40 weeks
For nulliparous women, an appointment at 40 weeks should be scheduled to:
- measure blood pressure and test urine for proteinuria
- measure and plot symphysis-fundal height
- give information, with an opportunity to discuss issues and ask questions; offer verbal information supported by antenatal classes and written information
More detailed "patient centred" guidance has been issued by NICE (2):
- ensure that interpreting services are available if needed. Use independent interpreters rather than the woman's family 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
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
- discuss the baby’s movements with the woman. Ask her if she has any concerns. If she does, assess her and the baby
- advise her to contact maternity services at any time of day or night if she:
- has any concerns about her baby's movements
- notices reduced fetal movements
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
- continue the discussions about preparing for labour and birth, recognising active labour, and the postnatal period
- confirm the woman's birth preferences, discussing the implications, benefits and risks of all options
- discuss prolonged pregnancy and options on how to manage this
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
- to measure symphysis fundal height (SFH) in women with a singleton pregnancy unless the woman is having regular growth scans or SFH has been measured less than 2 weeks ago. Plot the measurement onto a growth chart. If there are concerns that SFH is either large or small for gestational age, see managing complications and common problems for more information
- to identify possible breech presentation via abdominal palpation, in women with a singleton pregnancy. If you suspect breech presentation based on abdominal palpation, see managing complications and common problems for more information
- 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 complications and common problems for:
- heartburn
- high blood pressure (140/90 mmHg or more)
- nausea and vomiting
- pelvic girdle pain
- small or large baby for gestational age
- smoking
- unexplained vaginal bleeding.
Reference: