Antenatal schedule of care

Care:

• Obtain full maternal medical, mental health, social, and obstetric history. Review previous notes and SCI referral
• Commence and document initial SHANARI GIRFEC tab*
• Instigate any appropriate brief intervention relating to lifestyle raised through history – eg alcohol or drug use
• Antenatal examination – document on BadgerNet
  • Blood pressure
  • Urinalysis
  • Height & weight
  • Carbon Monoxide

• Routine enquiry about gender based violence
• Discuss and offer antenatal screening including
  • Down’s syndrome
  • Edwards’ syndrome
  • Patau’s syndrome
  • Papp-A
  • Second trimester

• Assess for GDM screening and refer for GTT at appropriate gestation if indicated
• Assess for low dose aspirin. [Document on Badger, but use GGC Guidance to interpret risk factors as Badger algorithm based on different guidance]
• Assess for small for gestational age risk
• Commence PPH risk assessment
• Discuss all options for place of birth [home, AMU, CMU, OLU]
• Consider preference of birth type, and if considering maternal request caesarean birth - at the earliest opportunity discussion and offer of referral to MNPI
• Offer referrals to financial inclusion, best start grant and voucher card. Consider maternity emergency grant
• Booking Bloods including Ferritin +/- HbA1c. Other bloods may be indicated [see Antenatal Pathways]
• Document initial Management Plan informed by complete booking assessment
• Contact, liaise with and refer to multi-professional team as appropriate following completed booking assessment (e.g. geographically aligned obstetrician, specialist obstetric clinic lead, MNPI, PNMT, Blossom, homebirth team)
• Offer options for resources - Ready Steady Baby, off to a good start including digital versions via app, or paper versions and in alternative language where appropriate.
• Provide supply of Healthy Start vitamins and FW8 Maternity Exemption Certificate
• Discuss and offer vaccinations
• Complete conversations in pregnancy (1^st trimester)
• Provide contact telephone numbers and advice about their use
• Check how the woman wishes to receive any results – whether via the Badgernet app or other means.  Identify whether Badgernet app activated.

Care:

• Enquire about overall wellbeing – physical and mental health – provide any appropriate self management advice or onward referral
• Antenatal examination – document on BadgerNet
  • Blood pressure
  • Urinalysis
• Ensure all blood results have been reviewed, actioned and recorded on BadgerNet
• Update GIRFEC*
• Complete PPH risk assessment with blood results and USS findings
• Enquire about compliance with Healthy Start Vitamins, Oral Iron and Low Dose Aspirin if required and document on BadgerNet
• Review 1st/2nd Trimester Screening result. (If PAAP-A result <0.42 MoM, ensure appropriate follow-up is arranged)
• Encourage healthy lifestyle choices – individualise care, but consider discussing diet, caffeine, exercise, smoking, alcohol, mental wellbeing
• Complete Conversations in pregnancy (2^nd trimester)
• Give Parent Education/Breastfeeding Workshop dates/online information
• Ensure FAS and Whooping Cough arranged for 20 weeks if consents
• Arrange/refer for  GTT and Anti-D if required.
• Discuss Flu vaccine (October-March)
• Discuss Best Start Grant and Best Start Foods
• Ensure all appropriate referrals have been completed (Blossom, FNP, PMHT, Smokefree, Threads (RAH), Financial Inclusion).
• Discuss, complete and send Health Visitor referral
• Ongoing risk assessment (which may include the need to review care from previous appointments, or from attendance at Maternity Assessment/Triage and any inpatient care) and ensure correct pathway documented on BadgerNet
• Review and update Management Plan
• Midwife review @ 22 weeks

Care:

• Enquire about overall wellbeing – physical and mental health – provide any appropriate self management advice or onward referral
• Antenatal examination – document on BadgerNet
  • Blood pressure
  • Urinalysis
  • Oedema
  • Palpate fundal height (only measure and plot if >24 weeks)
  • Auscultate fetal heart
• Enquire of compliance with Healthy Start Vitamins, Oral Iron and Low Dose Aspirin if required and document on BadgerNet
• Update GIRFEC*
• Discuss the importance of fetal movements and give leaflets – parentclub risks of stillbirth, GGC your baby’s movements. Use teachback.
• Discuss fetal development and attachment and Skin-to-Skin.
• Give MatB1 and Baby Box leaflet.
• Discuss contraception and offer GGC leaflet (or at 28 weeks)
• Encourage healthy lifestyle choices.
• Review FAS and ensure appropriate follow-up arranged.
• Review Whooping Cough and Flu vaccine status
• Confirm woman has contact telephone numbers and knows when to use them
• Ongoing risk assessment (which may include the need to review care from previous appointments, or from attendance at Maternity Assessment/Triage and any inpatient care) and ensure correct pathway documented on BadgerNet
• Review and update Management Plan
• Midwife review @ 28 weeks

Care:

