Appendix D: Antenatal appointments (schedule and content)

Appendix D: Antenatal appointments (schedule and content)

[2008] The schedule below, which has been determined by the purpose of each appointment, presents the recommended number of antenatal care appointments for women who are healthy and whose pregnancies remain uncomplicated in the antenatal period: 10 appointments for nulliparous women and 7 for parous women. These appointments follow the woman's initial contact with a healthcare professional when she first presents with the pregnancy and from where she is referred into the maternity care system. This initial contact should be used as an opportunity to provide women with much of the information they need for pregnancy (see section 1.1.1 for recommendations on information giving).

First contact with a healthcare professional

Give information (supported by written information and antenatal classes), with an opportunity to discuss issues and ask questions. Refer to section 1.1.1 for more about giving antenatal information. Topics covered should include:

  • folic acid supplementation

  • food hygiene, including how to reduce the risk of a food‑acquired infection

  • lifestyle advice, including smoking cessation, recreational drug use and alcohol consumption

  • all antenatal screening, including risks and benefits of the screening tests.

Booking appointment (ideally by 10 weeks)

At the booking appointment, give the following information (supported by written information and antenatal classes), with an opportunity to discuss issues and ask questions. Refer to section 1.1.1 for more about giving antenatal information. Topics covered should include:

  • how the baby develops during pregnancy

  • nutrition and diet, including vitamin D supplementation

  • exercise, including pelvic floor exercises

  • antenatal screening, including risks and benefits of the screening tests

  • pregnancy care pathway

  • place of birth (refer to 'Intrapartum care' [NICE clinical guideline 55])

  • breastfeeding, including workshops

  • participant‑led antenatal classes

  • maternity benefits.

At this appointment:

  • identify women who may need additional care (see appendix C) and plan pattern of care for the pregnancy

  • check blood group and rhesus D status

  • offer screening for haemoglobinopathies, anaemia, red‑cell alloantibodies, hepatitis B virus, HIV, rubella susceptibility and syphilis

  • offer screening for asymptomatic bacteriuria

  • inform pregnant women younger than 25 years about the high prevalence of chlamydia infection in their age group, and give details of their local National Chlamydia Screening Programme

  • offering screening for Down's syndrome

  • offer early ultrasound scan for gestational age assessment

  • offer ultrasound screening for structural anomalies

  • measure height, weight and calculate body mass index

  • measure blood pressure and test urine for proteinuria

  • offer screening for gestational diabetes and pre‑eclampsia using risk factors

  • identify women who have had genital mutilation

  • ask about any past or present severe mental illness or psychiatric treatment

  • ask about mood to identify possible depression

  • ask about the woman's occupation to identify potential risks.

At the booking appointment, for women who choose to have screening, the following tests should be arranged:

  • blood tests (for checking blood group and rhesus D status and screening for haemoglobinopathies, anaemia, red‑cell alloantibodies, hepatitis B virus, HIV, rubella susceptibility and syphilis), ideally before 10 weeks

  • urine tests (to check for proteinuria and screen for asymptomatic bacteriuria)

  • ultrasound scan to determine gestational age using:

    • crown–rump measurement between 10 weeks 0 days and 13 weeks 6 days

    • head circumference if crown–rump length is above 84 millimetres

  • Down's syndrome screening using:

    • 'combined test' at 11 weeks 0 days to 13 weeks 6 days

    • serum screening test (triple or quadruple) at 15 weeks 0 days to 20 weeks 0 days.

  • ultrasound screening for structural anomalies, normally between 18 weeks 0 days and 20 weeks 6 days.

16 weeks

The next appointment should be scheduled at 16 weeks to:

  • review, discuss and record the results of all screening tests undertaken; reassess planned pattern of care for the pregnancy and identify women who need additional care

  • investigate a haemoglobin level below 11 g/100 ml and consider iron supplementation if indicated

  • measure blood pressure and test urine for proteinuria

  • give information, with an opportunity to discuss issues and ask questions, including discussion of the routine anomaly scan; offer verbal information supported by antenatal classes and written information.

18 to 20 weeks

At 18 to 20 weeks, if the woman chooses, an ultrasound scan should be performed for the detection of structural anomalies. For a woman whose placenta is found to extend across the internal cervical os at this time, another scan at 32 weeks should be offered.

