Antenatal Care and Midwifery Assessment
The antenatal care and midwifery assessment domain tests whether you can structure the booking visit, apply the recommended appointment schedule, interpret screening results and recognise when a finding needs escalation. Questions often combine timeline recall with clinical reasoning: what is due now, what can wait, and what is abnormal.
Core rules and concepts
- Book by 10 weeks. The standard schedule is 10 appointments for a nulliparous woman and 7 for a parous woman, with more if risk factors are present.
- Dating scan at 11+0–14+1 weeks; anomaly scan at 18+0–20+6 weeks.
- From 24 weeks, measure symphysis–fundal height in centimetres and plot it on a customised chart. If the measurement is below the 10th centile or static, arrange ultrasound biometry.
- Booking bloods: full blood count, blood group and antibodies, HIV, hepatitis B, syphilis and rubella immunity.
- Assess GDM risk; offer a 75-g oral glucose tolerance test at 24–28 weeks if risk factors are present.
- RhD-negative women: offer anti-D 1500 IU at 28 and 34 weeks; give anti-D within 72 hours of delivery if the baby is RhD-positive.
- Folic acid 400 micrograms daily from pre-conception to 12 weeks; 5 mg for high-risk women (previous neural tube defect, diabetes, obesity, anticonvulsants).
- Whooping cough vaccine at 16–32 weeks; influenza vaccine in any trimester.
- Ask about mental health and safeguarding at every contact and document the response.
Worked example
A nullipara at 28+2 weeks has a symphysis–fundal height of 23 cm, below the 10th centile. She feels well, BP is 110/70 and urine is negative. Reasoning: a low symphysis–fundal height is a red flag for fetal growth restriction, but a single measurement can reflect fetal lie, bladder fullness or observer error. Re-measure; if still low, arrange ultrasound biometry and umbilical artery Doppler and increase surveillance. Do not reassure on the basis of normal BP alone.
Traps
- Measuring symphysis–fundal height before 24 weeks or in multiple pregnancy.
- Treating the dating scan as optional; gestational age affects every later decision.
- Giving rubella vaccine during pregnancy instead of postpartum.
- Recording a fundal height without plotting it on the chart.
Key points
- Book by 10 weeks; dating scan 11–14 weeks; anomaly scan 18–20+6.
- Symphysis–fundal height from 24 weeks; below the 10th centile triggers ultrasound.
- Anti-D 1500 IU at 28 and 34 weeks for RhD-negative women.
- 75-g OGTT at 24–28 weeks if GDM risk factors are present.
- Folic acid 400 micrograms daily until 12 weeks; 5 mg in high-risk women.