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2673 pages added, reviewed or updated during the last month (last updated: 11/4/2021)


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first appointment (routine antenatal care)

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At the booking appointment (ideally by 10 weeks)

  • antenatal information should be given to pregnant women according to the following schedule
    • at the first contact with a healthcare professional:
      • folic acid supplementation
      • food hygiene, including how to reduce the risk of a food-acquired infection
      • lifestyle advice, including smoking cessation, and the implications of recreational drug use and alcohol consumption in pregnancy
      • all antenatal screening tests , including screening for haemoglobinopathies, hepatitis B virus, HIV, and syphilis, fetal anomalies (including screening for Down's syndrome, Edwards' syndrome and Patau's syndrome and the 18+0 to 20+6 week fetal anomaly scan)

  • at booking appointment (ideally by 10 weeks)
      • how the baby develops during pregnancy
      • nutrition and diet, including vitamin D supplementation for women at risk of vitamin D deficiency, and details of the 'Healthy Start' programme (www.healthystart.nhs.uk)
      • exercise, including pelvic floor exercises
      • place of birth
      • pregnancy care pathway
      • breastfeeding, including workshops
      • participant-led antenatal classes
      • further discussion of all antenatal screening - discussion of mental health issues

    • at this appointment:
      • identify women who may need additional care (see linked item) 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, 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 (www.chlamydiascreening.nhs.uk)
      • offering screening for fetal anomalies (including screening for Down's syndrome, Edwards' syndrome and Patau's syndrome and the 18+0 to 20+6 week fetal anomaly scan) offer early ultrasound scan for gestational age assessment
      • 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, 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 length measurement between 10 weeks 0 days and 14 weeks and 1 day
        • head circumference if crown-rump length is above 84.0 millimetres

      • Down's syndrome, Edwards' syndrome and Patau's syndrome screening using:
        • 'combined test' when the CRL is between 45.0mm and 84.0mm (equates to at 11 weeks 2 days to 14 weeks 1 day

      • Down's syndrome only
        • serum screening test ( quadruple test) at 14 weeks 2 days to 20 weeks 0 days
        • ultrasound screening for 11 physical conditions between 18 weeks 0 days and 20 weeks 6 days

* antenatal rubella susceptibility screening has been withdrawn, as this is no longer offered on the NHS (2). 2 MMR vaccinations preconception or postnatally is advocated as the best protection from rubella infection.

  • follows reviews of the evidence by the UK National Screening Committee (UK NSC) in 2003 and 2012. On both occasions the evidence showed that screening for rubella susceptibility during pregnancy did not meet the UK NSC criteria for a screening programme (3)

Reference:

Last edited 05/2019

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