King Edward Memorial Hospital update

November 2024 updates

Not all non-invasive prenatal testing is for chromosomal conditions

A new Rhesus D (RhD) non-invasive prenatal testing (NIPT) is being offered to King Edward Memorial Hospital (KEMH) obstetric patients, bringing change to the management of Rhesus D negative pregnant people.

What do GPs need to know?

RhD negative pregnant people booked to deliver and receive antenatal care at KEMH will be offered the new RHD NIPT at 20 to 32 weeks’ gestation:

  • RhD negative women will not receive RhD Immunoglobulin (anti-D) during pregnancy if the fetus has been identified as being RhD negative using the new RHD NIPT. They are not at risk of developing antibodies to the RhD antigen.
  • Those women identified as carrying as RhD positive fetus will continue to receive RhD immunoglobulin (anti-D) as per current guidelines.Those pregnancies where the Rhesus status is unable to be determined using the RHD NIPT test will continue to receive RhD Immunoglobulin (anti-D) as per current guidelines.
  • The cord blood will be tested at delivery to confirm Rhesus status for all RhD negative women who deliver at KEMH, and RhD immunoglobulin will be given as per guidelines.
  • It is not possible to order the RHD NIPT test outside of KEMH currently due to the specific processes involved.The RHD NIPT test is different to fetal aneuploidy NIPT.
  • Potentially sensitising events before 20 weeks’ gestation will continue to be managed as per current guidelines, noting that RhD immunoglobulin (anti D) is not required for medical abortion less than ten weeks’ gestation.

A RHD NIPT patient fact sheet is available to download on the KEMH website under the letter R.

Update on Abortion Legislation Reform Act 2023

As of 27 September, the Abortion Legislation Reform Bill 2023 received Royal Assent and is now an Act of Parliament. However, this Act has not yet commenced, so the previous Legislation is still current. Women and Newborn Health Service welcomes the changes that the legislative reform will bring to women and pregnant people seeking an abortion across Western Australia.

At present, our service remains unchanged whilst we work towards fully implementing changes under the Abortion Legislation Reform Act 2023. It is intended that the Act will become operational within six months of assent being given. If you are referring a patient for an abortion, continue to follow the current legislation until the new Act is operational.

Further information and resources for referrers:

Resources for consumers:

Queries regarding the new legislation can be directed to abortionlaws@health.wa.gov.au

Syphilis update

A new Alert for Clinicians from WA Department of Health was published October 2023 highlighting the Syphilis outbreak across Western Australia.

A reminder to test three times in every pregnancy – at the first antenatal visit, 28 weeks, and 36 weeks gestation as a minimum. Diagnosis and treatment in pregnancy can prevent congenital syphilis.

Add syphilis serology to routine STI testing. Test, treat & trace will help decrease the number of cases in WA.

GPs can also refer to the Silver Book STI/BBV management guidelines.

Dr Sarah Smith
Hospital Liaison GP
King Edward Memorial Hospital
KEMH_HLGP@health.wa.gov.au

June 2023
Uterine Cancer Awareness Month at KEMH – clinical considerations for WA GPs

Special update from King Edward Memorial Hospital Liaison GP, Dr Sarah Smith and Professor Paul Cohen, Western Australian Gynaecologic Cancer Service & Clinical Professor UWA Division of Obstetrics and Gynaecology, Medical School.

The King Edward Memorial Hospital (KEMH) Women & Newborn Health Service (WNHS) together with the Western Australian Gynaecologic Cancer Service (WAGCS), announces June 2023 as the inaugural Uterine Cancer Awareness month. The International Gynecologic Cancer Society (IGCS) has collaborated with over 25 partner organisations from around the world to establish this global initiative to promote community education and access to care for those affected by uterine­­ cancer. WNHS encourages all GPs to take a moment to consider uterine and endometrial cancer and learn more about how to prevent and diagnose this common cancer and support the survivors of uterine cancer in our community.

Throughout the month of June, WNHS encourages all GPs to take a moment to consider uterine and endometrial cancer and learn more about how to prevent and diagnose this common cancer and support the survivors of uterine cancer in our community.

What do GPs in Western Australia need to know about uterine cancer?

