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Routine care during your pregnancy

Antenatal care means how your health, and the health of your baby, is monitored before your baby is born (antenatal means before birth).

About antenatal care

Once you know or suspect that you are pregnant, you should make an appointment with your GP to discuss your antenatal care. Your GP may test a sample of your urine to confirm that you are pregnant. However, you may not need to have another pregnancy test if you have a positive result from a home test.

Your GP will refer you for your first appointment, or "booking" appointment. This could be at a hospital, at your GP surgery, in a clinic or at home.

Arrangements for antenatal care vary but the National Institute for Health and Clinical Excellence (NICE) recommends that healthy women have up to 10 check-ups for a first pregnancy, including the booking visit. You will probably need about seven appointments if you have already had a healthy pregnancy.

First antenatal appointment

The first antenatal appointment is sometimes called the "booking appointment".

This should be as early as possible and before 12 weeks of pregnancy.

You may see a midwife, a doctor, or both. They will talk to you about your health and previous pregnancies, to find out about your needs.

You will be advised to take a daily supplement containing 400 micrograms (0.4mg) of folic acid. This reduces the risk of your baby being born with a neural tube defect, such as spina bifida. You may need a higher dose if you have a family history of spina bifida, or if you take medicine for epilepsy.

Your midwife or doctor will also take some blood samples for testing. This is to check whether you have any conditions that may affect you or your baby's health. These tests include:

  • your blood group
  • your rhesus (RhD) type - your blood is either rhesus positive or rhesus negative - women with RhD-negative blood are usually offered injections at 28 and 34 weeks to help prevent problems with the baby in future pregnancies, such as anaemia, jaundice or stillbirth
  • a test for anaemia
  • routine tests for infections that can affect you or your baby, such as hepatitis B, syphilis, HIV and bacterial infections
  • your immunity to rubella (german measles)

Your midwife or doctor will measure your height and weight, and work out your BMI (body mass index) once - usually on your first antenatal appointment. If your BMI is under 18 or over 35, you may need extra care.

Your blood pressure and urine will also be tested. Most women don't need to have a vaginal or breast examination.

Dating scan

You will be offered an ultrasound scan called the dating scan between 10 and 13 weeks to estimate when your baby is due. This is known as your estimated due date (EDD). The scan also tells you whether you are expecting more than one baby.

Additional antenatal appointments

At each antenatal appointment after your booking visit, your midwife or GP will measure your blood pressure, and test your urine for infection and the presence of protein. Protein in the urine and raised blood pressure are signs of pre-eclampsia, which can be harmful to both mother and baby. You will be offered another blood test for anaemia at 28 weeks.

As your baby grows, your womb (uterus) rises out of your pelvis and becomes the "bump". The top of this is called the fundus. Your GP or midwife will measure the height of the fundus to check how your baby is growing.

Your midwife or GP will ask about your baby's movements and try to find out the position of your baby by feeling your abdomen. Towards the end of your pregnancy, the baby's head usually drops down in the pelvis into a position ready for delivery (when the head is said to be engaged). The head may not engage until labour starts if you have had a baby before.

Your baby's heartbeat won't be routinely checked but some women ask to listen to it. Your midwife or doctor may put an ultrasound listening device on your abdomen to make the heartbeat sound louder.

Checking your baby

Your doctor or midwife will offer tests to look for conditions affecting your baby. These include screening tests and diagnostic tests. It's your choice whether to have any test in pregnancy.

Screening tests estimate the risk of your baby being born with certain conditions, such as Down's syndrome. They don't give a definite answer. Diagnostic tests confirm whether a baby has a certain condition and are offered if the screening tests predict an increased risk of a problem.


Screening for Down's syndrome

Different screening tests for Down's syndrome are done at different stages of pregnancy and may involve blood tests and/or scans. Not all hospitals offer the same screening test, but you will be offered one of the following.

At 11 to 14 weeks

nuchal translucency scan alone

combined test (nuchal translucency scan plus blood test for two substances)

At 14 to 20 weeks

triple test (blood test for three substances)

quadruple test (blood test for four substances)

At 11 and 14 weeks and at 14 to 20 weeks

integrated test (nuchal translucency scan and blood test at 11 to 14 weeks plus another blood test at 14 to 20 weeks)

serum integrated test (blood test at 11 to 14 weeks and another blood test at 14 to 20 weeks)

Nuchal translucency scan

This is an ultrasound scan offered between 11 and 13 weeks. It measures the thickness of the layer of fluid at the back of the baby's neck (the nuchal area). A thicker than normal layer of fluid may suggest that the baby has an increased risk of Down's syndrome. If this is the case, you will usually be offered a follow-up scan a few weeks later as this can sometimes indicate that the baby may have Down's syndrome.

Results of Down's syndrome screening

The results of the screening are an estimated chance of your baby having Down's syndrome. You can compare this to the average risk for women your age. For women aged 20, one baby out of every 1,440 born will have Down's syndrome. The risk rises to one baby in 338 for women aged 35, and one baby in 32 for women aged 45.

You will be offered diagnostic tests if, based on the screening test, the estimated chance of your baby having Down's syndrome is higher than one in 250. But the choice about whether to have a diagnostic test is yours. The diagnostic tests are as follows.

Diagnostic tests

Amniocentesis

This can test for conditions in the baby such as cystic fibrosis, Down's syndrome, neural tube defects, and metabolic disorders such as phenylketonuria (when the body doesn't produce a particular enzyme, resulting in problems with early brain development). For more information about this test, please see Related topics.

Chorionic villus sampling (CVS)

This test looks for similar conditions to amniocentesis. Your doctor inserts a fine instrument through your cervix into your womb and removes a tiny sample of your placenta (from a part called the chorionic villi, tiny finger-like projections in the placenta). These have the same genetic material as your baby.

Screening for sickle cell anaemia and thalassaemia

Sickle cell anaemia and thalassaemia are inherited blood conditions that are most common in people of African-Caribbean and sub-Saharan African origin. Screening for this condition involves a blood test and questions about your family history.

Ultrasound scans

You will be offered an ultrasound scan 18 to 20 weeks into your pregnancy. The scan is to check the fluid that surrounds the baby and to check the baby's head, spine, abdominal organs, arms and legs. Sometimes it may also be possible to check the baby's heart and face.

This scan is called the anomaly scan because it can identify some physical conditions, such as cleft lip or spina bifida. The anomaly scan can't diagnose Down's syndrome.

Scans later in pregnancy

If your pregnancy proceeds normally and your baby's measurements show that growth is good, you don't normally have any further scans during your pregnancy. If your baby is thought to be too large or too small, or if you have risk factors for either of these, then a growth scan might be done at around 30 weeks.

If your anomaly scan suggests that your placenta is lying too low in your womb - a condition known as placenta previa - your doctor may recommend that you have another scan at around 30 weeks to see if this has resolved.

No test can rule out all problems, but by far the majority of babies are healthy.

Further information

Antenatal Results and Choices (ARC)

NHS antenatal screening programmes

Royal College of Obstetricians and Gynaecologists (RCOG)

Sources

  • Antenatal care: routine care for the healthy pregnant woman. National Institute of Health and Clinical Evidence. October 2003. www.nice.org.uk
  • Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice. 2nd ed. Oxford University Press: 2006
  • Arulkumaran S, Symonds IM, Fowlie A. Oxford Handbook of Obstetrics and Gynaecology. 1st ed. Oxford University Press, 2004
  • Kohner N, Burningham S, Ford K, Phillips A. The Pregnancy Book. 2nd ed. London: COI for the Department of Health, 2006
  • Amniocentesis and chorionic villus sampling. Guideline No 8. Royal College of Obstetricians and Gynaecologists, 2005. www.rcog.org.uk
  • Chorionic villus sampling: what you need to know. Royal College of Obstetricians and Gynaecologists, 2006. www.rcog.org.uk
  • Placenta praevia and placenta praevia accreta: diagnosis and management. Royal College of Obstetricians and Gynaecologists, 2005. www.rcog.org.uk

Related topics

  • Amniocentesis
  • Common pregnancy symptoms
  • Down's syndrome
  • Preparing for pregnancy
  • Pre-eclampsia
  • What to expect during pregnancy
  • Ultrasound in pregnancy