GPAtlas🧭 Scope & the antenatal schedule
Antenatal care is the structured programme of appointments, screening and health promotion offered to healthy pregnant women from booking (by 10 weeks) until birth. Its purpose is to:
• Monitor maternal and fetal wellbeing.
• Screen for and pre-empt complications – pre-eclampsia, gestational diabetes (GDM), fetal growth restriction, infections and blood-group sensitisation.
• Support informed choice.
Most care is midwife-led. The GP role is:
• Pre-conception advice
• Prompt booking referral
• Recognising and acting on red flags between appointments
• Reviewing intercurrent illness and teratogenic medication
• Prescribing supplements, aspirin and vaccines
The unifying idea is that routine antenatal care is essentially structured screening: the value lies in what is checked at every visit (blood pressure, urine, growth, fetal movements) and in risk-stratifying at booking – not in the appointment itself.
Plan 10 routine appointments for a first baby (nulliparous) and 7 for subsequent pregnancies (parous), with extra or longer appointments where needed.
| Gestation | Key actions |
|---|---|
| Pre-pregnancy/pre-booking | • Folic acid 400 micrograms daily (5 mg if high-risk) and vitamin D 10 micrograms daily • Stop smoking and alcohol • Review long-term and teratogenic medicines |
| Booking – by 10+0 weeks |
• History, blood pressure, urine, body mass index (BMI). • Booking bloods: full blood count (FBC), blood group and rhesus D (RhD) status, red-cell antibodies, haemoglobinopathy screen. • Offer HIV, hepatitis B and syphilis screening. • Risk-assess for pre-eclampsia (start aspirin from 12 weeks if indicated), venous thromboembolism (VTE), GDM, mental health and domestic abuse. |
| Dating scan + combined test – 11+2 to 14+1 weeks | • Confirm gestation and viability and exclude multiple pregnancy • Combined screening for Down's (T21), Edwards' (T18) and Patau's (T13) syndromes |
| 16 weeks | • Review screening results • Offer pertussis (whooping cough) vaccine from 16 weeks |
| Anomaly scan – 18+0 to 20+6 weeks | • Detailed structural scan • Issue the MatB1 maternity certificate from 20 weeks. (Quadruple test for T21 offered 14+2–20+0 weeks if the combined test was missed.) |
| 24–28 weeks | • Measure symphysis–fundal height (SFH) and discuss fetal movements from 24 weeks • Oral glucose tolerance test (OGTT) if at risk of GDM • Repeat VTE assessment |
| 28 weeks | • FBC and antibody screen • First dose of routine antenatal anti-D prophylaxis (RAADP) for RhD-negative women • Offer respiratory syncytial virus (RSV) vaccine from 28 weeks |
| 34 weeks | • Second anti-D dose (if a two-dose regimen is used) • Birth preparation information |
| 36 weeks | • Check fetal presentation • If breech, offer a scan and external cephalic version (ECV) |
| 38–41 weeks | • Ongoing checks • Discuss prolonged pregnancy • Offer a membrane sweep and induction from 41 weeks |
Influenza vaccine is offered at any stage during the flu season. Pertussis, RSV, influenza and anti-D are repeated in every eligible pregnancy.
Source: NICE NG201 · NHS Fetal Anomaly Screening Programme
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