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Women’s Health & Shared Maternity Care

 

Antenatal Clinic Referral - Key Points

  1. Refer Early
  2. Calculate BMI essential for referral
  3. BP and Estimated Due Date essential for referral
  4. Start Supplements and Aspirin (if indicated) early
  5. Order Standard Investigations (some women need more tests in first trimester)
  6. Maternity Services Consumer Page – helpful patient information

1.  Refer Early

  • 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 +/- attached GP letter.
  • A detailed Past History in the referral form or included with an attached letter helps triage women earlier for higher risk and helps ensure safer care in their pregnancy.
  • 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 2647.

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
  • Consider low dose aspirin (150 mg nocte) from <16 weeks as this can reduce the risk of pre-eclampsia and fetal growth restriction.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

Standard supplements

  • 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

5. Standard investigations

Recommended at around 9-10 weeks2

  • Blood group and Antibodies
  • FBE (consider ferritin if risk factors for iron deficiency anaemia)
  • 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

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

___________________________________________________________________

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

Antenatal Clinic Referral Forms

URGENT – COVID-19 and GP Booking-In Referrals

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

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

Referral Form- Antenatal Clinic

A covering  GP letter can also be faxed with the referral form

Referrals FAX to 9788 1879

E-referral is available – see Outpatients page

All women should be referred to the Booking In Clinic (around 12 weeks). Phone 9784 2600

Also see:

Telehealth & Visit Schedules in Women’s Health Outpatients (COVID-19)

COVID -19 Care in Maternity Women’s Health Unit

If a shared maternity care GP affiliate is unable to see women in their practice eg. clinic closed due to COVID-19, please contact the Antenatal Clinic at Frankston Hospital on 9784 2626.

Gestational Diabetes Clinic Referral Form

Patient information

Having Your Baby at Frankston Hospital

The above link takes patients to information about services and clinics offered for pregnancy and post-natal care including the Enhanced Maternity Clinic and Koori Maternity Service.


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

Women's Health Services

For Women’s Health Clinic information including Early Pregnancy and Perinatal Assessment Clinic go to Outpatient Services.

Peninsula Health does have Colposcopy Clinic, Mirena IUD Clinic, Urogynaecology Clinic and Sexual & Reproductive Health Clinic.

However, there are NO  GENERAL GYNAECOLOGICAL Outpatient Services at Peninsula Health. Women who require general gynaecology review and/or intervention have may;

  1. be referred to a local private Gynaecologist and treated as a public patient at Frankston Hospital if surgery is required. A list of hospital specialists with private rooms who can refer patients to the Frankston Hospital Gynaecological Surgery waiting list can be found on our website (Specialist Directory- see left hand menu)
  2. be referred to another health service with public gynaecology outpatient services.

 
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.