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Routine Antenatal Care

According to Antenatal Care Guidelines developed by the National Institute for Health and care Excellence, here are the minimum set of tests for routine antenatal care:

First contact with health professional

  • Give specific information on folic acid supplements, food hygiene, healthy lifestyle, and all antenatal screening
  • offer information about screening for sickle cell diseases and thalassaemias.
  • Give information about the anomaly scan and let them know that this gives them a chance to terminate pregnancy, prepare for treatment or care of disability, manage the birth in a specialist center, and have intrauterine therapy. Inform them of the limitations of ultrasound screening and that the detection rates vary by the type of anomaly, pregnant person’s BMI, and the position of the fetus at the time of the scan.

At booking

  • Explain the development of pregnancy, nutrition and diet (including vitamin D supplements), exercising (including pelvic floor exercises)
  • start planning the place of birth
  • information about breastfeeding and workshops in the area
  • information on participant-led classes
  • information on maternity benefits.
  • Identify people who may need additional care and plan pattern of care for the pregnancy.
  • Measure blood pressure and test urine for proteinuria (pre-eclampsia)
  • Inform those under 25 of the high prevalence of chlamydia in their age group and give details about STI screening.
  • Offer early ultrasound scan for gestational age assessment and structural anomalies.
  • Ask about mental health, ask about mood to identify possible depression.
  • Ask about occupation to identify potential risks.
  • Haemoglobinopathies screen
  • Blood group and rhesus D status
  • Hepatitis B virus screen
  • HIV screen
  • Rubella susceptibility
  • Syphilis screen
  • MSU for asymptomatic bacteriuria
  • risk of venous thromboembolism evaluated (previous VTE, thrombophilia, medical comorbidities, surgical procedures such as appendicectomy, age about 35, BMI above 30kg/m, 3 or more children, smoker, varicose veins, systemic infection, immobility, pre-eclampsia, dehydration, etc.)
  • test for gestational diabetes if there is an identified risk (height, weight, family history, ethnic group, previous pregnancies, etc)
  • measure Height, weight, and body mass index and give health advice.

After 10 weeks 0 days

  • Before 13 weeks 6 days: ultrasound scan to determine gestational age
  • Before 14 weeks 1 day: Combined test for Down Syndrome

16 weeks

  • Review, discuss, and record the results of any screenings.
  • Measure blood pressure and test urine for proteinuria (pre-eclampsia)
  • investigate if haemoglobin level is below 11g/100ml and consider iron supplements.
  • Give information on the routine anomaly scan to take place at 18 weeks.
  • offer those with significantly atypical red-cell alloantibodies a referral to a specialist.

After 14 weeks 2 days

  • Before 20 weeks 0 days: Serum quadruple test for Down Syndrome

All appointments

  • blood pressure
  • urine test for proteinuria

At booking and 28 weeks

  • Haemoglobin
  • Red-cell alloantibodies

18 weeks

Before 20 weeks 6 days: ultrasound screen for structural anomalies including

  • fetal echocardiography of fetal heart
  • detection of neural tube defects

25 weeks

only needed if you’ve never been pregnant before to measure blood pressure/test urine and measure and plot symphysis-fundal height

28 weeks

  • measure blood pressure/test urine
  • offer a second screening for anaemia and atypical red-cell alloantibodies.
  • investigate a haemoglobin level below 10.5g/100ml and consider iron supplements
  • offer anti-D prophylaxis to people who are rhesus D-negative
  • measure and plot symphysis-fundal height.

31 weeks

Only needed if you’ve never been pregnant; review, discuss, and record the results of screening taken at 28 weeks, measure blood pressure/test urine, measure and plot symphysis-fundal height

34 weeks

  • Review, discuss, and record results of screening taken at 28 weeks
  • measure blood pressure/test urine
  • offer second dose of anti-D prophylaxis to those who are D-negative
  • measure and plot symphysis-fundal height
  • give specific information on preparation for labor and birth including the birth plan, recognizing labor, and coping with pain.
  • Give information about cesarean section including indications of a need for c-section, what the procedure involves, risks and benefits, and implications for future pregnancies after c-section.

36 weeks

Fetus is approximately full term.

38 weeks

  • measure blood pressure/test urine
  • measure and plot symphysis-fundal height
  • give options for management of prolonged pregnancy.

40 weeks

only necessary if this is your first pregnancy; measure blood pressure/test urine, measure and plot symphysis-fundal height, and further discussion of management of prolonged pregnancy.

41 weeks

  • offer membrane sweep
  • offer induction of labor
  • measure blood pressure/test urine
  • measure and plot symphysis-fundal height

42 weeks

  • from this point on offer those who decline induction of labor increased monitoring (at least twice-weekly)

People should be able to make an informed choice about whether to accept or decline each tests, and notes should include a record of any tests offered and declined as well as the results of tests accepted