May - Canterbury District Health Board

Women’s and Children’s Health
Childbirth Communiqué
In this edition...
May 2012
Editorial from Sam Burke ....................................................................................... 1
LMC Meetings ........................................................................................................ 2
NZCOM Meetings .................................................................................................. 2
News from Lincoln ................................................................................................. 2
Greetings from Birthing Suite ................................................................................. 3
News from Rangiora .............................................................................................. 3
News from Burwood .............................................................................................. 3
News from Ashburton ............................................................................................ 3
Residency on the Maternity Booking Form ............................................................. 5
Midwifery Educators Update .................................................................................. 6
Improving the Maternity Journey for Women in Canterbury .................................... 6
Maternity and NICU Social Work Services at CWH ................................................ 7
Midwife and Social Work Liaison Meeting .............................................................. 8
Antenatal HIV Screening Programme Update ........................................................ 9
GBS Alert Stickers—now available ........................................................................ 9
An Update for LMCs if having problems downloading the GROW software ......... 10
Centile Calculator (to develop a customised birth weight centile after birth) .......... 11
Beyond the Numbers: Maternal and Perinatal Deaths and
Neonatal Encephalopathy in New Zealand 2010 .................................................. 12
Update on CHIPS, PPROMT and Progress Trials ................................................ 13
The Role of the CNP Hormone in Pregnancy ....................................................... 13
Trainee Interns—Sixth year Medical Students ..................................................... 14
Highlight on Herpes Simplex ................................................................................ 15
Pertussis Vaccination ........................................................................................... 16
Influenza Vaccination in Pregnant Women ........................................................... 17
Consumer Feedback ............................................................................................ 18
Youthtalk Antenatal—Childbirth Education Classes ............................................. 18
Editorial
I hope you find this edition informative and interesting, and thank you as always for
the hard work and great contributions to this edition.
This is the first electronic edition of the Childbirth Communiqué. There will, of course,
be hard copies available in ward and administration areas of Christchurch Women‘s
Hospital.
Please let us know if you need to update your email address. We would welcome any
feedback and please let us know if you have any problems accessing the document.
Any feedback can be directed to Christine.King@cdhb.health.nz
Happy reading!
Sam
Please consider the environment before you print me!
1
LMC Meetings
News from Lincoln
The next meeting will be held on:
Hello to all
Thursday 13 September, 2.00pm
Seminar Room, Level 5, CWH
There is a definite chill in
the air, so it is timely to
remind everyone of the
importance of keeping
our babies warm for
transfer to the Primary
Units. The findings from
the annual Primary Unit temperature audit from
July last year showed that some babies were still
arriving at the Primary Units with sub-optimal
temperatures which has the potential for serious
problems for these babies.
NZCOM Meetings
Please note, that some dates and times for the
NZCOM Meetings for Canterbury/West Coast
region have changed:
Wednesday 02 May, 1.00pm
Hospital Services Seminar Room, LGF,
Parkside, Christchurch Hospital
Tuesday 05 June, 7.00pm
Seminar Room, Level 5, CWH
Wednesday 04 July, 1.00pm
NZCOM House
Tuesday 07 August, 7.00pm
Seminar Room, Level 5, CWH
Wednesday 05 September, 1.00pm
NZCOM House
Tuesday 02 October, 7.00pm
Seminar Room, Level 5, CWH
Wednesday 07 November, 1.00pm
MMPO House, 374 Manchester Street
Tuesday 04 December, 7.00pm
Seminar Room, Level 5, CWH
COMPILED BY STAFF OF THE WOMEN’S
HEALTH DIVISION
With thanks to all contributors for sharing of
information and items of interest.
Please ensure babies transferring in our cold
months have been fed, are warmly dressed with
woollen outer garments and hat, and are
transported in a warmed car seat. By asking the
partner to bring the car seat into the warm
hospital environment for 15 minutes or so, prior to
transfer should be enough to take the cold edge
off a seat and stop baby losing heat by
conduction.
Our room reconfiguration is now complete – some
minor decorating still to be done – and we have
beautiful new curtains in our balcony areas.
Please come and have a look! We also welcome
your women to view the facility but ask that they
phone first to arrange a mutually acceptable time.
We will be running more
antenatal classes from now on
but still need women to book
into these early. Our antenatal
examination room is available
for hire and can be booked by contacting the staff
member on duty.
We have recently farewelled Carol Nicholas from
our staff – she is off on an adventure in Australia and I am happy to welcome Lisa Preston, who will
be taking her place. We are also enjoying having
Ruth Martis working as a permanent member
of our team for several months.
Please contact me with any queries.
Amanda Daniell
Charge Midwife Manager
Lincoln Hospital
ph 364 0239 (80239)
2
Greetings from Birthing Suite
I wanted to share a scenario that happened to a
new mum. Following her birth, Sarah (name has
been changed) felt very strange and
uncomfortable with an odd feeling inside her
vagina and attributed this to having just given
birth and passing it off as being normal.
Following discharge home, Sarah continued to
feel uncomfortable all of the time, describing an
itchy and strange pain inside her vagina,
especially when she sat upright. Over time, this
pain developed into more of a sharp feeling.
Three weeks post partum, whilst showering,
Sarah felt something she described as plastic or
cloth, edging out of her vagina. This was
identified as being a swab! This swab was vey
smelly, and caused Sarah and her family great
anxiety and distress.
Something that I‘ve noticed as I tell the story is
that we all want to know how she delivered, ―was
she a caesarean?‖ LMC‘s have asked, ―was she
a vaginal birth?‖ The core team wanted to know.
None of us would like to think that we would
leave a swab behind and it‘s not about
apportioning blame. I‘m looking for support and
input from all midwives as we look at our
systems and processes to try to stop this
happening to another woman.
Implementation of Count Stamp
Birthing Suite plan to start the inclusion of a red
stamp to record swab, needle and instrument
counts in the clinical notes from 07 May. We
have had feedback from core staff, so now need
LMC input. The stamp will be attached by a
string to the each desk drawer in each birthing
room and spares will be available in birthing
suite including the LMC area in the ward clerk
office.
Delivery Summary
An audit was conducted in May 2011
determining the accuracy of information
documented on the yellow delivery summary.
This audit identified that 62% of the information
recorded was not accurate. The inaccuracy of
the information was mostly minor. However, this
is the final record in the woman‘s notes that
summarises the birth outcomes and care that we
have given. One recommendation from the audit
was that all delivery summaries are signed by
the midwives.
As of 1st May, Birthing Suite plan to generate just
one copy of the delivery summary which the
midwife (LMC or core) will check and sign to
confirm all information is correct. This delivery
summary will then be returned to the ward clerk
who will generate copies for the GP, woman and
LMC. The signed original will then be filed in the
woman‘s clinical notes. The yellow delivery
summary has also been updated to include “All
swabs, needles and instruments accounted for”
with the opportunity to circle ―yes/no‖.
Swabs
You will have noticed the appearance of new
swabs in the pantries to replace the old packs of
six. These tailed swabs are much larger, high
quality, x-ray detectable, and in countable packs
of five (and of course, more expensive). I‘m
happy to demonstrate rolling a tailed tampon
although some bright spark said I do such a good
job of this, I should be on Playschool!
In June, we shall be inviting all midwives and
doctors to complete an online survey to evaluate
the trial of the new swabs and offer suggestions.
I look forward to receiving your feedback on the
count stickers and the swabs.
Regards
Nat King
Charge Midwife Manager
Birthing Suite
NEWS FROM RANGIORA
It‘s nice to enjoy the wonderful autumn weather
and a more settled year after 2011.
Rangiora Hospital, in this current financial year,
has seen a 30% increase in births, which is
fantastic, and postnatal transfers up by 12%.
Thank you to all the LMCs who support this unit
and encourage more women to experience
birthing in a primary unit, it is much appreciated.
On 14 February 2012, an orientation and
afternoon tea was held here for new LMCs
planning to practise in North Canterbury, which
was well attended and we look forward to working
with you all.
This year, we are enjoying having midwives on
the new grad programme, having 4-7 week
placements in the primary units as well as many
first year midwifery students.
3
Sadly, the Rangiora Community Midwifery Team
was disbanded on 31 January after 16 years
based at Rangiora Hospital. We wish the team Marja McCarthy, Margaret D‘Oliveira, Sharon
Lindley and Rachael Van Dorp all the best in
their new positions.
Diana Hansen, our casual registered nurse,
resigned in February to take up a new career as
a baker‘s assistant.
Over the past year, we have seen a vast
increase in demand for hire of any spare rooms
in this unit, with the addition in the last month of
the Heart Failure Clinic once per month, Nurse
Maude Wound Clinic & Continence Clinics one
day each week, as well as more requests from
LMCs for clinic space. We plan to have another
antenatal room/meeting room ready for use
upstairs in the next month. Public Consultation
has now begun on services to be provided and
preferred site of the North Canterbury Health
Hub, and we await notification over the next few
months from Planning & Funding as to how this
will evolve.
We now have another breast pump kindly
purchased by the Friends of Rangiora Hospital,
so have enough to be able to offer one for hire to
women for up to one week for a small fee.
Pregnancy & Parenting Classes continue to be
very popular, so remember to ask your women to
book in early. Phone 311 8650.
We welcome any feedback from LMCs or
families as to how to improve services in the
future.
Suzanne Salton
Charge Midwife/RN Manager
Rangiora Hospital
News from Burwood
There have been some changes to the BBU
team, most notably the departure of our
wonderful Ward Clerk Linda, who has left us in
March to retire in Twizel.
Fortunately, we have another equally wonderful
Lynda to take her place, in Lynda Tonkin, who
you will all know, from Birthing Suite CWH. Linda
will join our team, working Monday to Thursday
from the 16th April.
We have also said farewell to Pam Phipps, one
of our CBE‘s, in March, and welcomed Heidi
Goebbels, who will taking the Wednesday
Pregnancy and Parenting class.
Midwife, Lisa Preston, is also leaving us at the
end of April to join the staff at Lincoln Hospital.
It is fair to say that the opening of the postnatal
beds at St George‘s Hospital has had an impact
on our Patient Numbers here at BBU, with a
decline in our admissions and births this year, so
far.
We would like to thank all the LMC‘s who
continue to support our Unit by birthing their
women here.
Any LMC‘s who are unsure about birthing their
women here are most welcome to view the
facilities and talk to us.
