GUIDELINES FOR SHARED MATERNITY CARE AFFILIATES 2021 GUIDELINES FOR SHARED MATERNITY CARE AFFILIATES 2021 The Royal Women’s Hospital Mercy Public Hospitals Incorporated Western Health Northern Health Disclaimer Guidelines for Shared Maternity Care Affiliates 2021 These Guidelines have been developed for the provision of Copyright State of Victoria 2021 shared maternity care between The Royal Women’s Hospital, Mercy Public Hospitals Incorporated, Western Health and © Copyright State of Victoria 2021 The Royal Women’s Northern Health (the Hospitals) and shared maternity care Hospital, Mercy Public Hospitals Incorporated, Western Health affiliates credentialed at these hospitals. and Northern Health. All rights reserved. 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Suggested citation: Guidelines for Shared Maternity Care Affiliates 2021, The Royal Women’s Hospital, Mercy Public While the Hospitals make every effort to ensure that the Hospitals Incorporated, Western Health and Northern Health, information is accurate and comprehensive, the information Melbourne, 2021. is only intended as a guide, and may not address particular circumstances. 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Guidelines for Shared Maternity Care Affiliates 2021 2. CONTENTS Disclaimer 2 Guideline Development Group 7 Acknowledgments 8 Abbreviations 9 Preface 11 Chapter 1: Maternity care at the hospitals 12 Scope of maternity care 13 Referring to hospital 15 Hospital satellite clinics 17 Childbirth education and hospital tours 17 Chapter 2: Pre-pregnancy consultation 18 Pre-pregnancy care 19 Pre-pregnancy checklist 25 Resources 26 Chapter 3: Shared maternity care 27 Credentialing 28 Responsibilities 29 Shared maternity care coordinators 30 Suitability for shared maternity care 31 Modified shared maternity care 33 Cessation of shared care 37 Patient-held pregnancy record 38 Resources 38 Chapter 4. Antenatal visits 39 Standard antenatal consultation and examination 40 Consultation discussion points 41 Common first trimester interventions: Aspirin and high dose folate 43 Schedule of visits: timing and place 44 Hospital visits schedule and care 45 Chapter 5: Maternal antenatal investigations 51 Initial routine investigations in first trimester 52 Other initial investigations to consider 55 CONTENTS Second trimester investigations: 26-28 weeks 57 Third trimester investigations 57 Screening tests not generally recommended 58 Repeating tests 58 Antenatal investigation summary 59 Resources 62 Chapter 6: Screening for fetal chromosomal and structural anomalies 63 Chromosomal screening 64 Down syndrome / other aneuploidies 66 Fetal structural anomalies 70 Diagnostic tests for chromosomal abnormalities 71 Resources 72 Chapter 7: Fetal chromosomal and structural anomalies 73 Fetal chromosomal and structural abnormal findings 74 High-risk aneuploidy screening result 74 Fetal abnormality on ultrasound and ultrasound markers 75 Abortion for fetal abnormality 77 Chapter 8: Fetal movement, growth and placental concerns 78 Decreased fetal movements 79 Fetal growth concerns 79 Common placenta abnormalities 81 Low-lying placenta and Placenta praevia 81 Vasa praevia 82 Cord issues 82 Placental Adhesion Disorders: accreta, increta and percreta 83 Resources 83 Chapter 9: Immunisation in pregnancy 84 Routinely recommended vaccinations 85 Not routinely recommended vaccinations: consider if high risk 87 Contraindicated vaccinations 87 Summary vaccination in pregnancy 88 Postnatal vaccines 88 CONTENTS Resources 88 Chapter 10: Rh and other Blood Antibodies 89 Rh D immunoglobulin (anti-D) 90 Other blood antibodies 91 Resources 91 Chapter 11: Labour and delivery 92 Trial of labour after caesarean section 93 Induction of labour 95 External Cephalic Version and Breech Delivery 96 Resources 97 Chapter 12: Aspirin, calcium and heparin 98 Aspirin 99 Low molecular weight heparin 100 Resources 100 Chapter 13: Common maternal conditions 101 Medicines in pregnancy 102 Hypertensive disorders 104 Hypothyroidism 105 Diabetes 107 Asthma 107 Rhinitis 108 Anaemia 110 Iron deficiency anaemia 110 Vitamin B12 Deficiency 113 Vitamin D Deficiency 113 Thalassemia 113 Infectious diseases 114 Skin changes and dermatoses 118 Resources 120 Chapter 14: Nutrition and lifestyle 122 Nutrition and Food safety 123 Recommended Supplements 125 CONTENTS Infections 126 Travel advice 126 Exercise 128 Alcohol and tobacco use in pregnancy 129 Resources 131 Chapter 15: Mental health and wellbeing 132 Risk factors 133 Screening 133 Management principles for depression 135 Mental health services 136 Mother and baby mental health services 139 Child protection and support services 140 Child and family services and support 140 Perinatal Psychotropic Medicines Information Service 140 Domestic violence 141 Resources 143 Chapter 16: Postnatal care 144 In hospital 145 In the community 146 Follow-up common maternal issues 148 Postnatal advice 150 Postnatal vaccination 151 Breastfeeding 151 Postnatal support and contact details 152 Maternal child health support services 152 Resources 153 Chapter 17: Hospital services and contacts 154 Chapter 18: Patient Resources 169 Appendix 1: Hospital contact details 178 GUIDELINE DEVELOPMENT GROUP Main Author & Project Lead Western Health Dr Ines Rio Dr Jo Silva Head General Practice Liaison Unit and Senior Medical Staff, General Practice Advisor The Royal Women’s Hospital Dr Elske Posma Obstetrics Unit Head Project Officer Jennifer Patterson Vasvi Kapadia Midwifery Unit Head General Practice Liaison Unit, The Royal Women’s Hospital Endorsed: Dr Elske Posma The Royal Women’s Hospital Djerriwarrh Health Dr Ines Rio Head General Practice Liaison Unit and Senior Medical Staff Dr Nisha Khot Director, Maternity Service Prof Mark Umstad Clinical Director, Maternity Services Endorsed: Dr Nisha Khot Dr. Stephen Cole North Western Melbourne Primary Head of Unit - Multiple Pregnancy Clinic and Health Network Shard Maternity Care Bianca Bell Trish Ryan Director, Primary Care Practice Midwifery Team Leader Dr Len Matthews Royal Australian College of General Practitioners Obstetrics Lead, Sandringham (RACGP) Fay Presbury Dr Sarah Lewis Midwife Lead, Sandringham General Practitioner Endorsed: A/Prof Mark Umstad Clinical Director, Maternity Services Shared Maternity Care Affiliates (General Practitioners) Mercy Public Hospitals Incorporated Dr Jane Doyle Dr Mary Anne McLean Dr Lauren Ong General Practice Liaison Medical Advisor Dr Natalia Rhode Dr Gillian Paulsen Maternity Unit Head, Heidelberg Dr Tamsin Rhodes Dr Jacqueline Van Dam Dr Angela Rutherford Director of Maternity Services, Werribee Mercy Hospital Endorsed: Dr Gillian Paulsen and Dr Jacqueline Van Dam Shared Maternity Care Affiliates (Midwives) Helen Ireland Northern Health Cindy Scott Dr Paul Howat Maternity Unit Head Dr Khalid Arzoo Obstetrics Unit Head Julie Kane Midwifery Director Endorsed: Dr Paul Howat Guidelines for Shared Maternity Care Affiliates 2021 7. ACKNOWLEDGMENTS Dr Helen Savoia The reviewing Shared Maternity Care Affiliates: Consultant Haematologist, The Royal Women’s Hospital Dr Luma Alkhayat Dr Michelle Giles Dr Ralph Audehm Physician, Microbiology and Infectious Diseases,