Fetal Growth Restriction unless contraindicated2. If low dose aspirin is started before 16/40 in high risk women, the rate of FGR can be halved.2,4.  
  • Consider Calcium supplementation 1500-2000mg daily if low calcium intake in diet as this can reduce the risk of pre-eclampsia and fetal growth restriction.10
  • Early Oral Glucose Tolerance Test (OGTT) should be arranged for 14-16 weeks. If normal or not attended all women have should have the Glucose Tolerance Test (GTT) at 26 weeks to exclude Gestational Diabetes.1

BMI 35–39:

  • As above for BMI > 30 and also consider baseline investigations of renal function in early pregnancy to assist in diagnosis and management later in pregnancy.1,9

BMI 40 or more:

  • As above for BMI > 30 and also test for baseline renal function (presence of proteinuria, serum creatinine and urea) and liver function.1,9

ULTRASOUNDS and high BMI

  • Where possible mid trimester fetal morphological assessment should be performed at 20-21 weeks rather than 18-20 weeks and maternal obesity should be highlighted on Ultrasound request form.1,9

3.  BP and Estimated Due Date essential for Referral

  • Hypertension in pregancy3
  • Estimated Due Date6

4.  Start Supplements and Aspirin early if indicated

RANZCOG Vitamin-and-Mine ral-Supplementation-and-Pregnancy

  • Folic acid 400mcg daily three months prior to conception and for first trimester4
  • High Dose folate 5mg 9 for women with Diabetes, BMI>30, PHx Gestational Diabetes, or PHx Neural Tube Defect.
  • Iodine 150mcg daily for duration of pregnancy11
  • Vitamin D supplementation should be discussed with women identified as being at high risk of vitamin D deficiency 7
  • Calcium supplementation assists with women who are at risk for pre-eclampsia 1500-2000mg daily if low calcium intake in diet10
  • Low dose aspirin (LDA) 150mg nocte prior to 16 weeks to 36 weeks if level 2 or 3 risk of Fetal Growth Restriction unless contraindicated2. If low dose aspirin is started before 16/40 in high risk women, the rate of FGR can be halved.2,4.  
  • See Routine Pregnancy Care Clinical Practice Guideline Table on page 3 for more information about level 2 or 3 risk

5. Standard investigations

Recommended at around 9-10 weeks2

  • Blood group and Antibodies
  • FBE, ferritin
  • Hepatitis B, Hepatitis C, HIV, Rubella, Syphilis
  • Midstream Urine for MC&S
  • Prenatal Screening5

Combined First Trimester Screening or Non-invasive prenatal testing (NIPT) (cfDNA) or, if not done offer Second Trimester Maternal Serum Screening5

RANZCOG Prenatal-Screening-for-Chromosomal-and-Genetic-Conditions

Some women need more tests to be done in first trimester

  • Chlamydia and Sexually Transmitted Infection (STI) screening

Offer testing to at risk populations (women 25 years or younger, multiple sexual partners)

  • Early Oral Glucose Tolerance Test (OGTT)2
    • Increased risk of Gestational Diabetes (GDM), BMI > 30
    • Family history of diabetes (1st degree relative with DM with GDM)
    • Previous GDM or previous macrosomia (>4500gm or >90th centile)
    • Elevated booking BGL
    • Multiple Pregnancy
    • Polycystic Ovarian Syndrome (PCOS)
    • Maternal age of 40 years or over
    • Corticosteroid or antipsychotic medication
    • Previous perinatal loss
    • Women with ethnicity of increased risk (Asian, Indian subcontinent, Aboriginal, Torres Strait Islander, Pacific Islander, Maori, Middle Eastern, African)

 

  1. Maternity Services Consumer Page – helpful information for women

https://www.peninsulahealth.org.au/services/services-n-z/womens-childrens-and-adolescent-health/maternity-services/

Healthy eating in pregnancy including foods to avoid8

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References

Note Peninsula Health CPG references can be viewed at our CPG page

https://www.peninsulahealth.org.au/health-professionals/gp-liaison/womens-health-shared-maternity-care/shared-maternity-care-guidelines/

References
1.Peninsula Health Women’s Health Service. (2018). Management of Women with a BMI >35 in Pregnancy, (6), 1-10, doc no: 48302433
2.Routine Pregnancy Care Guideline Peninsula Health Women’s Health Service. (2020). Routine Pregnancy Care, (2), 1-22, doc no: 54217345
3.Peninsula Health Women’s Health Service. (2018). Hypertension in Pregnancy (Pre- Eclampsia & Eclampsia), (4), 1-19, doc no: 41958905
4.Bujold, E., et al., Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy: a meta-analysis. Obstet Gynecol, 2010. 116(2 Pt 1): p. 402-14.
5.Peninsula Health Women’s Health Service. (2017). Pre-screening tests, (3), 1-9, doc no: 33260004
6.Safer Care Victoria; Maternity e-handbook. (2020). Accurate pregnancy dating (estimated due date). https://www.bettersafercare.vic.gov.au/resources/clinical-guidance/maternity-ehandbook/accurate-pregnancy-dating-estimated-due-date
7.Peninsula Health Women’s Health Service. (2018). Vitamin D deficiency during pregnancy and breastfeeding, (4), 1-4, doc no: 34960083
8.NHMRC. (2013). Healthy eating during your pregnancy; advice for eating for you and your baby.
https://www.eatforhealth.gov.au/sites/default/files/files/the_guidelines/n55h_healthy_eating_during_pregnancy.pdf
9.Safer Care Victoria; Maternity e-handbook. (2020). Obesity during pregnancy, birth and postpartum.
https://www.bettersafercare.vic.gov.au/resources/clinical-guidance/maternity-ehandbook/obesity-during-pregnancy-birth-and-postpartum
10.Safer Care Victoria; Maternity e-handbook. (2020) Hypertension in pregnancy https://www.bettersafercare.vic.gov.au/resources/clinical-guidance/maternity-ehandbook/hypertension-in-pregnancy
11.NHMRC (2010). Iodine supplementation for Pregnant and Breastfeeding Women.
https://www.nhmrc.gov.au/about-us/publications/iodine-supplementation-pregnant-and-breastfeeding-women

 


Urgent referral pathways for pregnant women

If a GP has an URGENT pregnancy concern, please contact the obstetric registrar via switchboard on 9784 7777.

 

 


Anti-D How to organise routine & sensitising event administration

 

Also see Women’s Health and Antenatal Clinics

Also see Clinical Practice Guidelines

Also see Antenatal Triage and Models of Care

 

 

 
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.