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NICE Antenatal schedule of Care
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Flashcards in this deck (179)

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  • What right do people have regarding decisions about their antenatal care?

    People have the right to be involved in discussions and make informed decisions about their antenatal care.

    rights antenatal

  • Which sources should healthcare professionals follow to ensure women can give informed consent in pregnancy?

    • General Medical Council (GMC) guidance
    • Nursing and Midwifery Council (NMC) Code
    • 2015 Montgomery ruling
    consent professional

  • Name some ways antenatal care can be started to meet women's needs.

    • Self-referral
    • Referral by GP, midwife or other healthcare professional
    • Referral via school nurse, community centre or refugee hostel
    access referral

  • What should be provided at the point of antenatal care referral to simplify the process?

    Provide an easy-to-complete referral form.

    referral administration

  • What early information should be offered before the antenatal booking appointment?

    Early pregnancy health and wellbeing information, including modifiable factors that may affect pregnancy.

    information wellbeing

  • Which modifiable factors should early pregnancy information include?

    • Stopping smoking
    • Avoiding alcohol
    • Taking supplements
    • Eating healthily
    lifestyle prevention

  • What topics do the NICE guidelines mentioned in the text cover related to pregnancy?

    • Maternal and child nutrition
    • Vitamin D
    • Tobacco: preventing uptake, promoting quitting and treating dependence
    guidelines nutrition tobacco

  • What accessibility requirement is specified for antenatal materials?

    Ensure materials are available in different languages or formats such as digital, printed, braille or Easy Read.

    access equity

  • What should the referral form for starting antenatal care enable healthcare professionals to identify?

    • Women with specific health and social care needs
    • Risk factors, including those addressable before booking (for example, smoking)
    referral risk

  • What contact detail must be included on the antenatal referral form?

    Include contact details about the woman's GP.

    referral communication

  • By when should the first antenatal (booking) appointment with a midwife be offered?

    Offer a first antenatal (booking) appointment with a midwife to take place by 10+0 weeks of pregnancy.

    appointments timelines

  • If a woman contacts or is referred later than 9+0 weeks, when should the booking appointment be offered?

    If referred later than 9+0 weeks, offer a first antenatal (booking) appointment to take place within 2 weeks if possible.

    appointments timelines

  • What should healthcare professionals ask if a woman books late in pregnancy?

    Ask about the reasons for the late booking because it may reveal social, psychological or medical issues that need to be addressed.

    appointments assessment

  • How many routine antenatal appointments with a midwife or doctor are planned for nulliparous women?

    • 10 routine antenatal appointments
    appointments nulliparous

  • How many routine antenatal appointments with a midwife or doctor are planned for parous women?

    • 7 routine antenatal appointments
    appointments parous

  • Which groups are specifically referenced for the NICE guideline on pregnancy and complex social factors?

    • Women who misuse substances
    • Recent migrants, asylum seekers or refugees, or women with difficulty reading or speaking English
    • Young women aged under 20
    • Women who experience domestic abuse
    vulnerable social

  • When should additional or longer antenatal appointments be offered?

    • When needed depending on the woman’s medical, social and emotional needs
    appointments individualised

  • What interpreting services requirement is stated for antenatal care?

    • Ensure reliable interpreting services are available when needed, including British Sign Language
    communication interpreting

  • Who should interpreters be independent of during antenatal appointments?

    • Interpreters should be independent of the woman, not a family member or friend
    interpreting safeguarding

  • What aim is recommended for those planning and delivering antenatal services regarding carer assignment?

    • Aim to provide continuity of carer
    continuity services

  • What communication standard is required between healthcare professionals involved in antenatal care?

    • Ensure effective and prompt communication between healthcare professionals involved in the woman’s care during pregnancy
    communication teamwork

  • How should healthcare professionals involve a partner during pregnancy according to NICE antenatal care guidance?

    • Involve partners according to the woman's wishes
    • Inform the woman she is welcome to bring a partner to antenatal appointments and classes
    antenatal partners policy

  • What should be considered when scheduling antenatal classes if the pregnant woman wishes partner attendance?

    • Arrange the timing of antenatal classes so the partner can attend
    antenatal classes partners

  • Give examples of ways to make antenatal services welcoming for partners.

    • Provide information about how partners can support the woman during and after pregnancy
    • Provide information about pregnancy for partners
    • Display positive images of partner involvement
    antenatal partners environment

  • What physical provision should be made in consultation rooms for partner involvement?

    • Provide seating in consultation rooms for both the woman and her partner
    antenatal partners facilities

  • What information should be provided specifically for partners in antenatal services?

    • Information about how partners can be involved in supporting the woman during and after pregnancy
    • Information about pregnancy for partners as well as pregnant women
    antenatal partners information

  • What option should be considered for partners attending antenatal appointments?

    • Offer opportunities for partners to attend appointments remotely as appropriate
    partners access

  • At the first antenatal booking appointment, which family histories should be asked about?

