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.

Emergency