A successful, but poorly attended familiarisation
workshop was held on the 2nd of February. The
few Midwives that attended found it a positive
experience.
To all of you that are continuing to deal with the
aftermath of the 2010 and 2011 Earthquakes, we
hope this year brings some resolution.
Pam Truscott and Anne Atkins
Charge Midwife Managers
Burwood Birthing Unit
News from Ashburton
This is Ashburton‘s first contribution to the
‗Childbirth Communiqué‘, so we would like to
take the opportunity to introduce you to the unit
and our team. Many changes have occurred
within the unit over the last year, not only with
staff but also our buildings.
My name is Annette Norton and I am the Charge
Midwife Manager. I have worked in Ashburton
since last February as a Core Midwife but only in
post as Charge since September 2011. In what
feels like a past life, I was Charge on a busy high
risk delivery suite in the UK. I relocated to New
Zealand with my husband and children, and
originally
took
a
post
in
Middlemore
Hospital. This was a brilliant introduction to
midwifery in New Zealand and showed me
quickly that babies deliver the same way the
4
world over! We made our way to Ashburton as we felt that the opportunities of the South Island would
suit our family perfectly.
Our Midwifery team have all changed, too. Annelore Elsen has arrived from Belgium (unfortunately
without chocolate). Karin Skjellerup, a well respected name in the Canterbury area, and Caroline Nye
who has spent many years working in the primary setting both in New Zealand and the UK, have all
joined our permanent staff. We are currently seeking one more midwife to join our small but very
friendly team.
We have three longstanding members of staff who remain the loyal constant with 75years service to
this unit between them. These Nurses are Margaret Rickard, Margaret Clifford and Kate Chapman.
The team‘s support has been invaluable in these changing days and is enormously appreciated. I know
that each of you quietly go ‗above and beyond the call of duty‘.
Due to the high seismic risk to some of the buildings on the Ashburton campus, other displaced
departments have had to utilise some of our space. This has resulted in a new layout for our
smaller but hopefully improved unit. It has also given us the opportunity to bring medical air to our
resuscitaires. We will, however, retain five postnatal rooms and two delivery rooms.
So, this is Ashburton Maternity – a unit well respected throughout the community for offering a relaxing
environment (once the builders have gone!) and excellent postnatal care. Please feel free to come and
see our unit and meet us in person. We all look forward to working closely with you.
Annette Norton and the Maternity Team
Ashburton Hospital
Residency on the Maternity Booking Form
The questions asked in the ―Residency‖ section of the Maternity Booking Form‖ has been slightly
changed and may change again in the near future. We have added ―Country of Birth‖. We need this
information to assist in our assessment of eligibility for publically funded healthcare.
The Residency section will now have the following or similar wording:
Place of Birth in New Zealand
Country of Birth
If COB is not New Zealand, please provide: verification of your citizenship/residency/immigration
status in New Zealand and provide copies of passport & visa details AND/OR proof that your
spouse/partner is a New Zealand citizen/resident/holds a two-year work permit and proof of your
relationship
It is important for us to have the residency information completed for all women who were not born in
New Zealand or are not New Zealand citizens.
This will make the process smoother for everyone and will ensure that we don‘t have to go back and
ask for more information.
NB: If the Woman is not eligible for Publicly Funded Treatment in her own right and her eligibility is
based on her partner‘s status, then she is funded for Maternity Services only.
5
Midwifery Educators Update
We are well into 2012 and have already worked
with many of you at some of our education
workshops held during the last few months. We
enjoy catching up with you at these times and
also when you come into the office to book, or
alternatively, if you ring to check whether there
are still spaces available in the various sessions.
At the beginning of February, we met many new
LMC‘s making their transition from student
midwife to new practitioner. As usual, we ran a
day‘s workshop and those of you who attended,
were able to meet many DHB colleagues who you
will be networking with in the future.
We are very lucky to have eight graduates on our
2012 Graduate Midwifery Programme. I‘m sure
that all practitioners join with us in welcoming
Chrissie Foy, Amy McFadden, Alice Cotter, Ali
Kolien, Ashleigh Peck, Angela Williamson, Bobby
Houlahan and Holly Little to the Canterbury DHB.
Please introduce yourselves to these grads on
your travels around Christchurch Women‘s and
the outlying primary units and wish them well on
their midwifery journey.
At present, we also have two midwives on our
Return to Practice programme. Many of you will
remember Peta Taylor, who has been teaching
science during recent years to CPIT student
midwives and nurses. Joan-Mary Heffernan is
also returning to midwifery after a period of time.
She originally worked in Auckland and was one of
our early LMC pioneers. A warm welcome to you
both and to others who have recently returned to
practice.
Workshops are filling fast, as
always: dates are on display
on the noticeboards around
the maternity areas and all
flyers can be emailed to you,
if you ask us to add you to
our workshop information list.
Just a reminder that all pre-reading is being sent
out by email now to save the trees. Paper copies
of pre-reading will be kept in the educators‘ office
in case you don‘t have access to a printer.
Booking information and quizzes will be emailed
out 1-2 weeks before each session, so if you
haven‘t received anything, please check in with
us as we may not have your name on the booking
list.
Also, the new and improved K2 fetal monitoring
training package is also free to all LMCs and is
worth up to 10 points per year of elective
education towards the Midwifery Council
Recertification Programme. Contact Lynne or
Tina in the Educator‘s Office, or Sonya Matthews
on Birthing Suite for a reminder of your K2 login
and password or if you need help in accessing
the programme.
