New Victorian Maternity eHandbook

Medical Indemnity InsuranceThe Victorian Maternity and Newborn Clinical Network (VMNCN) of Safer Care Victoria launched a Maternity eHandbook on 22 August 2017 which offers readily available information on pathways of care, in the context of a range of obstetric presentations. It is the culmination of a project spanning over approximately 4 years, which involved drawing on existing information and guidelines to collate a guidance on best practice easily accessed via the following link:

The maternity eHandbook is modelled on the success of the existing Neonatal eHandbook. It was developed in consultation with stakeholders, including a state-wide survey which was conducted addressing questions as to desired content, top 3 areas of clinical concern, and inquiries into recent ‘near misses’. The survey results were cross-referenced with perinatal performance indicators, PIPER transfers, and coronial recommendations in order to prioritise focus areas.

The project involved a multi-disciplinary clinical subcommittee representing all service level capabilities across Victoria, and a project officer (experienced midwife). The eHandbook was developed by the subcommittee with assistance of senior project officers.

The Maternity eHandbook takes the form of ‘guidance’ as opposed to ‘guidelines’ and as such, it is a ‘living’ document intended to be responsive to change. It is considered that consumer input is critical to its success, and feedback (including new evidence) to VMNCN is welcome via:

Amongst other things, the guidance offers audit tools relevant to each clinical pathway provided. It seeks to unify obstetric practice across Victoria by aligning variations in treatment and consolidating evidence-based practice in a simple fashion, providing practical advice on assessment, management and escalation of a range of clinical scenarios. It is intended to be applicable to all health services across Victoria, and while it aims to reduce variations it is acknowledged that modifications by individual services will be inevitable, and subject to clinical judgment.

Information and advice (such as on assessment, management, planning of care and follow up), including patient information (eg. in relation to DFM), is provided in the pathways of care – which cover various clinical scenarios, namely:

  1. Induction of labor (IOL): Builds on and updates existing guidelines – includes expanded indications, methods of induction, low volume oxytocin infusion, quick reference flowchart for process and assessment, IOL booking form template.
  2. Decreased fetal movements (DFM): Emphasises prompt assessment of all episodes (given association between DFM and poor obstetric outcomes), links to PSANZ information for women (available in 8 languages), flowchart for assessment and management (amalgamated and kept as simple possible).
  3. PROM (pre-labour rupture of membranes) and PPROM (pre-term pre-labour rupture of membranes): Antibiotic regimes for PROM and PPROM have been aligned with preterm labor (and those in the Neonatal eHandbook); for PROM – patient information including self-assessment if patient goes home for expectant management, advice on risk factors and active/expectant management, management of newborn; for PPROM – 3 gestation-specific flowcharts for assessment and management, focus on awareness of service capability, advice on corticosteroids, tocolysis, and magnesium sulfate (aligned with pre-term labor pathway), emphasis on early consultation with PIPER if required.
  4. Pre-term labour: Emphasis on awareness of service capability, quick reference flowcharts for assessment and management, antibiotic regime aligned with PROM and PPROM and Neonatal eHandbook, emphasis on early consultation with PIPER if required.

A guidance on maternal obesity is pending, in recognition of increased risk in pregnancy directly associated with high BMI and the variation in management within this patient group between health services.

Any questions about the application or significance of this eHandbook to your private practice can be directed to your medical indemnity insurer.

This publication is general in nature and is not comprehensive or constitute legal or medical advice. You should seek legal, medical or other professional advice before relying on any content, and practice proper clinical decision making with regard to individual circumstances. Persons implementing any recommendations contained in this publication must exercise their own independent skill or judgment or seek appropriate professional advice relevant to their own particular practice. Compliance with any recommendations will not in any way guarantee discharge of the duty of care owed to patients and others coming into contact with the health professional or practice. Tego Insurance Pty Ltd is not responsible to you or anyone else for any loss su­ffered in connection with the use of this information.