Antenatal Care
NICE guideline [NG201] Antenatal care. Published: Aug 2021.
NHS: Pregnancy: Pregnancy (antenatal) care, checks and screening tests: Your antenatal appointments. Last revised: Apr 2023.
Antenatal Timetable / Schedule
Disclaimer:
This does NOT represent the full antenatal timetable and has been condensed and simplified for educational and exam purposes.
Key exam-relevant points are highlighted in bold.
1st Trimester (≤ 12 Weeks)
| Gestation (weeks) | Key actions | Routine checks |
|---|---|---|
| 8-12 | Booking appointment
|
|
| 11-14 | 1) Dating scan – ultrasound
2) Combined test
|
2nd Trimester (13-27 Weeks)
| Gestation | Key actions | Routine checks |
|---|---|---|
| 16 | Review and discuss test results (booking bloods, screening tests) + give information on anomaly scan
Consider iron supplementation if anaemia identified on FBC (see the Anaemia in Pregnancy article for more information) |
|
| 18-21 | 1) Anomaly scan (ultrasound to screen 11 structural conditions – see the Fetal Anomaly Screening Programme for more information)
2) Offer whooping cough (pertussis) vaccine |
|
| 25 | This is only necessary in 1st pregnancy (i.e. only in nulliparity but not in multiparity)
|
|
| 24-28 | Offer OGTT to screen for gestational diabetes if at risk – ANY of the following:
See the Diabetes in Pregnancy article for more information |
3rd Trimester (≥ 28 Weeks)
| Gestation | Key actions | Routine checks (basically the same throughout) |
|---|---|---|
| 28 | 1) Repeat FBC, blood group (including Rhesus), antibody screen
2) 1st anti-D prophylaxis if Rhesus -ve and non-sensitised 3) Offer RSV vaccine 4) Discuss labour, birth and newborn care |
|
| 31 | This is only necessary in 1st pregnancy (i.e. only in nulliparity but not in multiparity) |
|
| 34 | 1) 2nd anti-D prophylaxis if Rhesus -ve and non-sensitised
2) Discuss birth plan |
|
| 36 | Check fetal presentation
If breech presentation → discuss options (ECV vs elective C-section vs breech vaginal delivery) (see the Breech Presentation article for more information) Provide information: breastfeeding, newborn screening, vitamin K, postnatal mental health |
|
| 38 | Review birth preferences
Discuss post-dates management options |
|
| 40 | This is only necessary in 1st pregnancy (i.e. only in nulliparity but not in multiparity)
|
|
| 41 | Offer membrane sweep
Discuss and offer induction of labour (see the Induction of Labour article for more information) |
|
| 42 | If induction of labour declined → offer increased fetal monitoring |
|
Extra Information
General Advice / Management
Sleeping Position
Advise women to avoid sleeping on their backs after 28 weeks of pregnancy
- Rationale: there may be a link between sleeping on the back and stillbirth in late pregnancy
- Consider using pillows to maintain their position while sleeping
Management of Common Problems During Pregnancy
| Problem | Management |
|---|---|
| Nausea and vomiting | Reassure that mild to moderate nausea and vomiting are common and are likely to resolve before 16-20 weeks
See the Nausea and Vomiting and Hyperemesis Gravidarum in Pregnancy article for more information. |
| Heart burn | Consider a trial of an antacid or alginate (avoid PPIs)
Offer lifestyle and dietary changes (see the Gastro-Oesophageal Reflux Disease (GORD) article for more information) |
| Symptomatic vaginal discharge | Advise pregnant women who have vaginal discharge that this is common during pregnancy.
However, the presence of symptoms (e.g. itching, soreness, offensive smell, dysuria) may indicate an underlying infection. |
| Pelvic girdle pain | Consider referral to physiotherapy for exercise advice and/or non-rigid lumbopelvic belt |
| Unexplained vaginal bleeding after 13 weeks | Refer to secondary care
Offer anti-D immunoglobulin if they are rhesus D-negative AND at risk of isoimmunisation |
Routine Checks
Key routine checks:
| Check | Purpose |
|---|---|
| Blood pressure | Screen for gestational hypertension / pre-eclampsia (see the Hypertension in Pregnancy article for more information) |
| Urinalysis | Screen for proteinuria (possible pre-eclampsia) and asymptomatic bacteruia which requires active treatment (see the Urinary Tract Infection (UTI) in Adults article for more information) |
| SFH | Monitor fetal growth
Check for growth restriction or macrosomia |
| Fetal movements | Assess fetal wellbeing
See the Reduced Fetal Movement (RFM) article for more information |
Combined Test and Anomaly Scan
More details are discussed in the Fetal Anomaly Screening Programme article.
Anti-D Prophylaxis
Routine antenatal anti-D prophylaxis (RAADP) is recommended for all pregnant women who are: [Ref]
- Rhesus D negative (confirmed on blood group typing), AND
- Not known to be sensitised to the RhD antigen (confirmed on antibody screen / indirect Coombs test)
Dosing: [Ref]
- Most common: 2 doses of anti-D immunoglobulin: one at 28 weeks and one at 34 weeks
- Single dose at 28 weeks OR between 28-30 weeks is also possible
Vaccines in Pregnancy
4 main vaccines are recommended in pregnancy
- Seasonal flu vaccine (any trimester)
- COVID-19 vaccine (recommended throughout pregnancy)
- Pertussis (whooping cough) vaccine – ideally 20-30 weeks
- RSV vaccine – from 28 weeks (protects baby from serious RSV in the first month)