Making a referral
Please write me a referral and either give it to your patient or send it to me at:
Prince of Wales Private Hospital
Locked Bag 2
Randwick NSW 2031
Or fax it to:
(02) 9650 4898
Or email me at email@example.com
If your referral is urgent or I can give you any advice please call me on my cellphone 0418 861 278
For pregnancy care I am happy to see women as soon as practicable after their pregnancy is diagnosed. This gives me an opportunity to establish the viability of the pregnancy and begin to discuss prenatal diagnosis.
The other advantage of an early referral is that once I have met your patient I am then available to them 24 hours a day to manage any concerns or complications that might arise.
I am happy to organise pregnancy booking blood tests and early ultrasound scans for your patients although it is worth remembering that some investigations such as Chorionic Villus Sampling (CVS) and Nuchal Translucency Screening (NTS) need to occur before 13 weeks gestation.
Pregnancy Booking Investigations
a) Laboratory tests:
If you are organizing your patients booking blood tests, I recommend the following investigations for straightforward pregnancies:
- Blood group and antibody screen
- Thyroid Function Tests
- Mid stream urine examination
- Serology for
- Hepatitis B
- Hepatitis C
Other investigations – such as a haemoglobinopathy screen – should be performed if needed.
b) A first trimester ultrasound scan:
I always perform an ultrasound scan at the first pregnancy visit although my equipment does not have the resolution to accurately assess a pregnancy below 8 weeks gestation. In addition some of your patients may not see me before 9 to 10 weeks gestation. Accordingly I think it appropriate that you organise an early (6 to 7 weeks) ultrasound in women with:
- A previous miscarriage including recurrent miscarriages
- A previous ectopic pregnancy
- Uncertain menstrual dates
- Maternal age over 40
- Significant medical conditions such as hypertensive disease or diabetes
As you know the use of folic acid both pre pregnancy and throughout the first trimester significantly reduces the risk of fetal neural tube defects and may confer other – as yet unproven – benefits upon the fetus.
The recommended daily dose of folic acid for straightforward pregnancies is 0.5 milligrams, or 500 micrograms. This can be obtained from any pharmacy. Many women prefer to use a more general pregnancy multivitamin such as Elevit or Blackmores Gold. These preparations contain the correct amount of folic acid although they are more costly and can exacerbate first trimester nausea and vomiting.
Women with a higher risk of neural tube defects and other congenital anomalies should be offered a higher dose of folic acid – 5.0 milligrams per day. Such women include those with:
- A previous child affected with a neural tube defect
- Epilepsy, REGARDLESS of whether anticonvulsant therapy is being taken
- Pre-existing diabetes, and
- An elevated body mass index (BMI)
I am happy to see any women prior to pregnancy in order to assess them and to begin to plan their pregnancy care. Such a visit might be particularly appropriate for women with:
- Any preexisting medical conditions
- A past or family history of a genetic condition
- A poor obstetric history such as a preterm birth, recurrent miscarriages or a perinatal death
- Previous preeclampsia
- A previous traumatic labour or birth
Please check out the other sections of this blog. Here I have summarised relevant up to date research articles relevant to obstetrics from the world’s major journals.