28 week appointment (routine antenatal care)

FREE subscriptions for doctors and students... click here
You have 3 more open access pages.

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

More detailed "patient centred" guidance from NICE (2):

  • ensure that interpreting services are available if needed. Use independent interpreters rather than the woman's family or friends
  • update the woman’s antenatal records with details of history, test results, examination findings, medicines and discussions
  • reassess the plan 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 or only at this appointment

  • offer
    • a blood test for full blood count, blood group and antibodies
    • anti-D prophylaxis to rhesus-negative women
  • discuss and give information on:
    • preparing for labour and birth
    • recognising active labour
    • the postnatal period, including:
      • caring for the new baby and feeding them
      • vitamin K prophylaxis
      • postnatal self-care (including pelvic floor exercises)
      • awareness of mood changes and postnatal mental health
  • advise the woman to avoid going to sleep on her back after 28 weeks of pregnancy. Discuss ways to maintain her position while sleeping. Explain that there may be a link between sleeping on one’s back and stillbirth in late pregnancy (after 28 weeks)
  • following is new for parous women (because they do not have an appointment at 25 weeks of pregnancy), and to be repeated for nulliparous women
  • 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

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:

Last edited 08/2021 and last reviewed 08/2021

Links: