Antenatal care and assessment, including screening and risk identification
This domain tests the New Zealand antenatal schedule, what each screening test can and cannot tell you, and when to refer. The exam favours scenarios where a result must be interpreted alongside history and gestation.
Booking and routine screening
- Book before 10 weeks: history, BP, BMI, urinalysis, bloods (FBC, group and antibodies, rubella, syphilis, HIV, hepatitis B, varicella, HbA1c, urine culture), and discuss folic acid 0.8 mg, iodine 150 mcg and vitamin D if indicated.
- First trimester combined screening: 11+0 to 13+6 weeks (nuchal translucency plus PAPP-A and hCG).
- Second trimester maternal serum screening: 14–20 weeks.
- Anatomy scan: 18–20 weeks.
- GTT: 24–28 weeks for risk factors.
- Group B streptococcus: New Zealand uses risk-based, not universal, screening.
- Immunisation: influenza in any trimester; Tdap from 16 weeks, ideally 28–38 weeks.
Risk and referral
- Red flags include BP ≥140/90, proteinuria, bleeding, reduced fetal movements, suspected growth restriction, pre-existing medical disease, previous pre-eclampsia, multiple pregnancy and BMI ≥35.
- Aspirin 100–150 mg at night from 12 weeks reduces pre-eclampsia risk in high-risk women.
- Refer to obstetric or medical teams for pre-existing disease, previous pregnancy loss or preterm birth, and suspected growth restriction.
- Ask about mental health, family violence and social needs at booking and again later.
Worked example
A woman with BMI 35 and previous pre-eclampsia books at 9 weeks. She is high risk: start aspirin, arrange baseline bloods, refer early, plan growth scans and BP monitoring, and document the discussion.
Traps
Treating screening as diagnosis; omitting consent and explanation; assuming risk is fixed; missing mental health and social risk.