For those of you wishing to attend the NZCOM
conference this year, the dates are 24 - 26
August and it will be held up in Wellington. Also
prior to that on 20 June, also in Wellington,
Midwifery Council are holding their Annual Forum.
Both these events are well recommended and are
an excellent way of keeping up with professional
issues and of course, earning valuable
professional activity points.
For any further
information on midwifery
education run by CDHB, please contact us by
telephone on our direct line on (03) 364 4730 (or
CWH internal extension 85730/pager 5061) or by
email on tina.hewitt@cdhb.govt.nz or
lynne.king@cdhb.govt.nz.
If you are at
Christchurch Women‘s Hospital, feel free to pop
into our office on Level 5.
Tina Hewitt and Lynne King
Midwifery Educators
Improving the Maternity Journey for
Women in Canterbury
Work on The Maternity Journey project began on
15 February 2011 with a workshop of 120
participants from a wide range of health and
maternity services as well as mothers and their
families. Ideas for improvement were grouped
into themes. A Development Group then
considered those themes and progressed them
into opportunities for improving the maternity
journey:
Establish
standardised
Canterbury-wide
information accessible from a wide variety of
sources
Improve access to suitable contraception for
women who identify as high risk of unplanned
pregnancy
Develop an electronic ‗Find a Midwife/LMC‘
database
Continue funding referrals from LMCs to
General Practitioners
6
Develop an integrated maternity model that
enables additional support for women with high
non-obstetric and/or psychosocial needs
Provide Pregnancy and Parenting Courses that
better meet the needs of the people in the
community
Align women‘s clinical needs with the most
appropriate level of birthing care and support
and reduce unnecessary intervention and
unsustainable demand on CWH
Develop standardised, streamlined processes
for notification and referral from LMC to Well
Child / Tamariki Ora provider and general
practice, and confirmation that the referral has
been accepted
Increase breast feeding education and support.
The group considered how well we are doing
now, whether there was evidence that the
opportunity would improve the maternity journey
and how we could go about implementing each
opportunity.
On 15 March, Canterbury DHB‘s Board endorsed
the direction of the document, which enables
each opportunity to progress as outlined in the
document.
To read the full document, go to:
http://www.cdhb.govt.nz/communications/documents/
the_maternity_journey_2012.pdf
Sam Burke
Director of Midwifery
Maternity and NICU Social Work
Services at Christchurch Women’s
Hospital, April 2012, – Support
Advocacy and Information
Keryn Burroughs is the Team Leader of our team
of 11 Social Workers, which includes Maternity
Social Workers - Sylvia Cramer (pager 5498),
Fiona Lothian (pager 5116) and Caroline Oliver
(pager 8745). Social Workers on NICU Ward and
covering Fetal Medicine are Nicci Weild (pager
5400), Fleur Harraway (pager 5100) and MaryAnne Beckingsale.
We are all qualified and experienced Social Work
professionals. One of our goals is to work with
help reduce stress in order for the parents to
attach and experience the most positive start they
can with baby.
Both teams of Social Workers routinely offer
advocacy, support and information as appropriate
with relationship difficulties, financial stress,
decision-making, stress management, anxiety,
family violence, attachment and bonding.
We value working alongside LMC‘s to try and
keep the communication lines between us open.
We all provide a service to in-patients, but also
with out-patients. We welcome referrals from
LMC‘s as early as possible, when they have
concerns about their client and her family. The
earlier that we receive a referral, the more we are
able to offer in terms of support and planning, and
the agencies we mostly refer to, have waiting
lists.
Where there are care and protection concerns for
the unborn or new-born baby, or other family
members, it is important to make that referral to
Social Work, especially now the Crimes Act has a
section 195a covering the offence of ―Failure to
protect child or vulnerable adult‖. Since 19 March
2012, we as health professionals have an
additional responsibility, and potential criminal
liability, for a failure to protect a vulnerable person
from the potential actions of others. A vulnerable
person is defined as ―a person unable, by reason
of detention, age, sickness, mental impairment or
any other cause, to withdraw himself or herself,
from the care or charge of another person‖.
We regularly liaise with CYF, the Police Family
Safety Team and put referrals through to the
CDHB Child and Family Safety Service (formerly
SCAN), so that concerns about a baby can be
noted on the database. We find it useful to have
professional planning meetings where you, the
LMC, CPS, CYF and CWH Social workers and
other pivotal workers involved in the case can
meet to plan for delivery and discharge details,
especially if there are aspects of security to
consider. We work alongside Kathy Simmons,
Maori Health Worker in many cases, and many
clients appreciate this additional help.
Together with the hospital staff, we work with the
parents and family when there is a still birth or
infant loss, and try and tailor our interventions to
the particular situation of the family, and their
wishes.
We appreciate the close working
relationship that we have with SANDS (Stillbirth
7
and Newborn Death Support), who will provide ongoing support to families.
Given that security of mother, baby, and hospital staff is sometimes an issue in our cases, and CYF
notifications might have to be made confidentially, we do appreciate patients following the process of
applying to Patient Information for copies of their medical file (the process should take less than 21
days). They should only view their file in the presence of a health professional that is aware of the
complexities of the social component of the case. NICU staff do not allow parents to read their baby‘s
file as they may read something, not understand it, and become upset.