25 weeks

At 25 weeks, another appointment should be scheduled for nulliparous women. At this appointment:

  • measure and plot symphysis–fundal height

  • measure blood pressure and test urine for proteinuria

  • give information, with an opportunity to discuss issues and ask questions; offer verbal information supported by antenatal classes and written information.

28 weeks

The next appointment for all pregnant women should occur at 28 weeks. At this appointment:

  • offer a second screening for anaemia and atypical red‑cell alloantibodies

  • investigate a haemoglobin level below 10.5 g/100 ml and consider iron supplementation, if indicated

  • offer anti‑D prophylaxis to rhesus‑negative women

  • measure blood pressure and test urine for proteinuria

  • measure and plot symphysis–fundal height

  • give information, with an opportunity to discuss issues and ask questions; offer verbal information supported by antenatal classes and written information.

31 weeks

Nulliparous women should have an appointment scheduled at 31 weeks to:

  • measure blood pressure and test urine for proteinuria

  • measure and plot symphysis–fundal height

  • give information, with an opportunity to discuss issues and ask questions; offer verbal information supported by antenatal classes and written information

  • review, discuss and record the results of screening tests undertaken at 28 weeks; reassess planned pattern of care for the pregnancy and identify women who need additional care.

34 weeks

At 34 weeks, all pregnant women should be seen again. Give information (supported by written information and antenatal classes), with an opportunity to discuss issues and ask questions. Refer to section 1.1.1 for more about giving antenatal information. Topics covered should include:

  • preparation for labour and birth, including information about coping with pain in labour and the birth plan

  • recognition of active labour.

At this appointment:

  • offer a second dose of anti‑D to rhesus‑negative women

  • measure blood pressure and test urine for proteinuria

  • measure and plot symphysis–fundal height

  • give information, with an opportunity to discuss issues and ask questions; offer verbal information supported by antenatal classes and written information

  • review, discuss and record the results of screening tests undertaken at 28 weeks; reassess planned pattern of care for the pregnancy and identify women who need additional care.

36 weeks

At the 36‑week appointment, all pregnant women should be seen again. Give the following information (supported by written information and antenatal classes), with an opportunity to discuss issues and ask questions. Refer to section 1.1.1 for more about giving antenatal information. Topics covered should include:

  • breastfeeding information, including technique and good management practices that would help a woman succeed, such as detailed in the UNICEF Baby Friendly Initiative

  • care of the new baby

  • vitamin K prophylaxis and newborn screening tests

  • postnatal self‑care

  • awareness of 'baby blues' and postnatal depression.

At this appointment:

  • measure blood pressure and test urine for proteinuria

  • measure and plot symphysis–fundal height

  • check position of baby

  • for women whose babies are in the breech presentation, offer external cephalic version (ECV)

38 weeks

Another appointment at 38 weeks will allow for:

  • measurement of blood pressure and urine testing for proteinuria

  • measurement and plotting of symphysis–fundal height

  • information giving, including options for management of prolonged pregnancy, with an opportunity to discuss issues and ask questions; verbal information supported by antenatal classes and written information.

40 weeks

For nulliparous women, an appointment at 40 weeks should be scheduled to:

  • measure blood pressure and test urine for proteinuria

  • measure and plot symphysis–fundal height

  • give information, including further discussion about the options for prolonged pregnancy, with an opportunity to discuss issues and ask questions; offer verbal information supported by antenatal classes and written information.

41 weeks

For women who have not given birth by 41 weeks:

  • a membrane sweep should be offered

  • induction of labour should be offered

  • blood pressure should be measured and urine tested for proteinuria

  • symphysis–fundal height should be measured and plotted

  • information should be given, with an opportunity to discuss issues and ask questions; verbal information supported by written information.

General

Throughout the entire antenatal period, healthcare providers should remain alert to risk factors, signs or symptoms of conditions that may affect the health of the mother and baby, such as domestic violence, pre‑eclampsia and diabetes (refer to diabetes in pregnancy NICE guideline CG63).

ISBN: 978-1-4731-0891-2

  • National Institute for Health and Care Excellence (NICE)