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Decreased fetal movements – maternal awareness and acting early 

Maternal perception of DFM is a common reason for women to make contact with their healthcare provider. Maternal concerns regarding their baby’s movement overrides any number of fetal movements¹. Women should be advised that any change in their baby’s movements should be taken seriously and to contact their maternity care provider immediately rather than waiting.

GPs should be aware of recommended advice for women which includes:

• Fetal movements may be first felt from 18-20 weeks gestation 
• To be aware of her baby’s movements and the pattern of movements. 
• The number of fetal movements tends to level out around 32 weeks gestation but there is typically no reduction in the number of fetal movements later in the third trimester. 
• In late pregnancy, fetal movements tend to increase during the day and are highest in the evening. 
• Mothers generally feel most movements when they are lying down
  
  ( RPAH – Decreased fetal movements guidelines) ²

Resources and references: 

• Movements Matter - suite of resources for both consumers and to health professionals. 

           - “Your Baby’s Movements Matter” flyer  (including translations to more than 15                     languages) 
           - “ Movements Matter” video - consumer video outlining the importance of women                 knowing their baby’s  DFM
           - DFM e-learning guide for health care providers – online module Caring for                           women who present with DFM 

¹ NSW Health – Maternity- Decreased fetal movements in third trimester 

² RPAH – Decreased fetal movements guidelines 

Assisting women to maintain a healthy lifestyle during pregnancy?

Did you know that NSW Health’s “Get Healthy in pregnancy” (GHiP) service provides a FREE, confidential telephone based health coaching service to support all women achieve a healthy gestational weight gain during their pregnancy.

The service provides support and information around positive behavioural lifestyle changes including healthy eating, physical activity and alcohol abstinence.

The service includes: 

• 6 month coaching program including 10 phone calls and information packages
• University qualified personal health coach 
• Option for a single coaching call and printed information 
• Motivation and support to set healthy lifestyle goals 
• Option to re-enrol for free in a further 6 months of coaching or six months of SMS based coaching (for free.) 
• Free interpreter services available 

The service is accessible to ALL women regardless of gestation or BMI and should be offered as part of routine antenatal care. Referrals can be made at a woman’s first antenatal episode of care and reminded of the service at subsequent antenatal visits. 

To refer: 

• Complete General Practitioner Referral Form and fax to 1300 013 242. These referral forms are also available as templates in both MD & BP software. 
• Patients can self-refer by registering online or ph.1300 806 256

The service complements GP care and with patient consent, GPs will be informed of women’s progress. 

Resources and further information 

• NSW Health: Get Healthy in Pregnancy - includes patient fact sheets and service brochure 

• Pregnancy weight gain calculator : Women can track their weight gain during pregnancy 

Click here to order FREE GHiP program resources for your practice 

Perinatal mental health: NEW Information Hubs for health professionals & expectant Dads

COPE (Centre for Perinatal Excellence) has a new dedicated section to their website for health professionals. 

These Information Hubs allow easy access to a tailored guideline summary, screening and assessment tools, and fact sheets for specific health professionals and those in their care. 

These Information Hubs have been tailored for the following professions: 

• Midwives 
• Maternal, Child and Family Health Nurses 
• General Practitioners 
• Obstetricians 
• Mental Health Nurses 
• Psychologists 

Ready to COPE for Dads COPE has recently developed guides for expectant fathers. Dads can sign up (same way as women) to receive editions of the guides which include an antenatal and postnatal series . 

Tresillian Postnatal Depression and Circle of Security Parenting Groups - July

Tresillian will be facilitating a FREE Sequential Postnatal Depression & Circle of Security Parenting (COS-P) Group designed to support mothers with postnatal depression (PND) and anxiety and their families. The program will run for 12 weeks which include 8 x 2hr core PND group sessions, followed by 4x 4hr COS-P group sessions.

Where: Tresillian Canterbury McKenzie St, Belmore 

When: 8 weeks on Tuesday morning : 23 July - 27 August , Time :11am-1pm 

4 weeks with partners Saturday 31 August - 21 September, Time : 10am-2pm 

Free babysitting is offered on the premises. 

Referrals include: 

• Women in the postnatal period up to 12 months who are experiencing PND and /or anxiety of a non-acute nature 
• Women who reside or work within CESPHN area. 

For bookings and further information click here 

Reproductive carrier screening

Reproductive carrier screening is used to identify carriers of genetic conditions with an autosomal recessive inheritance or x-linked inheritance pattern. Information about carrier screening should be offered to all women or couples during pre-conception and early in the pregnancy (ie first trimester). 

• All women or couples planning a pregnancy, or who are already pregnant, should have a comprehensive family history recorded.
• Women or couples who are known carriers of a genetic condition or have a relevant family history should be made aware of the availability of carrier screening and offered referral to specialist services (ie genetics or obstetrics).
• Information on carrier screening for the more common genetic conditions that affect children (eg cystic fibrosis [CF], spinal muscular atrophy [SMA], fragile X syndrome [FXS]) should be offered to low-risk women and couples (ie regardless of family history and ethnicity).

• The decision to have screening is a personal choice to be made by the individual or couple². 

Information on reproductive carrier screening should include the potential benefits of screening, limitations, and associated costs¹. Couples who are considering reproductive carrier screening should be aware that not all tests look for the same genetic conditions and screening does not screen for every genetic condition³. Women wanting more information about carrier screening should be given the opportunity to have a more detailed discussion about carrier screening with an informed clinician¹.

GPs requiring further information regarding reproductive carrier screening and available service providers, please contact relevant hospital Clinical Genetics Department below: 

• RPAH Medical Genomics/Clinical Genetics: ph. 9515 5080 
• RHW: ph. 9382 6098 
• St George Hospital: Clinical Genetics ph. 9113 3635 

References and resources

¹.RANZCOG Statement - Genetic carrier screening (March 2019)
².RACGP - Genomics in General Practice (2018) Reproductive carrier screening - page 76
³.NSW Health Centre for Genetics Education - Preconception (Reproductive) carrier screening (Fact Sheet ) 

GP ANSC educational requirements – have you fulfilled your requirements for 2017-2019?

GPs undertaking antenatal shared care are expected to maintain affiliation/recognition as an ANSC GP provider and be familiar with ANSC guidelines and protocols. Maintaining GP ANSC affiliation/recognition involves the accrual of at least 12 Cat 2 points in either antenatal or postnatal specific educational activities over each RACGP triennium. The end of 2019 concludes this current triennium.

These educational activities can be completed as face-to-face (CESPHN or external) or on-line activities.

▪ Click here to view 2019 CESPHN Maternal Health events 

▪ Click here to view relevant on-line activities 

Please note, CESPHN does not have access to individual GPs RACGP CPD statement, therefore confirmation of any external or on-line activities need to be forwarded to CESPHN for our records. Please contact Lauren Thomas, Maternal Health CPD Officer to clarify your CPD point status and/or to forward copies of completion certificates or your RACGP CPD credit statement.