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New RANZCOG statement about prevention of congenital cytomegalovirus (CMV) infection 

Cytomegalovirus (CMV) is a common herpes virus circulating widely in the community. If a pregnant woman acquires CMV in pregnancy, this can result in infection and damage to the developing fetus. Some babies born with congenital CMV will die, have hearing loss, epilepsy, intellectual impairment and/or cerebral palsy.  

Cytomegalovirus (CMV) is a common virus that can be passed from person-to-person without their knowledge, usually via intimate contact. The most common sources of CMV infection are young children, as they are more likely to shed high levels of virus in their saliva, urine or nasal secretions for long periods. Women who catch CMV infection while pregnant may pass the virus to their unborn child. Pregnant women can use simple hygiene strategies to reduce their risk of CMV infection. However most women have never heard of CMV.   

The International consensus guidelines in The Lancet ID recommend: “all pregnant women should be provided information on congenital CMV infection…(including)…potential dangers of CMV infection for the fetus, the most likely sources of infection, and steps to prevent infection”.  
 
Universal CMV screening of pregnant women with blood tests is not recommended. Hygiene practices to reduce infection should be recommended to all pregnant women and women trying to conceive, regardless of their CMV serology status. While the greatest risk of fetal harm occurs with maternal primary infection, congenital infection with long term complications occurs with similar levels of severity in primary and nonprimary (reactivation and/or reinfection) maternal infections. 

Further information:  

• CMV Australia:  Includes printable resources  
• Cerebral Palsy Alliance : Video outlining simple messages to minimise exposure to virus during pregnancy. Captioned versions of this video, flyers and posters available.  
• RACGP : Congenital CMV Webinar (2018)  
• NSW Health:  CMV and pregnancy fact sheet 
• NSW Health : Handle with Care: Looking after yourself during pregnancy (p 22)  

Influenza and pertussis vaccination in pregnancy  

Please note that the evidence around the timing of pertussis vaccination in pregnancy has recently been reviewed and the pertussis-containing vaccine is now recommended as a single dose between 20 and 32 weeks in each pregnancy, including pregnancies that are closely spaced to provide maximal protection to each infant.  This advice is reflected in the Australian Immunisation Handbook 
 
For women undertaking GP ANSC model of care, this should be administered at a routine GP ANSC consultation. 

       Key messages 

• Antenatal vaccination is recommended to protect both pregnant women and their babies from influenza and pertussis and their complications. 
• Maternal antibodies against pertussis provide protection to babies until they have received at least two doses of pertussis containing vaccines (at six weeks and four months of age). 
• Maternal antibodies against influenza provide protection to babies for the first few months of life until they are able to be vaccinated themselves at six months of age. 
• Babies less than six months of age are at greatest risk of severe disease and death from influenza and pertussis.  
• Pregnant women are also at increased risk of morbidity and mortality from influenza compared with non-pregnant women. Pregnant women are more than twice as likely to be admitted to hospital as other people with influenza. 
  
  Further information:
    
• Influenza and pertussis vaccination for pregnant woman 
• Clinical advice fact sheet 
• Vaccinations during pregnancy fact sheet - NCIRS 
• Immunisation for pregnancy - DoH 
• Promotional materials - search 'pregnant' 
• Pregnancy: Protection and Vaccination from Preconception to Birth - brochure 

Billing Medicare funded services for newborns

To register a newborn for Medicare, parents are required to submit the Newborn Child Declaration Form which registers their child for Centrelink and Medicare. This form is provided in the Parent Pack given to women by the hospital or midwife. Women have up to 52 weeks or up to the child’s 1st birthday to register their child.

A number of options are available for billing Medicare funded services for newborn babies.
This include (1) newborns that have been enrolled but have not yet received a Medicare number. Medicare can be contacted (ph. 132 011) to obtain the child’s number (2) newborns who are eligible for Medicare can be treated and bulk billed later when their Medicare number is provided or (3) the parents can be billed and be provided with an invoice to claim when the newborn is enrolled and Medicare number is supplied. 
Please note, if the newborn’s parents aren’t eligible for Medicare, the child may also not be eligible.
Source : AMA 
 

Perinatal Mental Health

Domestic and Family Violence

Working with families experiencing family violence can be difficult work for general practitioners. Starting the conversation can be challenging, but health professionals are uniquely place to identify and respond to family violence with help of resources and support services.
 
RACGP learning modules : Can you identify the warning signs of family violence 
RACGP has a series of on-line CPD modules and resources dealing with family abuse and violence. This modules cover the role of general practice in responding to family violence, skills needed to identify and respond to family violence, effective collaboration with the broader family violence sector and self-care for the whole practice team in context of family violence.

Click here for further information and module registration.

Family Violence Law Help is now live 
The new national website Family Violence Law Help has been launched for people wanting to understand more about domestic and family violence, the law and where to get help. The website provides information on child protection law, family law, DVOs and family advocacy and support services 

Domestic Violence Screening Forum - 3 May 
The Education Centre against Violence (ECAV) has a free forum for Domestic Violence Screening. As mandatory reporters, this forum aims to enhance professional judgment and practice with screening and assessing the safety of women and children.

Click here for further information and registration

Have your say - Cervical screening during the antenatal and postnatal periods  

You are invited to complete an online survey for a study from CESPHN, SESLHD and Cancer Institute NSW that aims to increase rates of participation in cervical screening of never screened and under screened women from priority populations during the antenatal and postnatal periods.

Click here to complete the survey or click here for further information.