Please call us at any time if you want to discuss a case. We welcome your questions and may be able
to point you in the right direction, sometimes without a referral to us being required. If you need Social
Work referral forms faxed to you, please contact the Social Work Secretary (Monday to Friday, 08.00
– 16.30) on 3644441, ext 85441, fax 3644001.
Nicci Weild, Fleur Harraway, Mary-Anne Beckingsale (NICU).
Keryn Burroughs, Fiona Lothian, Sylvia Cramer and Caroline Oliver (Maternity).
Midwife and Social Work Liaison Meeting
All Midwives and Social Workers
are welcome to attend this valuable meeting
Dates:
Time:
Venue:
Wednesday 13th June
9.30am
Seminar room, O&G Dept, Level 3, CWH
and
Dates:
Time:
Venue:
Tuesday 4th September
9.30am
Seminar Room, Maternity, Level 5, CWH
8
Antenatal HIV Screening
Programme Update
This quarter, I would like to share a woman‘s
own story with you. This is Olivia‘s story, a
woman who would never have expected to be at
risk of HIV.
Mum with HIV positive son encourages
women to get tested during pregnancy
When Olivia was pregnant with her second son
in 1994, her doctor feared she had leukemia. A
blood test found her platelets were low and she
was tested for cancer.
“But I wasn’t tested for HIV as I didn’t fall into that
bracket of people who were thought to be at risk.
I was married with one son already.”
Eventually, the doctor decided the cause of her
low platelets was unexplained and it would right
itself after she had her baby.
“But it didn’t come right after he was born, so
they took out my spleen.”
Then the bombshell hit. When her son was just
one year old, her husband was tested and found
to be HIV positive. She and their sons were
tested and it was found that both she and her
second-born child were also HIV positive. Blood
taken when she was pregnant was also tested
and it was found that, at the time, she already
had HIV.
“If I had known when I was carrying him, I would
have been treated and my son’s chances of
being born with the virus would have been
substantially reduced. And I wouldn’t have had to
have my spleen removed.”
Olivia has since had a third son and, because of
the treatment she was given, he did not get the
virus. She was put on special medication in the
third trimester of her pregnancy and her viral load
was brought right down for the birth – the riskiest
time for passing on the virus to the baby.
Her son was also given medication for the first
six weeks after he was born and he had a series
of blood tests to make sure he didn’t have HIV.
Olivia says anyone who is pregnant should be
screened for HIV, whether they think they are
likely to have it or not.
“It’s worth it for your piece of mind. I didn’t have a
clue my husband would be HIV positive.”
Olivia says discovering she and her son were HIV
positive was very tough but support from Positive
Women and talking with other HIV positive
women helped her through.
She has since remarried and says her second
husband was amazing after the initial shock of
learning she had HIV.
“There are still a few knights in shining armour
out there!”
I hope this story strikes a chord, there may be
more women in our community, who do not see
themselves as being at risk, and it is our duty as
practitioners to ensure women are fully informed
of the risks to themselves and their baby if they
go untested.
I have now moved into a new office with the rest
of the Community & Public Health staff.
My contact details are:
Janette Philp
Antenatal HIV Screening Coordinator
310 Manchester Street
PO Box 1475
Christchurch 8140
DDI (03) 3786 794
Int 82794
Now available GBS alert stickers
to highlight need for
intravenous antibiotics for
Group B Streptococcus
(GBS) positive women.
These can be used on drug
charts and medical records.
This initiative has come about following an
incident, where there was a failure to give IV
antibiotics to a woman who was GBS positive in
labour and consequently, her baby became ill
and was admitted to the Neonatal Unit.
For supplies of these stickers for hospital and
LMC, please contact Document Coordinator:
Linda Haisman at linda.haisman@cdhb.health.nz
9
An update for LMC’s if they are having problems downloading the GROW
SOFTWARE
GROW:
1.
2.
3.
4.
5.
6.
Automatically generates BMI which is essential for early pregnancy risk selection.
Generates a graph of fundal height and estimated optimal fetal weight for an individual
woman.
Increases antenatal detection of the growth-restricted baby.
Reduces the need for scanning in small women who have babies that are appropriately sized
for them.
Enables birthweight centiles to be generated for previous babies - if a previous SGA baby is
identified, low dose aspirin should be given and serial growth scans planned.
The fundal height component is not reliable in women >100kg but the estimated weight from
scans, if performed, can be charted on GROW.
Simple Instructions for how to download and use.
1.
Go to http://www.gestation.net/fetal_growth/download_grow.htm
2.
Select download GROW
3.
4.
5.
6.
Download NZ Edition (as of Feb 2012, it will be GROW v8.2), enter your details, press
Submit and follow the installation instructions.
When GROW is installed, go to Start to find it on your computer, then to All Programs, then
to Gestation Network, then to GROW chart. (To create a shortcut on your desktop, hold
down the control button and click/hold on GROW chart icon in the menu and drag to your
desktop).
Enter all required information into the top left hand corner of the chart and press Generate
Chart. If a woman has had a previous baby, then a popup box will appear requesting baby
details to be entered in birth order. This will calculate the customized centile for each
offspring and place it on the top of the graph.
