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Dr Dragica Sosa Lets refresh 2015!. Learning Objectives You will be able to: Describe accreditation requirements of the SA OSC program Manage a low risk.

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Presentation on theme: "Dr Dragica Sosa Lets refresh 2015!. Learning Objectives You will be able to: Describe accreditation requirements of the SA OSC program Manage a low risk."— Presentation transcript:

1 Dr Dragica Sosa Lets refresh 2015!

2 Learning Objectives You will be able to: Describe accreditation requirements of the SA OSC program Manage a low risk pregnancy using the SA OSC protocols and SA PPGs Identify and manage key risk factors encountered in low risk pregnancies

3 Accreditation Requirements To maintain accreditation with GP OSC SA, GPs must attend in every triennium: three GP OSC evening CPD events, or one GP OSC Update Day or may contact us regarding other options….

4 OSC Visit Schedule GESTATION LOCATION 1 st visitDiagnosisGP 2 nd visit10-12 weeksGP or Hospital 3 rd visit22 weeksGP 4 th visit28 weeksGP 5 th visit32 weeksGP 6 th visit34 weeksGP 7 th visit36 weeksHospital 8 th visit38 weeksGP 9 th visit40 weeksHospital

5 Antenatal Booking Process All metro patients need a ‘booking reference number’ from Pregnancy SA Info line: Arrange hospital booking visit ASAP (before 20 weeks) Women requiring specialist perinatal care can be referred directly to the relevant hospital. Rural locations: follow usual booking processes The SA Pregnancy Record (orange book) must be used to document all care of OSC patients. Version 6 Order forms available on GP OSC website.

6 Routine Supplements The following supplements are recommended:  Folic Acid: 500 ųg/day from at least one month prior to conception* until 12 weeks gestation.  5 mg/day if at increased risk of neural tube defect: taking certain antiepileptic medications, diabetic, family history NTD, multiple pregnancy, haemolytic anaemia, known MTHFR mutation  Iodine:150ųg/day should be taken during pregnancy and for the duration of breastfeeding

7 Routine Supplements

8 Antenatal Protocols Developed 2002, recent update 2014 Protocols must be followed to meet indemnity requirements & provide ‘best practice care’  Including non Medicare insured women  Unless have procedural insurance Protocols recently been updated National Antenatal Care Guidelines  Module 1 Dec 2012; Module 2 Oct 2014

9 Routine Antenatal Booking Tests  CBP  Blood group and antibody screen  Rubella titre  Syphilis  Hepatitis B  Hepatitis C  HIV  MSSU for M,C&S  Pap smear if this has not been done within the last 18 months

10 Additional 1 st Trimester Tests for Women at Risk Vitamin D screening for patients at risk of deficiency- meet new Medicare rebate guidelines has deeply pigmented skin or has chronic and severe lack of sun exposure for cultural, occupational, medical or residential reasons OGTT at weeks for patients at high risk of gestational diabetes LMHS/MH patients: test ferritin but red blood cell folate has been removed since medicare rebate changes Other

11 OGTT at weeks for patients at high risk of gestational diabetes High risk factors (need only 1): PH Gestational Diabetes, age >40, FH, obesity (BMI >35), previous macrosomic baby BW > 4.5kg or 90th centile, PCOS, medication including corticosteroids or antipsychotics Moderate risk factors (need 2, if only 1, do random or fasting serum BGL & proceed to GTT if indicated) : Ethnicity- Asian, Indian subcontinent, Aboriginal, Torres Strait & Pacific Islanders, Middle East, non-white African, BMI > Interpret GTT results (path lab interpretation may vary) : Diagnosis fasting ≥5.5 &/or ≥ 7.8 at 2hrs (SA PPG) If normal, repeat GTT at weeks.

12 Vitamin D Deficiency  If level is <60 nmol/L, commence vitamin D 1000IU  Use 1000IU tablets, not larger dose sachets or oils  Test is repeated at 28 weeks  If 2 nd level is <60 nmol/L, increase dose 2000IU  If 2 nd level is >60 nmol/L, continue 1000IU  Continue therapy postpartum and retest at 6 months  Breastfed infants require 400IU (0.45ml) Pentavite until at least 12 months of age

13 Bariatric Guidelines Standards for the Management of the Obese Obstetric Woman in South Australia Calculate BMI, if > 35 apply Bariatric Guidelines High BMI - liaise with hospital re special requirements. Consider:  Counselling - risks, exercise and nutrition  Appropriate booking hospital/anaesthetic referral  Early OGTT  Morphology scan may need to be repeated a week later  Close monitoring of BP (using appropriate cuff)

14 Further Routine Tests  Maternal Serum Screening  Routine morphology scan 19-20/40  Booked with private radiology firms  weeks gestation:  CBP  OGCT (50gm glucose)  Blood group/antibodies (Rh negative women) prior to anti D  Vitamin D if low at booking visit 36 weeks gestation  Low vaginal swab for Group B streptococcus

15 Routine Visit Essentials Document in SAPR: Gestation (completed week) Progress BP – right arm, seated, correct cuff Fundal height in cm and plot on graph Foetal heart Fetal movements Investigation results Presentation and descent from 30 weeks

16 Routine Anti-D Prophylaxis  Hospital staff issue GP with 2 doses of Anti-D for prophylaxis of Rh negative OSC patients. Please use only for allocated patient.  All Rh negative women need antibody screen at 28/40, before giving Anti-D.  All Rh negative women without preformed Anti-D antibodies receive 625 IU Rh-D Ig at 28/40 and 34/40.  If patient misses Anti-D at 28/40 give at next visit with 2 nd injection 6 weeks later.

17 Need help? Program information and news Updated OSC Protocols, resources, order forms and links Upcoming CPD events Accredited OSC GP Registry – update your contact details! OSC Program Coordinator: ph

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19 Need help? SA GP Obstetric Shared Care Protocols 2014 SA Perinatal Practice Guidelines OSC Midwife Coordinators contact details in brochure GP Medical Advisors contact via GP OSC Program SA


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