Antenatal checklist

Routine antenatal check

Table 2.1   

Every visit First visit — ALSO

Ask

  • How she is feeling
  • Physical problems — urine symptoms, STI symptoms, vaginal loss, bleeding, pain, DVT or PE symptoms
  • Wellbeing — social or emotional issues, risk of family violence
  • Substance use — tobacco, alcohol, caffeine, other drugs
  • Baby’s movements — 18–20 or more weeks first baby, 15–16 or more weeks next babies

Check

  • If any time-specific interventions are due (see next page)
  • Weight — see Weight gain in pregnancy
  • BP
  • BGL
  • U/A — midstream urine
  • Oedema — face, feet, ankles
  • After 12 weeks — Fundal height

Do

Ask or check file notes

Check

  • Height
  • BMI — use pre-pregnancy weight
  • U/A — midstream urine, send for MC&S even if U/A normal
  • Head-to-toe exam, including vulva
  • Risk factors for preeclampsia — see Hypertension in pregnancy

Take blood for

  • FBC, iron studies, POC Test for Hb
  • Blood group, antibody screen
  • Rubella serology
  • Hepatitis B serology, Hepatitis C serology
  • HIV serology
  • Pregnancy STI check including syphilis serology
  • Diabetes tests — HbA1c and OGTT
  • If known diabetes, high BP or kidney disease — UEC, LFT, TFT, B12ACR
  • If known thyroid problems — TFT, T3, T4
  • Cervical screening, if due (up to 20 weeks gestation). If speculum exam not done BUT eligible for HPV test offer lower vaginal swab (LVS)
  • If history of preterm birth — LVS for MC&S for bacterial vaginosis

Do

  • Offer immunisations as recommended during pregnancy, at appropriate gestation

Table 2.2  

Things to offer at specific times Antenatal education

11-13 weeks+6 days

  • If woman unsure of last period — dating scan
  • First trimester screen for anomalies
  • Edinburgh Postnatal Depression Scale (EPDS) at least twice in pregnancy — before 28 weeks and after 36 weeks

14-20 weeks

18-22 weeks

  • Morphology ultrasound + cervical length measure, if risk of preterm birth
  • Antenatal review at regional service
  • After 20 weeks — pertussis immunisation for woman, partner and other adults in household

24-28 weeks

28 weeks

  • FBC, iron studies, POC Test for Hb
  • If RhD negative with no Anti-D antibodies — repeat antibody screen THEN give prophylactic RhD-Ig IM – 625 international units
  • If other antibodies detected earlier — repeat antibody screen
  • Pregnancy STI check including syphilis serology
  • Encourage woman to sleep on her side until baby born

34 weeks

  • If RhD negative with no Anti-D antibodies — give second prophylactic RhD-Ig IM – 625 international units
  • Discuss transfer to regional centre for birth

36 weeks

38 weeks

  • Transfer to regional centre to wait for birth 

Try to talk about each of these topics during pregnancy — see Antenatal parent education

  • Nutrition and supplements
  • Exercise
  • Sleep
  • Smoking, alcohol and other drugs
  • Prescribed and over the counter medicines
  • Immunisations
  • Common discomforts of pregnancy
  • Mental health and wellbeing
  • Domestic/family violence, safety
  • Birth plan, travel to regional centre for birth
  • Signs of labour, process of birth
  • After birth — breastfeeding, family supports, looking after baby
  • Contraception