Uterine cancer is the most common gynaecologic cancer in Australia and the sixth most common cancer in women worldwide. It accounts for nearly 50 per cent of all gynaecologic cancer cases in high-income countries. Endometrial cancer represents 90-95 per cent of all uterine cancer diagnoses.

This year, Cancer Australia estimates 3300 new cases and 667 deaths from uterine cancer. Rates of uterine cancer continue to increase by almost 2 per cent per year in women younger than 50 years of age, and by one per cent per year in older women.While the associated mortality rates are also rising, the five-year survival rate is over 80 per cent. Many GPs will be caring for survivors of uterine cancer.

The most common presentation of uterine cancer is abnormal vaginal discharge or bleeding, particularly postmenopausal bleeding.  These early signs of potential cancer require further evaluation and investigation, including a transvaginal ultrasound with measurement of endometrial thickness and review of known risk factors for uterine cancer.  Almost 70 per cent of cases of uterine cancer can be diagnosed at an early stage following investigation of these symptoms.

There is currently no recommended screening test for uterine cancer.

What are the risk factors for uterine cancer?

Known risk factors include:

  • Oestrogen exposure – endogenous oestrogen such as obesity, metabolic syndrome, polycystic ovarian syndrome, hormonal factors (e.g., age at menarche, parity, age at menopause);
  • Exogenous oestrogens such as tamoxifen in post-menopausal patients;
  • Menopausal hormonal therapy (unopposed oestrogen without a progestin); and
  • Familial cancer predisposition and known genetic risk profile.

Recognised modifiable risk factors for uterine cancer include obesity, diabetes, and hypertension.

How can GPs help women reduce the risk of uterine cancer?

The main lifestyle factor known to be associated with an increased risk of endometrial cancer is being overweight or obese. Cancer Australia estimates over a quarter of cases of endometrial cancer in Australia are due to overweight and obesity.

For every five-unit increase in BMI, the risk of endometrial cancer increases by 50 per cent. This means that a woman who is overweight is around 1.5 times more likely to develop endometrial cancer than a woman of healthy weight. A woman whose BMI is in the obese range is between two and 10 times more likely to develop endometrial cancer than a woman of healthy weight.

Encouraging women to be physically active and make lifestyle changes towards a healthy weight range will help reduce the risk of endometrial cancer.

How can GPs support survivors of uterine cancer?

The care of survivors of gynaecological cancers is often shared between the gynaecologic cancer service and the patient’s GP.  Holistic support of survivors includes identifying and managing treatment related side effects and psychosocial distress related to the cancer journey, management of co-morbidities and exploring and supporting the woman’s needs relating to her care and living well. See Cancer Australia’s Shared cancer follow-up and survivorship care: low-risk endometrial cancer.

Where can GPs find out more information and access education? 

Referring a patient with suspected uterine cancer

Detailed referral information for GPs is available on the HealthPathways WA websiteReferral information and contact details for the Western Australian Gynaecologic Cancer Service are available on the KEMH website.

For clinical advice regarding gynaecologic oncology issues, GPs are always welcome and encouraged to phone King Edward Memorial Hospital and ask to speak to the gynaecologic oncology fellow or the on-call gynaecologic oncology consultant on (08) 6458 2222.

The gynaecologic oncology clinical nurse liaison is available for general queries on (08) 6458 2222.

Dr Sarah Smith
Hospital Liaison GP
King Edward Memorial Hospital
KEMH_HLGP@health.wa.gov.au

April 2023
Western Australian Trophoblastic Centre at KEMH

Women & Newborn Health Service announces the start of a new, statewide trophoblastic disease service, the Western Australian Trophoblastic Centre (WATC) at King Edward Memorial Hospital (KEMH)

The long planned and awaited service will allow KEMH to provide centralised and specialised care to patients with trophoblastic diseases. This includes all patients with partial mole, complete mole, choriocarcinoma, atypical placental site nodule, placental site trophoblastic disease and epithelioid trophoblastic disease, regardless of the planned follow-up or treatment.

What does the Western Australian Trophoblastic Centre offer?

The service has several components:

  • A bespoke trophoblastic diseases patient registry
  • A multidisciplinary clinic involving nursing, oncology and psychology staff
  • A trophoblastic diseases multidisciplinary case conference
  • A specific clinic for the administration of low-risk chemotherapy (methotrexate)

The service is led by clinical nurse Marion Kember, who can be contacted at watc@health.wa.gov.au or 0403137408.

