Maternity Workshop: Reinforcing Activity 2023

Metro North GP Alignment Program requirements include completion of a predisposing activity, attendance & participation at the workshop, completion of a reinforcing activity and completion of an evaluation. GPs will be awarded RACGP CPD Accredited Activity hours after attending the workshop.

Reinforcing Activity ID: 546725

This is a joint initiative between Metro North Health and Brisbane North PHN

Name:

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RACGP No.:

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Email:

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Please complete your Reinforcing Activity and Evaluation by 11 September 2023.

Activity 1

Access Referral Guidelines and other resources for GPs from the ‘Refer your patient’ page of the Metro North Health (MNH) website and Brisbane North ‘HealthPathways’.

Review the Metro North Health ‘Refer your patient’ Antenatal and Maternity Referral Guidelines, GP Education Maternity resources, and Brisbane North ‘HealthPathways’ Pregnancy pathways.

https://metronorth.health.qld.gov.au/specialist_service/refer-your-patient/antenatal-and-maternity

https://metronorth.health.qld.gov.au/refer-your-patient-page/gp-events/education-resources

https://brisbanenorth.communityhealthpathways.org/

(Username: Brisbane, Password: North)

Activity 2

To demonstrate your knowledge of safe and effective maternity care and to highlight your learning needs, please complete this assessment by ticking the correct response.

Unless stated, questions have only one correct response.

All questions relate to “Amy”.

“Amy”, a healthy 32 year old, has just had her pregnancy confirmed. She lives with her partner Tim.

They are very excited to be expecting their first baby.

You are the General Practitioner (GP) ordering Amy's initial screening tests at 12 weeks of pregnancy. Which of the following actions are required?

* required

a. Order a Full Blood Count, blood group and antibodies; Rubella, Hep B, Hep C, HIV, Syphilis serology; MSU.

b. Offer combined first trimester screening (nuchal translucency scan and first trimester screening blood test)

c. Offer to perform Cervical Screening Test if due.

d. All of the above.

Amy is 12 weeks pregnant. Which statement is NOT correct?

* required

a. Advise Amy if she has a Nuchal Translucency Scan (NTS), she will not require additional ultrasounds.

b. Appropriate timing for a NTS is between 11+0 to 13+6 weeks of pregnancy.

c. If Amy’s NTS demonstrates a chance of Down Syndrome of one in 300, she is to be referred to the hospital for counselling about options for further tests.

d. Screening for fetal chromosomal conditions should be discussed and offered to women of all ages.

Amy requests information about available models of maternity care. Which response is most appropriate?

* required

a. “As I am your regular GP and have ordered your initial tests, it would be best if you continue to see me for antenatal care”.

b. “I can give you some information and show you where to find information on the hospital website. We can discuss this further at your 2nd visit and I’ll indicate your preference on the hospital referral form”.

c. “As this is your first pregnancy you are not eligible for a midwifery model of care. You need to see a hospital doctor for all maternity care”.

d. “I recommend that you wait and discuss this with the midwife at the hospital booking in visit”.

In line with best practice communication between General Practitioners (GPs) and Hospital Clinicians, which of the following apply?

* required

a. GPs are to complete a GP Smart Referral or Maternity eReferral and send electronically to Metro North Central Patient Intake (CPI).

b. All investigations are to be followed up and reviewed by the clinician who ordered them.

c. GPs are to inform the obstetrician, obstetric registrar or GP liaison midwife of adverse events.

d. All of the above

You calculate Amy’s pre pregnancy BMI at 23 kg/m2. What advice or action is most appropriate?

* required

a. Explore diet and physical activity as Amy is overweight.

b. Consult with birthing facility to enable transfer of Amy from GP care to hospital obstetric care.

c. Reassure Amy that she is a healthy weight.

d. Explore diet and physical activity as Amy is underweight.

Amy has an Oral Glucose Tolerance Test (OGTT) as recommended between 24 and 28 weeks. The result is a fasting glucose level of 5.3 mmol/L. What does this mean?

* required

a. The result indicates Amy has Gestational Diabetes Mellitus (GDM)

b. The result is not indicative of GDM

c. Only if Amy has known risk factors for GDM would her results indicate that she has GDM

d. It is not clear if Amy has GDM as a diagnosis can only be made if her 1-hr glucose is 10.0mmol/L or greater and 2-hr glucose is 8.5 to 11.0 mmol/L.

10.