If you have any problems downloading or using this program, please e-mail grow@pi.nhs.uk
10
CE NT IL E C AL C UL AT O R : used to develop a customised birthweight centile ‗after birth’ – February
2012
Use of customised centiles identifies babies at higher risk of morbidity and mortality than are identified
using population based centiles.
To download from Gestation Network:
1.
Go to http://www.gestation.net/register/centilereg/select_edition.htm
2.
Click on Download for the ‗New Zealand calculator‘.
3.
Enter your details, submit and then click on ’Click here to download’ and follow instructions.
4.
When the individual centile calculator is installed, to find it on your computer go to Start, then to
All Programs, Individual Centile Calculator for New Zealand v5.16. (To create a shortcut on
your desktop, hold down the control button and click/hold the Individual Centile Calculator for
New Zealand v5.16 application icon in the menu and drag to your desk top).
To use the centile calculator after delivery, enter the delivery gestation in weeks and days,
the parity before delivery, booking weight and height, infant‘s birth-weight and sex. The
centile will then be calculated.
Some tips about ethnicity - for Samoan women, use ‗Other‘ or ‗Unclassified‘, as this will
generate the correct centile (this bug is anticipated to be corrected in future versions).
If you have any problems downloading or using this program, please e-mail
grow@pi.nhs.uk
Di Leishman
PMMRC Coordinator
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Update on CHIPS, PROMPT and PROGRESS
Trials
20-34 weeks. Half will have progesterone, while
the others receive a placebo.
CHIPS TRIAL
At CWH, we have recruited 46 women. Currently,
there are 10 women on the trial. Only 27 to go to
meet the target of 984.
Control of Hypertension in
Pregnancy Study
The CHIPS trial is looking at
what
is
the
best
management for women with
pre-existing
hypertension
and
pregnancy-induced
hypertension (PIH). It is a randomised control trial
to decide whether ‗tight‘ or ‗less-tight‘ blood
pressure control is more optimal for pregnant
women and their babies.
To date, 823 women have been recruited
internationally, only 205 to recruit. CWH have
recruited 13 women.
CHIPS - Child Study
The CHIPS-Child study is currently gaining ethics
approval and this is the follow up of babies born
to mothers who were part of the chips trial.
Growth of the babies will be measured at age
1,2,3,4 and 5 years. The CHIPS - Child Sub
Study is designed to find out if blood pressure
management during pregnancy affects baby‘s
potential growth.
PPROMT
Preterm Prelabour Rupture of Membranes
Close To Term Trial is a randomised control
trial for women who rupture their membranes
between 34 to 36 weeks and do not go into
labour.
Women will be randomised into either early
planned birth or expectant management. Early
planned birth will be delivered as soon as
possible usually within 24 hours. In the expectant
management group, the birth will occur after
spontaneous labour or if clinically indicated.
At CWH, we have recruited 30 women,1270
women recruited internationally and 1812
required.
PROGRESS
Progesterone After Previous Preterm Birth
for the Prevention of Neonatal Respiratory
Distress Syndrome
The Progress trial is a randomised control trial for
women with a history of previous pre-term
I work 4½ days a week for the
Otago University O&G Department as Research Midwife and
can be contacted on:
Di Leishman
Phone 3644 631
Cell
027 5316131
Email di.leishman@otago.ac.nz
The Role of the CNP Hormone in
Pregnancy
A research group from the
University of Otago, Christchurch is
calling on first time mothers to be
part of some exciting research into
the effects hormones play on fetal
growth.
C-type Natriuretic Peptide (CNP) – a growth
hormone, has recently been discovered to act as
a vital signal for fetal growth.
Professor Eric Espiner from the Christchurch
Cardioendocrine Group of the University of
Otago, Christchurch and Dr Rosemary Reid from
the Dept of Obstetrics and Gynaecology,
Christchurch Women‘s Hospital, explain that
discovering how CNP is involved in growth and
development requires precise collection and
processing of blood samples.
―Normally, very little of the tissue hormone enters
the bloodstream. However, in a world first, a new
approach has been developed by the
Christchurch Cardioendocrine Group . A specific
test has been developed to measure a product of
CNP in the blood,‖ Professor Espiner says.
―Recent work in pregnant sheep shows that CNP
is produced by the placenta and that the level in
maternal plasma reflects the stage of the unborn
lamb‘s growth and welfare. Another finding in
these ovine studies is that when there is a threat
to the nutrient supply to the fetus, e.g. restricted
placental flow, there is a reciprocal increase in
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maternal CNP and concurrent fall in fetal CNP.‖
Together, these findings suggest that CNP is
carefully regulated during pregnancy and may
have an important place in maintaining nutrient
supply to the fetus, Professor Espiner says.
―It is not yet known whether similar findings occur
in human pregnancy as there has been no serial
study to our knowledge of human maternal or
placental levels of CNP. Therefore, we have
started a new research study aimed at increasing
our basic understanding of CNP‘s involvement in
human pregnancy where we will study the links
between the production of CNP by the placenta,
maternal changes in CNP and fetal growth and
welfare.‖
Impaired function of the placenta is an important
cause of intrauterine growth restriction and preeclampsia, which are themselves major
contributors to fetal loss and perinatal morbidity
and mortality in New Zealand.