    • Medical history, obstetric history and family history of both biological parents
    history booking

  • Which mental health concerns should be asked about at the first antenatal appointment?

    • Previous or current depression, anxiety, severe mental illness, psychological trauma or psychiatric treatment
    mentalhealth screening

  • What should be asked about medicines at the first antenatal appointment?

    • Current and recent medicines including over-the-counter medicines, health supplements and herbal remedies
    medication safety

  • What allergy information should be collected at the first antenatal appointment?

    • Any allergies the woman has
    allergies history

  • What should be discussed regarding the woman's occupation at the first antenatal appointment?

    • Her occupation, including any risks and concerns
    occupation risk

  • Which aspects of family and home life should be asked about at the first antenatal appointment?

    • Family and home situation, available support network and any partner or family health or other issues significant for her wellbeing
    support social

  • What should be asked about other people in relation to the baby's care at the first antenatal appointment?

    • Other people who may be involved in the care of the baby
    care planning

  • What contact details should be recorded at antenatal booking?

    • Partner's contact details
    • Next of kin's contact details
    antenatal administration

  • What lifestyle and social factors should be reviewed at antenatal booking?

    • Nutrition and diet
    • Physical activity
    • Smoking and tobacco use
    • Alcohol consumption
    • Recreational drug use
    antenatal lifestyle

  • When should a clinician consider reviewing a woman’s previous medical records?

    Consider reviewing previous medical records if needed, including records held by other healthcare providers.

    records antenatal

  • How does the maternal death rate for black women compare with white women?

    • White women: \(8/100000\)
    • Black women: \(34/100000\) (4 times higher)
    ethnicity mortality

  • What is the maternal death rate for women with mixed ethnic background compared with white women?

    • White women: \(8/100000\)
    • Mixed ethnic background: \(25/100000\) (3 times higher)
    ethnicity mortality

  • What is the maternal death rate for Asian women compared with white women?

    • White women: \(8/100000\)
    • Asian women: \(15/100000\) (2 times higher)
    ethnicity mortality

  • How does the stillbirth rate for black babies compare with white babies?

    • White babies: \(34/10000\)
    • Black babies: \(74/10000\) (more than twice as high)
    ethnicity stillbirth

  • How does the stillbirth rate for Asian babies compare with white babies?

    • White babies: \(34/10000\)
    • Asian babies: \(53/10000\) (around 50% higher)
    ethnicity stillbirth

  • How does living in the most deprived areas affect maternal death risk?

    • Most deprived areas: \(15/100000\)
    • Least deprived areas: \(6/100000\)
    • Risk is more than 2.5 times higher in the most deprived areas
    deprivation mortality

  • How does the stillbirth rate vary with level of deprivation?

    • Most deprived areas: \(47/10000\)
    • Least deprived areas: \(26/10000\)
    • Almost twice as many stillbirths in the most deprived areas
    deprivation stillbirth

  • When should a pregnant woman be offered a referral to NHS Stop Smoking Services?

    Offer a referral at 2 weeks to NHS Stop Smoking Services in line with the NICE tobacco guideline.

    smoking prevention

  • When and how should you ask about domestic abuse at antenatal care?

    Ask about domestic abuse at the first antenatal (booking) appointment, or at the earliest opportunity when the woman is alone, in a kind, sensitive manner with a private one-to-one discussion.

    domesticabuse safeguarding

  • What should you do regarding female genital mutilation (FGM) during antenatal care?

    Assess the woman's risk of FGM in a kind, sensitive manner and take appropriate action in line with UK government safeguarding guidance.

    fgm safeguarding

  • When should a pregnant woman be referred for a clinical assessment to detect cardiac conditions?

    Refer for a clinical assessment by a doctor if there is concern based on the woman's personal or family cardiac history.

    cardiac referral

  • When should you refer a pregnant woman to an obstetrician or other doctor?

    Refer to an obstetrician or other relevant doctor if there are any medical concerns or if review of current long-term medicines is needed.

    referral medication

  • What action should be taken regarding the woman's GP during pregnancy?

    After discussion with and agreement from the woman, contact her GP to share information about the pregnancy and potential concerns or complications.

    communication gp

  • What should be included in the risk assessment at every antenatal appointment?

    Ask about general health and wellbeing; ask the woman (and partner if present) about any concerns; provide a safe environment to discuss home concerns, domestic abuse, birth concerns or mental health.

    riskassessment appointments

  • What are two main concerns of antenatal care listed in the guideline?

    • Review and reassess the plan of care for the pregnancy
    • Identify women who need additional care
    antenatal goals

  • What must be updated at every antenatal contact?

    • Antenatal records including history, test results, examination findings, medicines and discussions
    records documentation

  • What measurements should be offered at the first face-to-face antenatal appointment?

    • Measure height and weight and calculate body mass index
    assessment bmi

  • Which blood tests should be offered at the first face-to-face antenatal appointment?

    • Full blood count
    • Blood group
    • Rhesus D status
    investigations blood

  • Which infectious disease screens should be offered at the booking appointment?

    • HIV
    • Syphilis
    • Hepatitis B
    screening infectious

  • Which genetic and fetal screening programmes should be discussed and offered at booking?

    • NHS sickle cell and thalassaemia screening programme
    • NHS fetal anomaly screening programme
    screening genetics

  • Where should practitioners look for guidance on caring for pregnant women approaching end of life?

    • See the NICE guideline on end of life care for adults: service delivery
    guidance endoflife

  • What choice should a pregnant woman be informed about regarding screening programmes?

    She can accept or decline any part of any of the screening programmes offered.

    consent screening

  • When should the first routine antenatal ultrasound scan be offered?

    Between 11+2 weeks and 14+1 weeks of pregnancy.

    ultrasound timing

  • What are the purposes of the ultrasound offered at 11+2–14+1 weeks?

    • Determine gestational age
    • Detect multiple pregnancy
    • Optional: screen for Down's, Edwards' and Patau's syndromes
    ultrasound screening

  • When should the second routine antenatal ultrasound scan be offered?

    Between 18+0 weeks and 20+6 weeks of pregnancy.

    ultrasound timing

  • What are the purposes of the ultrasound offered at 18+0–20+6 weeks?

    • Screen for fetal anomalies
    • Determine placental location
    ultrasound anomalies

  • What blood tests should be offered at the antenatal appointment at 28 weeks?

    • Full blood count
    • Blood group
    • Antibodies
    28weeks bloodtests

  • Who should be offered anti-D prophylaxis at 28 weeks?

    Rhesus D-negative women who are not known to be sensitised to the rhesus D antigen.

    antid rhesus

  • What should be done if antenatal examinations or investigations produce unexpected results?

    Offer referral according to local pathways and ensure appropriate information provision and support.

    referral support

  • When should a pregnant woman's risk factors for venous thromboembolism (VTE) be assessed during antenatal care?

    • At the first antenatal (booking) appointment
    • After any hospital admission or significant health event during pregnancy
    vte antenatal risk-assessment

  • What should be considered when assessing VTE risk in pregnancy?

    Consider using guidance by an appropriate professional body, for example the Royal College of Obstetricians and Gynaecologists' guideline on reducing the risk of VTE during pregnancy.

    vte guidelines rcog

  • For pregnant women admitted to hospital or a midwife-led unit, where should clinicians look for intervention guidance?

    See the section on interventions for pregnant women and women who gave birth or had a miscarriage or termination in the past 6 weeks in the NICE guideline on venous thromboembolism in over 16s.

    vte interventions guidelines

  • What action is recommended for pregnant women identified as being at risk of VTE?

    Offer referral to an obstetrician for further management.

    vte referral management

  • When should an oral glucose tolerance test be offered for women at risk of gestational diabetes?

    Offer referral for an oral glucose tolerance test between 24+0 weeks and 28+0 weeks of pregnancy.

    gestational-diabetes screening

  • What action should be taken if a woman is identified as at risk of gestational diabetes?

    Offer referral for an oral glucose tolerance test to take place between 24+0 weeks and 28+0 weeks.

    gestational-diabetes referral

  • When should a woman's risk factors for pre-eclampsia be assessed?

    At the first antenatal (booking) appointment and again in the second trimester.

    pre-eclampsia risk-assessment

  • What advice should be given to women at risk of pre-eclampsia?

    Advise those at risk to take aspirin, following recommendations for antiplatelet use in pregnancy.

    pre-eclampsia prevention

  • How often should a woman's blood pressure be measured during routine antenatal care?

    Measure and record blood pressure at every routine face-to-face antenatal appointment using a device validated for use in pregnancy.

    blood-pressure monitoring

  • What should be done for women under 20+0 weeks who have hypertension?

    Follow the recommendations on the management of chronic hypertension in pregnancy.

    hypertension chronic

  • What is the recommended action for a first episode of hypertension occurring after 20+0 weeks?

    Refer women over 20+0 weeks with a first episode of hypertension (blood pressure ≥140/90 mmHg) to secondary care to be seen within 24 hours.

    hypertension referral

  • At what blood pressure should a pregnant woman with severe hypertension be urgently referred to secondary care?

    • Blood pressure of 160/110 mmHg or higher
    hypertension referral

  • When should a urine dipstick test for proteinuria be offered during antenatal care?

    • At every routine face-to-face antenatal appointment
    proteinuria screening

  • When should a risk assessment for fetal growth restriction be offered?

    • At the first antenatal (booking) appointment and again in the second trimester
    fetal-growth risk-assessment

  • When should symphysis fundal height (SFH) be measured in a singleton pregnancy?

    • At each antenatal appointment after 24+0 weeks
    sfh monitoring

  • What is the recommended maximum frequency for measuring symphysis fundal height?

    • No more frequently than every 2 weeks
    sfh frequency

  • When should symphysis fundal height measurements be plotted on a growth chart?

    • Plot the measurement onto a growth chart in line with the NHS saving babies' lives care bundle version 2
    growth-chart nhs

  • What should be considered if the symphysis fundal height is large for gestational age?

    • Consider an ultrasound scan for fetal growth and wellbeing
    sfh ultrasound

  • What should be offered if the symphysis fundal height is small for gestational age?

    • Offer an ultrasound scan for fetal growth and wellbeing
    sfh ultrasound

  • Should routine ultrasound scans be offered after 28 weeks for uncomplicated singleton pregnancies?

    No. Do not routinely offer ultrasound scans after 28 weeks for uncomplicated singleton pregnancies.

    ultrasound antenatal

  • When should healthcare professionals discuss babies' movements with a pregnant woman?

    Discuss babies' movements with the woman after 24+0 weeks of pregnancy.

    movements antenatal

  • What should clinicians ask at each antenatal contact after 24+0 weeks regarding fetal movements?

    Ask if she has any concerns about her baby's movements at each antenatal contact after 24+0 weeks.

    movements screening

  • What advice should be given to women who are concerned about reduced fetal movements after 24+0 weeks?

    Advise her to contact maternity services at any time of day or night if she has concerns or notices reduced fetal movements after 24+0 weeks.

    movements advice

  • What action should be taken if there are concerns about a baby's movements?

    Assess the woman and baby if there are any concerns about the baby's movements.

    assessment movements

  • Have structured fetal movement awareness packages been shown to reduce stillbirth rates?

    No. Structured fetal movement awareness packages, such as the one studied in the AFFIRM trial, have not been shown to reduce stillbirth rates.

    movements evidence

  • When should abdominal palpation be offered to identify possible breech presentation in a singleton pregnancy?

    Offer abdominal palpation at all appointments after 36+0 weeks to identify possible breech presentation for women with a singleton pregnancy.

    breech antenatal

  • If breech presentation is suspected on abdominal palpation, what should be offered to determine presentation?

    Offer an ultrasound scan to determine the presentation.

    breech diagnosis antenatal

  • For an uncomplicated singleton pregnancy with breech confirmed after 36+0 weeks, what options should be discussed with the woman?

    • External cephalic version (ECV)
    • Breech vaginal birth
    • Elective caesarean birth
    breech management options

  • What is the purpose of external cephalic version (ECV)?

    To turn the baby from bottom to head down (cephalic).

    ecv procedure breech

  • When should external cephalic version be offered to women who prefer a cephalic vaginal birth?

    Offer ECV for women with uncomplicated singleton breech who prefer cephalic vaginal birth after breech is confirmed post 36+0 weeks.

    ecv timing breech

  • To which group of pregnancies do the recommendations about discussing options and offering ECV apply?

    Women with an uncomplicated singleton pregnancy with breech presentation confirmed after 36+0 weeks.

    eligibility breech antenatal

  • What should you do when caring for a pregnant woman regarding communication and needs?

    Listen to her and be responsive to her needs and preferences.

    communication antenatal

  • What must be discussed when offering any assessment, intervention or procedure in antenatal care?

    The risks, benefits and implications, and that she has a right to decline.

    consent risk

  • How should healthcare professionals treat a woman's decisions that conflict with their own view?

    The woman's decisions should be respected even if contrary to the professional's views.

    consent ethics

  • How should information about antenatal care be communicated in terms of language and timing?

    Use clear language and tailor timing, content and delivery to the woman's needs, preferences and stage of pregnancy.

    information communication

  • List the delivery formats for antenatal information that should be offered and supplemented.

    • One-to-one or couple discussions
    • Group discussions (women only or women and partners)
    • Written information in suitable formats (digital, printed, braille, Easy Read)
    information formats

  • When should antenatal information be offered to a woman?

    Information should be offered throughout the woman's care.

    timing antenatal

  • What qualities should antenatal information have regarding how it is presented to women and partners?

    Individualised, sensitive, supportive and respectful.

    qualities communication

  • What standards should antenatal information meet in terms of content?

    It should be evidence-based and consistent.

    evidence information

  • What provision should be made if a woman needs antenatal information in another language?

    Information should be translated into other languages if needed.

    equity access

  • What should clinicians explore with the woman (and her partner) about antenatal topics?

    Explore the woman’s (and partner’s) knowledge and understanding about each topic to individualise the discussion.

    communication antenatal

  • What must clinicians check regarding information given to the woman and her partner?

    Check that they understand the information, how it relates to them, provide chances to ask questions, and allow enough time to discuss concerns.

    communication consent

  • What should be discussed and provided at the first antenatal (booking) appointment?

    Discuss antenatal care with the woman (and partner) and provide her schedule of antenatal appointments.

    booking appointments

  • Which topics should be discussed at the first antenatal appointment (and later if appropriate)?

    What antenatal care involves and why it is important, and the planned number of antenatal appointments.

    education appointments

  • Which additional guideline and standard are cited for more guidance on communication and information provision?

    The NICE guideline on patient experience in adult NHS services and the NHS Accessible Information Standard.

    guidelines communication

  • Which evidence reviews contain full details and committee discussion related to antenatal information provision?

    Evidence review B: approaches to information provision; evidence review A: information provision; and evidence review J: referral and delivery of antenatal care.

    evidence references

  • Where should the first antenatal (booking) appointment include discussion about?

    • Where antenatal appointments will take place
    • Which healthcare professionals will be involved
    • How to contact the midwifery team for non-urgent advice
    antenatal booking access

  • How should women be informed about contacting maternity services for urgent concerns?

    • How to contact the maternity service about urgent concerns such as pain and bleeding
    contact urgent safety

  • What screening programmes should be discussed in antenatal care?

    • Blood tests and ultrasound scans that are offered and why
    screening tests ultrasound

  • What fetal topics should be covered during antenatal appointments?

    • How the baby develops during pregnancy
    • What to expect at each stage of pregnancy
    fetal development stages

  • Which maternal changes should antenatal care address?

    • Physical and emotional changes during pregnancy
    • Mental health during pregnancy
    • Relationship changes during pregnancy
    maternal mentalhealth relationships

  • What guidance should be given about partner support?

    • How the woman and her partner can support each other
    partner support relationships

  • Which immunisations in pregnancy are mentioned?

    • Flu, pertussis (whooping cough) and RSV and other infections in line with guidance
    immunisation vaccination infection

  • Which infections that can impact the baby are listed?

    • Group B streptococcus, herpes simplex, cytomegalovirus
    infections vertical risk

  • What infection prevention advice should be discussed in antenatal care?

    • Reducing the risk of infections, for example encouraging hand washing
    prevention hygiene infectioncontrol

  • What medication and product guidance should be provided during pregnancy?

    • Safe use of medicines, health supplements and herbal remedies during pregnancy
    medication safety supplements

  • What support resources should antenatal care provide information about?

    • Resources and support for expectant and new parents
    • How to get in touch with local or national peer support services
    support resources peersupport

  • What lifestyle topics should antenatal care discuss in a non-judgemental, personalised way?

    • Nutrition and diet
    • Physical activity
    • Smoking cessation
    • Recreational drug use
    lifestyle antenatal

  • What should be explained about alcohol at the booking appointment?

    • There is no known safe level of alcohol during pregnancy
    • Drinking can lead to long-term harm to the baby
    • Safest approach is to avoid alcohol altogether
    alcohol antenatal

  • When should alcohol consumption be discussed during pregnancy?

    • At the first antenatal (booking) appointment and later if appropriate
    timing alcohol

  • What personal topics should be discussed throughout pregnancy?

    • Physical and emotional changes
    • Relationship changes
    • How partners can support each other
    support relationships

  • What parental support and bonding topics should be provided during pregnancy?

    • Resources and support for expectant and new parents
    • How parents can bond and importance of emotional attachment
    bonding support

  • What information about tests should be given during pregnancy?

    • The results of any blood or screening tests from previous appointments
    screening tests

  • What antenatal guidance is recommended for pelvic floor issues?

    • Provide information about pelvic floor dysfunction
    • Offer pelvic floor muscle training during and after pregnancy
    pelvic exercise

  • When should healthcare professionals discuss babies' movements with pregnant women?

    • After 24 weeks of pregnancy
    fetal movements

  • Before 28 weeks, what should be discussed with the woman regarding birth?

    • Start talking about birth preferences
    • Discuss implications, benefits and risks of different options
    antenatal timing

  • From 28 weeks, what topics should be discussed and information given about preparing for labour and birth?

    • Preparing for labour and birth, including coping and creating a birth plan
    • Recognising active labour
    antenatal labour

  • Which postnatal topics should be discussed and given as information after 28 weeks?

    • Care of the new baby
    • The baby's feeding
    • Vitamin K prophylaxis
    • Newborn screening
    • Postnatal self-care including pelvic floor exercises
    • Awareness of mood changes and postnatal mental health
    postnatal antenatal

  • After 28 weeks, how should the woman's birth preferences be managed?

    • Continue discussions as appropriate
    • Confirm birth preferences and discuss implications, benefits and risks of all options
    antenatal preferences

  • From 38 weeks, what discussion should be held about pregnancy?

    • Discuss prolonged pregnancy and options to manage it (in line with the guideline on inducing labour)
    antenatal term

  • When should the guideline on preterm labour and birth be consulted?

    • For women at increased risk of, or with symptoms and signs of, preterm labour (before 37 weeks)
    • For women having a planned preterm birth
    preterm antenatal

  • What key elements should be included when discussing birth before 28 weeks versus after 28 weeks?

    • Before 28 weeks: start discussion of birth preferences and options' risks/benefits
    • From 28 weeks: give practical information on labour, postnatal care and confirm preferences
    antenatal comparison

  • Who should be offered antenatal classes according to recommendation 1.3.20?

    • Nulliparous women
    • Their partners
    antenatal classes recommendation

  • Name the topics antenatal classes should include for nulliparous women and partners.

    • Preparing for labour and birth
    • Supporting each other during pregnancy and after birth
    • Common events in labour and birth
    • How to care for the baby
    • Parent–baby bonding and importance of emotional attachment
    antenatal classes topics

  • Which evidence reviews contain the full details of the guideline committee's discussion on antenatal care?

    • Evidence review A: information provision
    • B: approaches to information provision
    • C: involving partners
    • D: peer support
    • G: content of antenatal appointments
    • J: referral and delivery of antenatal care
    • P: fetal movement monitoring
    evidence reviews antenatal

  • What should antenatal care include regarding planning for the baby's feeding?

    • Discuss planning and managing the baby's feeding with parents
    feeding antenatal

  • When should antenatal classes be considered for multiparous women?

    • If they could benefit, e.g., after a long gap between pregnancies or never having attended antenatal classes before
    antenatal classes

  • How should antenatal classes be provided to meet local needs?

    • Ensure classes are welcoming, accessible and adapted to meet the needs of local communities
    antenatal access

  • Who should antenatal classes be welcoming and accessible for?

    • Local communities, including young pregnant women aged under 20
    antenatal inclusion

  • What are three potential benefits of peer support for pregnant women?

    • Provide practical support
    • Help to build confidence
    • Reduce feelings of isolation
    peer-support benefits

  • What should clinicians do about peer support during antenatal care?

    • Discuss the potential benefits of peer support with pregnant women and their partners
    peer-support communication

  • What information should be offered about peer support services?

    • Offer information about how to access local and national peer support services
    peer-support resources

  • After which week of pregnancy should women be advised to avoid going to sleep on their back?

    After 28 weeks of pregnancy

    sleep pregnancy

  • What sleeping aid is suggested to help maintain a side position during sleep in late pregnancy?

    Consider using pillows to help maintain position while sleeping

    sleep practical

  • What possible risk is explained to women about going to sleep on their back in late pregnancy?

    There may be a link between going to sleep on the back and stillbirth after 28 weeks

    sleep risk

  • How should healthcare professionals reassure women about mild to moderate nausea and vomiting in pregnancy?

    Reassure that mild to moderate nausea and vomiting are common and are likely to resolve before 16 to 20 weeks

    nausea reassurance

  • What should clinicians recognise about women seeking advice for nausea and vomiting in pregnancy?

    Recognise that women may have already tried several interventions before seeking professional advice

    nausea care-seeking

  • Which non-pharmacological option is suggested for pregnant women with mild-to-moderate nausea and vomiting who prefer it?

    Suggest trying ginger

    nausea treatment

  • What should be discussed when considering pharmacological treatments for nausea and vomiting in pregnancy?

    Discuss advantages and disadvantages of different antiemetics, taking into account the woman’s preferences and experience in previous pregnancies

    nausea pharmacology

  • For pregnant women with nausea and vomiting who choose pharmacological treatment, what should be offered?

    • Offer an antiemetic
    nausea vomiting antenatal

  • For pregnant women with moderate-to-severe nausea and vomiting, which outpatient treatment should be considered?

    • Intravenous fluids, ideally on an outpatient basis
    nausea intravenous antenatal

  • What adjunct treatment should be considered for moderate-to-severe nausea and vomiting in pregnancy?

    • Acupressure as an adjunct treatment
    nausea acupressure antenatal

  • When should inpatient care be considered for vomiting in pregnancy?

    • If vomiting is severe and not responding to primary care or outpatient management
    vomiting inpatient antenatal

  • Which specific severe condition is included among women who may need inpatient care for vomiting in pregnancy?

    • Hyperemesis gravidarum
    hyperemesis vomiting antenatal

  • What information should be given to pregnant women with heartburn?

    • Information about lifestyle and dietary changes in line with NICE guidance on gastro-oesophageal reflux disease and dyspepsia in adults
    heartburn lifestyle antenatal

  • What pharmacological trial should be considered for pregnant women with heartburn?

    • A trial of an antacid or alginate
    heartburn antacid antenatal

  • What should you tell a pregnant woman about experiencing vaginal discharge?

    • Vaginal discharge is common during pregnancy
    • Seek review if accompanied by itching, soreness, unpleasant smell, or pain on passing urine
    antenatal discharge

  • Which symptoms alongside vaginal discharge suggest an infection that needs investigation?

    • Itching
    • Soreness
    • Unpleasant smell
    • Pain on passing urine
    symptoms infection

  • When should a vaginal swab be considered for a pregnant woman with symptomatic discharge?

    • Consider a vaginal swab if there is doubt about the cause of symptomatic vaginal discharge
    investigation vaginal-swab

  • What action should be taken if a sexually transmitted infection is suspected in pregnancy?

    • Consider arranging appropriate investigations for a suspected sexually transmitted infection
    sti investigation

  • What is the recommended treatment for vaginal candidiasis in pregnant women?

    • Offer vaginal imidazole (for example, clotrimazole or econazole)
    treatment candidiasis

  • How should bacterial vaginosis in pregnant women be treated according to the guideline?

    • Consider oral or vaginal antibiotics to treat bacterial vaginosis, in line with antimicrobial stewardship guidance
    treatment bacterial-vaginosis

  • For pregnancy-related pelvic girdle pain, what referral should be considered?

    • Refer to physiotherapy for exercise advice and/or a non-rigid lumbopelvic belt
    pelvicgirdle physiotherapy

  • When should anti-D immunoglobulin be offered for vaginal bleeding after 13 weeks of pregnancy?

    • Offer anti-D immunoglobulin if the woman is rhesus D-negative and at risk of isoimmunisation
    antibody rhesus

  • What immediate action is recommended for pregnant women with unexplained vaginal bleeding after 13 weeks?

    • Refer to secondary care for a review
    bleeding referral

  • Which factors should be considered when deciding whether to admit a pregnant woman with unexplained bleeding after 13 weeks?

    • Risk of placental abruption
    • Risk of preterm delivery
    • Extent of vaginal bleeding
    • Woman's ability to attend secondary care in an emergency
    admission riskassessment

  • What interventions may physiotherapy provide for pregnancy-related pelvic girdle pain?

    • Exercise advice and/or a non-rigid lumbopelvic belt
    physiotherapy management

  • What should be offered to pregnant women with unexplained vaginal bleeding when the placental site is not known?

    Offer placental localisation by ultrasound.

    bleeding ultrasound antenatal

  • When should corticosteroids for fetal lung maturation be considered for pregnant women with unexplained vaginal bleeding who are admitted to hospital?

    Consider corticosteroids if there is an increased risk of preterm birth within 48 hours.

    corticosteroids preterm antenatal

  • What important factor should be taken into account when considering corticosteroids for fetal lung maturation?

    Take into account gestational age.

    gestation corticosteroids antenatal

  • What discussion should be considered with women who have unexplained vaginal bleeding?

    Consider discussing the increased risk of preterm birth.

    communication preterm bleeding

  • Define 'bonding' as used in the guideline.

    Bonding is the positive emotional and psychological connection that the parent develops with the baby.

    bonding definition attachment

  • What is 'emotional attachment' according to the guideline?

    Emotional attachment is the relationship between baby and parent, driven by innate behaviour, ensuring proximity and safety and depending on sensitive, emotionally attuned parent interactions.

    attachment definition parenting
Notatki do nauki

Antenatal care — essential points

  • Principle: Women have the right to be involved in decisions about their care; support informed consent and shared decision making.
  • Information sources: Follow NICE guidance, GMC/NMC guidance and the Montgomery ruling when discussing risks, benefits and options.

1. Organisation and access

  • Starting care: Allow multiple referral routes (self-referral, GP, midwife, community services). Provide an easy referral form and early pregnancy information.
  • Referral form should: identify specific medical/social needs, modifiable risks (eg smoking), and include the woman's GP contact.
  • Booking timing: Offer first (booking) appointment with a midwife by \(10+0\) weeks; if referred after \(9+0\) weeks, offer within 2 weeks if possible.
  • Routine appointment schedule: plan 10 routine visits for nulliparous women and 7 for parous women.
  • Accessibility & continuity: provide interpreting services (including BSL), materials in multiple formats/languages, and aim for continuity of carer.

2. Involving partners

  • Invite and involve partners according to the woman's wishes; make environments and appointment times partner-friendly and offer remote attendance options.

3. Routine clinical care — history & risk assessment

  • At booking, record: medical, obstetric and family history (both biological parents), current/recent medicines, allergies, occupation, social support, partner details, lifestyle (smoking, alcohol, drugs), and mental health history.
  • Vulnerable groups: women from some minority ethnic groups and deprived areas have higher risks (examples: maternal death rates observed as \(8/100000\) white vs \(34/100000\) black in MBRRACE-UK) — consider closer monitoring and extra support.
  • Smoking: if she or partner smokes or stopped within 2 weeks, offer referral to stop-smoking services.
  • Safeguarding: ask about domestic abuse and FGM sensitively, provide private opportunity to disclose, follow relevant safeguarding guidance.
  • Records & communication: update antenatal records at every contact and share agreed information with the GP after discussion with the woman.

4. Examinations, screening and investigations

  • First face-to-face visit: measure height, weight and calculate BMI; offer blood tests for full blood count, blood group and rhesus D.
  • Screening programmes to offer and discuss at booking: infectious diseases (HIV, syphilis, hepatitis B), sickle cell and thalassaemia, fetal anomaly screening.
  • Ultrasound scans: offer dating/NT scan between \(11+2\) and \(14+1\) weeks (gestation, multiples, optional aneuploidy screening); offer anomaly/placental location scan between \(18+0\) and \(20+6\) weeks.
  • 28-week checks: repeat full blood count, blood group and antibodies; offer anti-D prophylaxis to rhesus D–negative women who are not sensitised.
  • Give choice: women can accept or decline any screening element.
  • Unexpected results: refer according to local pathways and provide support.

5. Venous thromboembolism (VTE)

  • Assess VTE risk at booking and after any hospital admission or major event; use professional guidance (eg RCOG).
  • Hospital admission: follow NICE VTE guidance for pregnant/postpartum women; refer at-risk women to obstetrics for management.

6. Gestational diabetes (GDM)

  • Risk assessment at booking per diabetes-in-pregnancy guidance.
  • Testing: if at risk, offer an oral glucose tolerance test between \(24+0\) and \(28+0\) weeks.

7. Pre-eclampsia & hypertension

  • Assess pre-eclampsia risk at booking and in 2nd trimester; advise aspirin where indicated (see hypertension-in-pregnancy guidance).
  • BP monitoring: measure and record BP at every routine face-to-face appointment using a pregnancy-validated device.
  • Referral thresholds: first episode of hypertension after \(20+0\) weeks (BP ≥ \(140/90\ \text{mmHg}\)) → refer to secondary care to be seen within 24 hours; severe hypertension (BP ≥ \(160/110\ \text{mmHg}\)) → urgent same-day referral.
  • Proteinuria: offer urine dipstick at every routine face-to-face appointment.

8. Monitoring fetal growth & wellbeing

  • Fetal growth risk assessment at booking and again in the 2nd trimester; use local/professional guidance (eg RCOG small-for-gestational-age guidance).
  • Fundal height: measure after \(24+0\) weeks at each appointment (no more often than every 2 weeks) and plot on a growth chart.
  • When to scan: scan if fundal height is large or small for dates or if clinical concerns (reduced fetal movements, high maternal BP).
  • Routine late scans: do not routinely offer ultrasound after 28 weeks for uncomplicated singleton pregnancies.
  • Fetal movements: discuss from \(24+0\) weeks; ask about concerns at each contact and advise contacting maternity services any time for reduced movements.
  • Breech: palpate after \(36+0\) weeks; if suspected, confirm with ultrasound and discuss options including external cephalic version, vaginal breech birth or elective caesarean.

9. Information, communication & shared decision making

  • Core principles: listen, individualise information, use clear language, check understanding and offer repeated opportunities for questions.
  • Information topics to cover (booking and ongoing): what antenatal care involves; appointment schedule and locations; contacts for urgent and non-urgent concerns; screening and scans; fetal development; physical and emotional changes; mental health; immunisations (flu, pertussis, RSV where applicable); infections; safe medicine use; resources and peer support.
  • Birth planning: start discussing birth preferences before 28 weeks and continue after 28 weeks; discuss prolonged pregnancy from 38 weeks.

10. Antenatal classes & peer support

  • Offer antenatal classes to nulliparous women (and partners) covering labour preparation, caring for the baby, feeding plans and emotional attachment.
  • Offer classes to multiparous women if beneficial; ensure classes are accessible and culturally adapted.
  • Peer support: discuss benefits (practical support, confidence, reducing isolation) and provide details of local/national services.

11. Specific advice — sleep position

  • Advise women to avoid going to sleep on their back after \(28\) weeks and consider pillows to maintain position; explain possible link between supine sleep in late pregnancy and stillbirth risk.

12. Interventions for common pregnancy problems

  • Nausea & vomiting
  • Reassure that mild–moderate symptoms often resolve by 16–20 weeks.
  • Offer ginger as a non-pharmacological option; discuss antiemetics if pharmacological treatment chosen.

  • For moderate–severe cases consider IV fluids (outpatient if possible) and acupressure as adjunct; admit if refractory or hyperemesis gravidarum.

  • Heartburn

  • Advise lifestyle/dietary measures and consider a trial of antacid or alginate.

  • Symptomatic vaginal discharge

  • If discharge is symptomatic (itching, malodour, dysuria or pain) investigate with swab and screen for STIs when suspected.

  • Treat candidiasis with vaginal imidazole; consider antibiotics for bacterial vaginosis per antimicrobial stewardship.

  • Pelvic girdle pain

  • Consider physiotherapy for exercise advice and/or a non-rigid lumbopelvic belt.

  • Unexplained vaginal bleeding after 13 weeks

  • Offer anti-D immunoglobulin to rhesus D–negative women at risk of isoimmunisation.
  • Refer to secondary care, consider admission depending on bleeding severity and preterm risk.
  • Offer ultrasound for placental localisation if unknown.
  • If admitted and preterm birth is likely within 48 hours, consider corticosteroids for fetal lung maturation depending on gestation.

13. Terms (concise definitions)

  • Bonding: the parent’s positive emotional and psychological connection with the baby.
  • Emotional attachment: the broader caregiver–infant relationship that develops through sensitive, attuned interactions and supports infant safety and social development.

Quick practical checklist for antenatal visits

  • Confirm appointment schedule and contact details.
  • Update history and medicines; screen for domestic abuse and safeguarding concerns.
  • Measure weight/BMI and blood pressure; urine dipstick for protein.
  • Record fetal movements discussion after \(24+0\) weeks; measure fundal height after \(24+0\) weeks.
  • Ensure screening tests and scans are offered and results communicated.
  • Provide personalised information and signpost peer/support services.