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Shared Care Case Study

A woman presents to her GP shared care doctor at 32 weeks, feeling well however reports reduced fetal movements (RFMs) felt since yesterday.

GP action:

  • BP 100/60
  • Symphysis fundal height (SFH) measured = 30cm (stagnant) and plotted in chart
  • Fetal Heart Rate auscultated 147bpm over 1 minute
  • Comparison of SFH chart made, noting SFH is now 2cm below gestational age (28 weeks = 30cm, stagnant SFH)
  • Re-discuss fetal movements and reiterate the importance of reporting RFMs without delay.
  • Provide reassurance as FHR present and the need to refer to maternity assessment unit (MAU) at Werribee Mercy Hospital for urgent review of fetal heart rate monitoring (cardiotocograph, CTG) and a bedside ultra sound of the water volume around baby (DVP = deepest vertical amniotic fluid pocket)
  • Call the Werribee Mercy Hospital Obstetric and Gynaecology Registrar on 8754 3448 to provide handover.
  • Explain to the patient that the pathway of care will change and that future antenatal clinic appointments will be at the Werribee Mercy Hospital

Obstetric and Gynaecology department action:

  • Urine analysis performed for proteinuria
  • CTG and DVP performed and satisfactory
  • Formal fetal growth US, DVP and dopplers requested for urgent review
  • Review in Werribee Mercy Hospital antenatal clinic by O&G in 1 week with pathway escalation (admin team will call with appointment)
  • Emphasise importance of calling (24-hour WMH maternity Services 8754 3400) without delay if RFM present again at any time, even if this is today/tomorrow
  • Ensure FM and side sleeping information already received
  • Use teach-back to ensure the patient understands her care and plan of management

BELOW:  Is a guide of what we aim to discuss with women at their appointments (28 weeks and 30-32 weeks included only).

Contacts at Werribee Mercy Hospital:

Obstetric and Gynaecology Registrar on call 8754 3448 (medical professionals only)

24-hour maternity Services 8754 3400 (for patients)

More information:

 

Last reviewed November 21, 2023.