This research study has the potential to open up
new methods of detecting fetal growth restriction
and distress, as signalled by the placenta‘s
response, thereby allowing timely interventions
and improved treatment strategies.
Preliminary results (from a small group of enrolled
subjects) already indicate that maternal levels of
CNP increase markedly in some women. But to
fully understand and interpret these changes, we
need to enrol more women –particularly those in
their first pregnancy.
Trainee Interns - Sixth Year Medical
Students
Trainee Interns (TI‘s) have a four-week
attachment in Obstetrics and Gynaecology at
Christchurch Women‘s Hospital with eight
students in each group.
The Dept of O&G is very keen for TI‘s to gain
experience of community-based midwifery care
and so over the past two years, we have had a
student placed with an independent LMC midwife
for 1-2 days.
This has been very successful and has been a
positive experience for both midwives and
students. It has been a valuable opportunity for
students to gain experience in working closely
with a midwife and observing how midwives work
in partnership with women. This experience also
gives students an understanding of the issues
around primary health care in the community.
The Dept is keen to expand this scheme and is
seeking more midwives who would be willing to
have a student placed with them. This could be a
combination of home visits and/or clinic, and the
commitment need be as much or as little as suits
your workload.
This work is remunerated and this will be
discussed with any interested applicants.
If you are interested in hearing more, please
contact:
The study involves women having three extra
blood tests and three extra ultrasound scans
during their pregnancy.
Barbra Pullar
Research Midwife:
For more information contact:
barbra.pullar@otago.ac.nz
Tel: 3644625
Barbra Pullar, Research Midwife
3644 625 / 027 521 7434
barbra.pullar@otago.ac.nz
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Highlight on Herpes Simplex
A recent case has focussed our attention on how
aggressive and devastating this virus can be and
felt that a summary with some key points may
raise awareness and help guide LMC‘s.
Refer to guidelines for the management of genital
herpes in New Zealand – 9th edition 2009
www.herpes.org.nz
Antenatal
Pregnant women should be asked about a
history of genital herpes in them and in their
partners early in the pregnancy
An assessment can then be made on the risk
to the fetus
Information can be given on the potential
risks of transmission in pregnancy to the fetus
and to the neonate around delivery
Strategies can be offered to try to avoid
transmission in pregnancy if the mother has
not had genital herpes but the father has. For
example, using condoms and avoiding
contact when lesions are present.
Clinical diagnosis of genital herpes is often
inaccurate and should be confirmed with
swabs of lesions being sent for herpes PCR
Women with active lesions in pregnancy
should have a consultation with
an
obstetrician (Section 88)
Different modes of delivery should be
discussed with an obstetrician for potential
clinical scenarios at the time of birth
Oral acyclovir from 36 weeks gestation (in
those known to have recurrent herpes)
decreases the chance of having lesions at the
time of delivery and reduces the need for a
caesarean section.
Primary infection
recently acquired infection
no maternal antibodies to provide protection
for the fetus
however, can be asymptomatic with no
evidence of any lesions
however, may be the first time lesions are
seen
can also be asymptomatic with no lesions
present
maternal antibodies will be present and can
confirm recurrence status
Postnatal
Most neonatal HSV infections (70%) are
acquired from mothers with unrecognised
herpes infection acquired in pregnancy so
there needs to be an index of suspicion to be
able to diagnose this disease despite the
absence of maternal symptoms.
85% of neonatal herpes is acquired in labour
Risk Factors
primary infection in the mother
forceps/ventouse
preterm delivery
scalp electrode
prolonged rupture of membranes
skin trauma
Primary Infection
57% chance of transmission to baby
if this is known to be present at birth then
deliver by LSCS
LSCS, however, does not completely
eradicate risk of transmission
Recurrence
2% chance of transmission to baby
can offer delivery by LSCS if lesions are
present but this is not absolutely required as
maternal antibodies offer protection
Neonatal Presentation
Neonates can present in many ways and the
signs can be subtle so again herpes needs to be
thought of even if the signs and symptoms are not
―textbook‖
Disseminated
acutely unwell with viraemia, respiratory
distress, jaundice, liver
failure and 90% die if untreated
CNS
Recurrence
will not be the first infection the person has
had
encephalitis from around day 10-28 of age
50% die if untreated and most survivors
have disability
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Skin/Eye/Mouth
these lesions are only vesicular in about 40%
so babies with lesions or rashes on the face
or scalp after known instrumentation/scalp
electrodes or on the buttocks with a breech
delivery could be herpetic and would need a
separate viral swab to be taken
usually associated with skin trauma
good prognosis if the rash is diagnosed and
treated, but, disease rapidly spreads if
untreated
Adrienne Lynn
Geeta Singh
Booster vaccinations are recommended for adults
(not funded) who work or live with infants, such as
healthcare workers, household members and
carers of infants
Neonatal Consultant
Obstetric Consultant
Pertussis Vaccination
Recently, there have been increasing numbers of
confirmed cases of Pertussis (Whooping Cough).
It can be potentially very serious in babies and
therefore it must be emphasized that timeliness of
vaccination according to the national
immunisation schedule is very important.
Reported infection rate in infants < 1 year old is
currently 4 per 1000, more than 10 times the
usual background rate.
