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
More detailed guidance from NICE states (2):
- ensure that interpreting services are available if needed. Use independent interpreters rather than the woman's family members or friends
- update the woman’s antenatal records with details of history, test results, examination findings, medicines and discussions
- reassess the pattern of care for the pregnancy
- identify whether the woman needs additional care
- all discussions should support shared decision making and be tailored to the woman’s needs, preferences and stage of pregnancy.
New at this appointment
- measure symphysis fundal height (SFH) in women with a singleton pregnancy unless the woman is having regular growth scans or SFH has been measured less than 2 weeks ago. Plot the measurement onto a growth chart
- if there are concerns that SFH is either large or small for gestational age, see managing complications and common problems for more information
- discuss the baby’s movements with the woman. Ask her if she has any concerns. If she does, assess her and the baby
- advise her to contact maternity services at any time of day or night if she:
- has any concerns about her baby's movements
- notices reduced fetal movements
- start or continue discussing with the woman:
- her birth preferences
- their implications
- their benefits and risks.
Update the history
Ask the woman about:
- her general health and wellbeing
- domestic abuse
- mental health
- any other concerns she would like to discuss - also ask her partner about this, if present
Provide a safe environment for the discussion.
Continue discussions
Discuss and give information on:
- physical, emotional and relationship changes
- support between partners
- resources for expectant and new parents
- bonding with the baby and emotional attachment
- results of any tests from previous appointments
Repeat examinations and investigations
If the appointment is face to face, offer:
- to take blood pressure using a device validated for use in pregnancy (for urgent actions to take when a woman's blood pressure is very high [160/110 mmHg or more], see managing complications and common problems)
- a urine dipstick test for proteinuria
If the woman has had any hospital admission or significant health event since her last appointment, assess her risk of venous thromboembolism.
Offer additional or longer antenatal appointments if needed, depending on the woman’s medical, social and emotional needs.
Be aware that closer monitoring may be needed for women and their babies from black, Asian and minority ethnic family origins, and those who live in deprived areas, because they are at an increased risk of adverse outcomes.
Also see managing complications and common problems for:
- heartburn
- high blood pressure (140/90 mmHg or more)
- nausea and vomiting
- pelvic girdle pain
- small or large baby for gestational age
- smoking
- unexplained vaginal bleeding.
Reference: