WHO eight-contact model (2016)
| Contact | Gestation | Key tasks beyond BP, weight, urine and fetal assessment |
|---|---|---|
| 1 | Up to 12 weeks | Booking history and investigations, dating scan, risk assessment, start iron and folic acid, plan tetanus–diphtheria vaccine |
| 2 | 20 weeks | Anomaly and placental scan, first IPTp dose (from 13 weeks), fundal height |
| 3 | 26 weeks | Haemoglobin, glucose screening in at-risk women (24–28 weeks), fetal movements advice |
| 4 | 30 weeks | Haemoglobin, anti-D prophylaxis if rhesus negative (28 weeks) |
| 5 | 34 weeks | Growth assessment, birth preparedness and complication readiness plan |
| 6 | 36 weeks | Presentation — offer external cephalic version for breech; discuss labour, breastfeeding and contraception |
| 7 | 38 weeks | Fetal wellbeing, birth plan |
| 8 | 40 weeks | Discuss membrane sweep and induction for prolonged pregnancy |
The old four-visit focused antenatal care model had more stillbirths; eight contacts is now the minimum WHO recommends.
Booking investigations
| Test | If abnormal |
|---|---|
| Haemoglobin or packed cell volume | Below 11 g/dL (PCV below 33%): investigate and treat anaemia |
| Blood group and rhesus, antibody screen | Rhesus negative: anti-D plan; antibodies: titres and fetal medicine referral |
| Haemoglobin genotype | AS or AC: test partner; SS or SC: joint haematology and obstetric care |
| HIV | Start antiretroviral therapy the same day |
| Hepatitis B surface antigen | Viral load and HBeAg; tenofovir from 28 weeks if viral load high; birth-dose vaccine for the baby within 24 hours |
| Syphilis serology | Benzathine benzylpenicillin 2.4 million units IM, treat partner |
| Urinalysis and urine culture | Asymptomatic bacteriuria: treat to prevent pyelonephritis and preterm birth |
| Blood glucose | Early diabetes: HbA1c or OGTT |
| Ultrasound before 24 weeks | Dating, number, chorionicity, anomalies, placental site |
| Cervical screening if due | HPV test or VIA per programme |
Routine prophylaxis and supplements
| Intervention | Dose and timing |
|---|---|
| Iron and folic acid | 30–60 mg elemental iron plus 400 micrograms folic acid daily throughout pregnancy |
| Folic acid before conception | 400 micrograms daily; 5 mg in women with diabetes, epilepsy on antiepileptics, sickle cell disease, obesity (BMI 30 or more) or a previous neural tube defect |
| IPTp with sulfadoxine–pyrimethamine | 3 tablets (1500 mg/75 mg) as directly observed therapy at each scheduled contact from 13 weeks, at least 1 month apart, until delivery — not with co-trimoxazole |
| Insecticide-treated net | From booking |
| Tetanus–diphtheria vaccine | Two doses 4 weeks apart in a first pregnancy, the second at least 2 weeks before delivery; boosters to a total of five doses |
| Calcium | 1.5–2 g daily where dietary intake is low |
| Low-dose aspirin | 75–150 mg from 12 weeks for women at high risk of pre-eclampsia |
| Deworming | Albendazole 400 mg once after the first trimester in endemic areas |
Who needs specialist-led care
| Category | Examples |
|---|---|
| Maternal medical | Hypertension, diabetes, sickle cell disease, heart disease, HIV with a detectable viral load, epilepsy, kidney disease, thyroid disease, BMI 35 or more |
| Previous pregnancy | Caesarean section or other uterine surgery, pre-eclampsia, stillbirth or neonatal death, postpartum haemorrhage, preterm birth, growth restriction, three or more miscarriages |
| Current pregnancy | Multiple pregnancy, malpresentation after 36 weeks, antepartum haemorrhage, low-lying placenta, anaemia below 9 g/dL, rhesus antibodies, age under 16 or over 40, grand multiparity |
Examiner questions
References
- Cunningham FG, Leveno KJ, Dashe JS, Hoffman BL, Spong CY, Casey BM, eds. Williams Obstetrics. 26th ed. New York: McGraw Hill; 2022.
- World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience. Geneva: WHO; 2016.
- National Institute for Health and Care Excellence. Antenatal care (NG201). London: NICE; 2021.