Pertussis is highly contagious and especially
severe in infants under 1 year of age. Around 7
out of 10 babies who catch pertussis before the
age of 6 months require hospitalisation and 1 in
30 of those hospitalised die from pertussis
infection. There are very few true
contraindications to vaccinating and delaying
vaccination leaves babies vulnerable to disease
unnecessarily.
Some important
Pertussis:
points
to
consider
Delaying vaccination in babies by as little as
30 days increases the risk of hospitalisation
with pertussis by 4-6 times (Grant 2005)
Antibiotics do not treat the infection itself,
they only stop someone from spreading the
infection, so once infected we can only treat
the symptoms as the infection runs its
course.
Babies need to have received their 6 week, 3
and 5 month vaccinations to ensure good
protection from pertussis.
about
Pertussis continuously circulates in our
communities, as there is always a pool of
susceptible adults.
Immunity from pertussis is not lifelong, either
from natural infection or vaccination.
Immunity last 4-6 years following
vaccination
Following the natural infection immunity
may last up to 7 years.
Mother‘s do not pass on immunity to pertussis
to their babies, as they do with other diseases
like Measles, unless they have received a
booster vaccination between 30-36 weeks
(ideally 31-33 weeks) of pregnancy.
Pertussis vaccinations are now funded for
pregnant women and immediately postpartum
Pertussis Vaccination is advised for all pregnant
women:
between 30 - 36 weeks of pregnancy.
up to 2 weeks post-partum for women
who choose not to be vaccinated in
pregnancy
Due to the current high level of pertussis in the
community, pertussis vaccination as Tdap
(Boostrix) containing inactivated tetanus,
diphtheria and acellular pertussis is
recommended and funded in Canterbury.
This results in passive antibody transfer via the
placenta to the baby. This may prevent 2 out of 3
cases of infection. These antibodies decrease at
6 weeks of age. For maximum protection, infants
should therefore commence their vaccinations at
6 weeks.
Most adults will not have had this particular
pertussis vaccine as Boostrix was introduced in
2005. Women with a previous history of other
pertussis vaccines should also receive this Tdap
booster.
Questions about vaccinations?
Locally, Jayne or Susie
Immunisation, 03 383 9332
at
Canterbury
Di/Ann/Glenys at Pegasus Health, PHO 379 1739
www.immune.org.nz or 0800 IMMUNE (466863)
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Influenza Vaccination in Pregnant
Women
very comfortable, my wife and son were going to
be well taken care of.
Pregnant women have significantly more
complications associated with influenza illness
than other groups.
Burwood
I wanted to express my absolute gratitude and
thanks for all the staff at Burwood Post Natal Unit.
The support that we received was certainly over
and above what I and my family expected. How
the staff treat everyone is fantastic.
Seasonal influenza vaccination is strongly
recommended for all women who will be pregnant
during the influenza season. The influenza
vaccine has been shown to be safe and effective
for pregnant women in all trimesters, vaccination
during pregnancy protects the pregnant woman
and her fetus, as well as the new mother and her
newborn baby.
Maternal influenza vaccination protects TWO high
risk groups. Influenza vaccine can be safely given
to lactating women.
For more information:
Flu Pregancy FAQ
060312.pdf
http://www.ranzcog.edu.au/womens-health/statements-a-guidelines/
new-a-revised-statements-and-guidelines/744influenzavaccinationforpregnantwomenc-obs45.html
It is strongly recommended that all healthcare
workers are vaccinated against influenza
annually, to protect themselves and those in their
care.
Visit the CDHB intranet to access information
about the influenza vaccination clinics at the
different CDHB sites or contact the CDHB
Occupational Health Department.
Article written by:
Jayne Thomas, Immunisation Co-ordinator,
Canterbury Immunisation;
Ann Fraser, Immunisation Co-ordinator, Pegasus
Health;
Margaret Kyle, NZCOM representative for ISLA.
Consumer Feedback
Maternity, Neonatal & Birthing Suite
Absolutely fantastic - brilliant staff, capable,
confident, friendly and reassuring. It made me
The staff were amazing, so friendly and helpful,
all of the time, they had so much patience. They
all do an amazing job. I would recommend
Burwood as the place to come after giving birth.
Rangiora
Thank you so much for a relaxing, rehabilitating
stay after my 81 hr labour. The staff have been
very accommodating with my vegetarian, glutenfree diet and have allowed me to stay on extra
night, which was honestly invaluable to me. I
appreciate all the support, also with breast
feeding. I feel much more confident.
I had an awesome time in Rangiora Hospital. I am
amazed how friendly, kind and wonderful staff
are. They come to me and ask how I am and
baby doing all the time. I feel like I am staying in
my house, feels like a homely environment. All
staff are great to us. Thank you very much for
your traditional service, which I heard people
talking about before I came to stay here.
Lincoln
Superb service, wonderful facility, nice and calm
and relaxed. Excellent meals. Outstanding staff,
really enjoyed using Lincoln as a birthing facility,
and would definitely use again and recommend to
other families.
A very big thank you to the staff. Your patience
understanding and guidance has been nothing
short of amazing.
Your staff are amazing. Our daughter is our first
addition to the family, so we are both nervous
parents wanting the best for our wee one. They
were there every step of the way with great
advice and training to put us on the right path. As
a new dad, it was great to be
here as much as possible and
being able to have lunches and
inners together – great meals!
Thank you for our start as
being a family.
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