OP13.03: “Inverting the pyramid” of specialist antenatal care in Australia: the Initial Maternity Assessment and Planning Service

Implementation science methodology was used to redesign care in alignment with the inverted pyramid of antenatal care (Nicolaides et al.) at a tertiary unit in NSW, Australia. Gaps in preventative maternity care provision were identified and a codesign process empowered stakeholders to create a comprehensive population-based IMAP service incorporating current and emerging local guidelines for optimal early antenatal care. Final service design comprised the following elements for all women planning public maternity care, initiated at a visit scheduled at 11-14 weeks; 1) comprehensive ultrasound assessment (ISUOG guidelines), 2) aneuploidy and pre-eclampsia screening (FMF UK algorithm) and 3) complete intake review of obstetric, medical, and personal history with a dedicated midwife. An Obstetrician collated all information within a standardised protocol which provided comprehensive early pregnancy risk stratification including dating, early fetal anatomy, algorithm-based screening for aneuploidy and pre-eclampsia, and clinical risk-factor based assessment for fetal growth restriction, preterm birth, gestational diabetes, and venous thromboembolism. A consistent reporting template aimed to reduce the risk of inadvertent omission of any element of screening and assessment and ensure optimal communication between the woman, her primary care physician, and her maternity care providers. This is the first study describing the implementation of a population-based first trimester service which aligns with the principles of inverting the pyramid of antenatal care. Fragmented early pregnancy care has been described in a range of healthcare settings and this study confirms the feasibility of a redesigned approach to first trimester specialist maternity care.