16 weeks
- review, discuss and document the results of all screening tests undertaken; reassess planned pattern of care for the pregnancy and identify women who need additional care
- investigate a haemoglobin level of less than 11 g/dL and consider iron supplementation if indicated
- measure blood pressure and test urine for proteinuria
- give information, with an opportunity to discuss issues and ask questions; offer verbal information supported by antenatal classes and written information
More detailed guidance has been issued from NICE (2):
16-week (14 to 18 weeks) appointment
- ensure that interpreting services are available if needed. Use independent interpreters rather than the woman's family members or friends
- update the woman’s antenatal records with details of history, test results, examination findings, medicines and discussions
- reassess the plan of care for the pregnancy
- identify whether the woman needs additional care
- all discussions should support shared decision making and be tailored to the woman’s needs, preferences and stage of pregnancy
New or only at this appointment
- reassess the risk of pre-eclampsia and advise those at risk to take aspirin
- also reassess the risks of fetal growth restriction if the woman agrees
- start discussing with the woman:
- her birth preferences
- their implications
- their benefits and risks.
Update the history
- ask the woman about:
- her general health and wellbeing
- domestic abuse
- mental health
- any other concerns she would like to discuss - also ask her partner about this, if present
- provide a safe environment for the discussion
- continue discussions
- discuss and give information on:
- physical, emotional and relationship changes
- support between partners
- resources for expectant and new parents
- bonding with the baby and emotional attachment
- results of any tests from previous appointments
Repeat examinations and investigations
If the appointment is face to face, offer:
- to take blood pressure using a device validated for use in pregnancy (for urgent actions to take when a woman's blood pressure is very high [160/110 mmHg or more], see managing complications and common problems)
- a urine dipstick test for proteinuria
If the woman has had any hospital admission or significant health event since her last appointment, assess her risk of venous thromboembolism.
Offer additional or longer antenatal appointments if needed, depending on the woman’s medical, social and emotional needs.
Be aware that closer monitoring may be needed for women and their babies from black, Asian and minority ethnic family origins, and those who live in deprived areas, because they are at an increased risk of adverse outcomes.
Also see managing managing complications and common problems for:
- heartburn
- high blood pressure (140/90 mmHg or more)
- nausea and vomiting
- pelvic girdle pain
- smoking
- unexplained vaginal bleeding.
Reference:
- NICE (March 2016). Antenatal care for uncomplicated pregnancies
- NICE (August 2021). Antenatal care.