Amy brings healthy term 7 day old Jack to you for a routine post birth check. She asks you if she should continue keeping him in her room at night now that she is at home. Which of the following responses would be most appropriate?

* required

a. “Yes, it is recommended Jack sleeps in the same room as his caregiver for the first 6 to 12 months"”.

b. “It is a personal choice, but Jack needs to become familiar with his own room as soon as possible”.

c. “Rooming – in is only important whilst you are in hospital for security reasons”.

d. “No, ideally Jack will sleep in his own room, so you don’t disturb one another”.

11.

At 10 days postpartum, Amy has a temperature of 39°C and a tender red area on her right breast consistent with mastitis. Appropriate management of infective mastitis includes which of the following?

* required

a. Encourage Amy to express and discard her breast milk due to the presence of bacteria.

b. Advise Amy to supplement Jack’s feeds with infant formula as the fat concentration is lower than usual during acute infection

c. Advise Amy to express and discard her breast milk during antibiotic therapy.

d. Advise Amy to continue exclusive breastfeeding feeding with appropriate antibiotic use.

12.

At 4 weeks post-partum, Amy is diagnosed with depression. Which of the following statements is true in relation to perinatal depression?

* required

a. As antidepressant medication is contra-indicated in breastfeeding women, Amy should be advised to wean.

b. In Qld in 2018 and 2019, suicide was the leading cause of death of women during pregnancy and within a year of the end of pregnancy.

c. Pregnancy is protective for perinatal depression.

d. The Edinburgh Postnatal Depression Score (EPDS) is only to be administered if there are valid concerns about a woman’s mental health.

13.

If Amy was diagnosed with GDM, what would you include in your postnatal management?

* required

a. No further testing is required with a diagnosis of Gestational Diabetes Mellitus (GDM)

b. Perform a random blood glucose test at the routine 6 week post-partum visit

c. Order a repeat Oral Glucose Tolerance Test (OGTT) to be performed between 6 and 12 weeks postpartum.

d. Order a 50 gram one hour non-fasting Glucose Challenge Test (GCT) to be performed between 6 and 12 weeks postpartum.

Evaluation

Metro North GP Alignment Program requirements include completion of a predisposing activity, attendance & participation at the workshop, completion of a reinforcing activity, and completion of an evaluation. Pending RACGP approval, GPs will be awarded 3.0 Educational Activities (EA) and 4.5 Reviewing Performance (RP) hours after attending the workshop.

This evaluation provides an opportunity for comment and suggestions for the Metro North GP Alignment Program workshops. Your feedback is appreciated and is confidential.

Were Learning Outcomes of the program met?

Please rate to what degree the learning outcomes were met. Upon completion of this activity in relation to care provided for women and babies from pre-conception to 6 weeks post birth, you are able to:

14.

Choose effective referral pathways and options for maternity care that support patient centred continuity of care

* required

Entirely Met

Partially Met

Not Met

15.

Communicate effectively with Metro North birthing facilities and distinguish referral requirements that will enable an efficient hospital booking in process

* required

Entirely Met

Partially Met

Not Met

16.

Apply best practice to assess and manage care of patients with standard and complex pregnancies

* required

Entirely Met

Partially Met

Not Met

17.

Classify high risk features and common complications to determine indications and pathways for consultation and referral of high risk presentations

* required

Entirely Met

Partially Met

Not Met

18.

Locate and use relevant services within hospital and local community

* required

Entirely Met

Partially Met

Not Met

Did this CPD activity meet your expectation?

Please rate to what degree this CPD activity met your expectations about:

19.

Content:

Current, contemporary, evidence-based, and relevant to general practice

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20.

Delivery:

Engaging/interactive, e.g. with opportunities for questions and feedback

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21.

Presenters/Facilitators:

Engaging, qualified/skilled, and knowledgeable

Select option

22.

Comments

23.

Would you likely recommend this CPD activity to a colleague?

Select option

24.

Why:

25.

Would you likely change anything in your practice as a result of this CPD activity?

Select option

26.

Why

27.

What Maternity or other topics are you particularly interested in and/or would like included in future education events?

* required

28.

Which presentation/session did you find most useful?

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29.

Which presentation / session did you find least useful?

30.

If attending GP education events in future, which model of education would you prefer?

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31.

I would like to be informed of future Metro North GP education events

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32.

I would be interested in my name and contact details being included in a Metro North Health GP Shared Care Database

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33.

I consent to being contacted by a member of the Program team as part of the evaluation of the program

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