KEMH is keen to register all patients in WA with trophoblastic disease on the registry to gather a comprehensive idea of numbers and move into research with national and international collaboration in the future. KEMH hopes to standardise the care of all patients with trophoblastic disease, and part of registration includes access to their internationally consistent protocols for management of all trophoblastic disease.

The WATC is up and running and the multidisciplinary team clinic is on a Thursday afternoon, with the methotrexate clinics available alternate days on site at King Edward Memorial Hospital.

Referrals to Western Australian Trophoblastic Centre

As we transition the care of patients with trophoblastic diseases to the WATC, we would be grateful of assistance from referring GPs. The WATC aims to capture all existing as well as new trophoblastic disease patients in the registry and clinics. In addition to ensuring these women are registered with the service, we can provide follow up, discharge reviews, and long term follow up or ongoing registration, particularly as these patients are all at risk of recurrence.

We are seeing an increasing number of referrals to our service already, however we would ask that if a trophoblastic disease patient presents for review in your practice, that you contact Marion or send a referral via CRS to the service.  If at a hospital clinic, an ereferral can be sent. (WATC is in ereferrals under oncology) This will ensure that patients can be transitioned to the state-wide registry and service.

GP referral guidelines are available here

Trophoblastic diseases includes:

  • Any partial or complete molar pregnancy not receiving chemotherapy but having follow up BHCGs, regardless of where in their surveillance they are and regardless of whether their BHCG has already normalised.
  • Any trophoblastic disease patient currently on methotrexate, as these patients can be seen through our methotrexate clinic.
  • Any new diagnosis of trophoblastic disease (partial mole, complete mole, choriocarcinoma, atypical placental site nodule, placental site trophoblastic disease, epithelioid trophoblastic disease). You will notice on pathology reports moving forward that the conclusion includes information about the WATC and a request to refer new patients to the service.
  • Anyone else GPs think may benefit from this service, as we are trying to capture everyone.

Dr Sarah Smith
Hospital Liaison GP
King Edward Memorial Hospital
KEMH_HLGP@health.wa.gov.au

March 2023
KEMH on call consultants to provide advice to GPs

Women and Newborn Health Service (WNHS) at King Edward Memorial Hospital (KEMH) advise GPs that calls for advice regarding urgent referrals, gynaecological or obstetric issues during business hours (Monday to Friday) will be directed to the relevant On Call Consultant. After hours requests for advice will be directed to the On Call Registrar.

Ring the switchboard on (08) 6458 2222 and ask to speak with the On Call team, and your call will be directed to the Consultant first where possible:

  • For obstetric related issues at >20 weeks’ gestation, ask for the On Call Obstetrician
  • For gynaecological issues and obstetric issues <20 weeks’ gestation ask for the On Call Gynaecologist.
  • For maternal fetal medicine concerns ask for the On Call Maternal Fetal Medicine Consultant or Fellow.
  • See KEMH Maternal Fetal Medicine Team at WNHS
  • For gynaecologic cancer concerns, ask for the On Call Gynaecologic Oncology Consultant or Fellow KEMH Western Australian Gynaecologic Cancer Service
  • For early pregnancy assessment concerns, ask for the Early Pregnancy Assessment Service (EPAS) Clinical Nurse Midwife.

If your query is about a referral process to a clinic at King Edward Memorial Hospital, please refer to the appropriate page on the KEMH website.

Abortion care information available online

Sexual and reproductive health issues are prevalent in Australian media, with the current Senate Committee Inquiry into the universal access to reproductive health care. WHNS KEMH would like to remind GPs there is information available on the WNHS KEMH public website for GPs addressing abortion care in Western Australia, including the booklet Abortion Care: information and legal obligations for medical practitioners

There is information about the service provided at WNHS KEMH for those who have complex needs, and how to make a referral. The WNHS KEMH website also includes comprehensive information for those seeking information about pregnancy choices, KEMH Pregnancy choices (including abortion), including consumer booklets and information about support services.

Information is also available for GPs on the Healthpathways WA.

Dr Sarah Smith
Hospital Liaison GP
King Edward Memorial Hospital