• Enquire about overall wellbeing – physical and mental health – provide any appropriate self management advice or onward referral
• Antenatal examination – document on BadgerNet
  • Blood pressure
  • Urinalysis
  • Oedema
  • Palpate, measure and plot first fundal height measurement on BadgerNet
  • Auscultate fetal heart
• Review fundal height plot on Intergrowth chart and action accordingly.
• Discuss the importance of fetal movements. Use Teachback.
• Update woman’s weight, complete VTE risk assessment and action accordingly.
• Enquire of compliance with Healthy Start Vitamins, Oral Iron and Low Dose Aspirin (if required) and document on BadgerNet.
• Obtain 28 week bloods (Blood Group and Antibodies, FBC and Ferritin) or review blood results if taken at Anti D appointment.
• Revisit Routine Enquiry, Lifestyle, financial inclusion
• Revisit Parent Education/Breastfeeding Workshop dates/online information and signpost Birth Preferences. Discuss and offer MNPI referral if considering maternal request caesarean birth.
• Discuss contraception and document on BadgerNet (if not discussed at 22 weeks)
• Enquire whether HV antenatal contact has taken place.
• Review/complete GIRFEC*
• Confirm woman has contact telephone numbers and knows when to use them
• Ongoing risk assessment (which may include the need to review care from previous appointments, or from attendance at Maternity Assessment/Triage and any inpatient care) and ensure correct pathway documented on BadgerNet
• Review and update Management Plan
• Midwife review @ 32 weeks

Care:

• Enquire about overall wellbeing – physical and mental health – provide any appropriate self management advice or onward referral
• Antenatal examination – document on BadgerNet
  • Blood pressure
  • Urinalysis
  • Oedema
  • Palpate, measure and plot fundal height on BadgerNet if 2 weeks or more since last measurement
  • Auscultate fetal heart
• Review fundal height plot on Intergrowth chart and action accordingly.
• Discuss the importance of fetal movements. Use teachback.
• Enquire of compliance with Healthy Start Vitamins, Oral Iron and Low Dose Aspirin (if required) and document on BadgerNet.
• Review 28 week blood results and ensure actioned
• FBC/ferritin if commenced on iron at 28 weeks
• Signpost to birth Preferences for discussion at next appointment
• Confirm woman has contact telephone numbers and knows when to use them
• Ongoing risk assessment (which may include the need to review care from previous appointments, or from attendance at Maternity Assessment/Triage and any inpatient care) and ensure correct pathway documented on BadgerNet
• Review and update Management Plan
• Midwife review @ 34 weeks

Care:

• Enquire about overall wellbeing – physical and mental health – provide any appropriate self management advice or onward referral
• Antenatal examination – document on BadgerNet
  • Blood pressure
  • Urinalysis
  • Oedema
  • Palpate, measure and plot fundal height on BadgerNet if 2 weeks or more since last measurement
  • Auscultate fetal heart

• Review fundal height plot on Intergrowth chart and action accordingly.
• Discuss the importance of fetal movements
• Enquire of compliance with Healthy Start Vitamins, Oral Iron and Low Dose Aspirin (if required) and document on BadgerNet.
• Obtain FBC and Ferritin
• Discuss and document Birth Preferences in Birth planning section on BadgerNet
• Discuss optimal fetal positioning for labour and birth (leaflet available)
• Complete Conversations in Pregnancy (3^rd trimester)
• Revisit Routine Enquiry and Lifestyle
• Confirm woman has contact telephone numbers and knows when to use them

• Ongoing risk assessment (which may include the need to review care from previous appointments, or from attendance at Maternity Assessment/Triage and any inpatient care) and ensure correct pathway documented on BadgerNet
• Review and update Management Plan
• Midwife review @ 36 weeks

Care:

• Enquire about overall wellbeing – physical and mental health – provide any appropriate self management advice or onward referral
• Antenatal examination – document on BadgerNet
  • Blood pressure
  • Urinalysis
  • Oedema
  • Palpate, measure and plot fundal height on BadgerNet if 2 weeks or more since last measurement
  • Auscultate fetal heart
• Review fundal height plot on Intergrowth chart and action accordingly
• Discuss the importance of fetal movements. Use teachback
• Enquire of compliance with Healthy Start Vitamins, Oral Iron and Low Dose Aspirin (if required) and document on BadgerNet
• Update woman’s weight
• Obtain FBC and Ferritin if not obtained at 34 weeks

• Review 34 week blood results and ensure actioned
• Complete PPH Prevention Assessment
• Discuss perineal massage and give GGC leaflet

• Confirm woman has contact telephone numbers and knows when to use them
• Discuss and document signs of labour and ensure appropriate telephone number (CMU, Triage or Maternity Assessment)
• Ongoing risk assessment (which may include the need to review care from previous appointments, or from attendance at Maternity Assessment/Triage and any inpatient care) and ensure correct pathway documented on BadgerNet
• Review and update Management Plan
• Midwife review @ 36 weeks

Care:

• Enquire about overall wellbeing – physical and mental health – provide any appropriate self management advice or onward referral
• Antenatal examination – document on BadgerNet
  • Blood pressure
  • Urinalysis
  • Oedema
  • Palpate, measure and plot fundal height on BadgerNet if 2 weeks or more since last measurement
  • Auscultate fetal heart
• Review fundal height plot on Intergrowth chart and action accordingly
• Discuss the importance of fetal movements. Use teachback.
• Enquire of compliance with Healthy Start Vitamins, Oral Iron and Low Dose Aspirin (if required) and document on BadgerNet.
• Confirm woman has contact telephone numbers and knows when to use them
• Discuss induction of labour for post dates / Membrane Sweep** – discuss, give leaflet and arrange
• Ongoing risk assessment (which may include the need to review care from previous appointments, or from attendance at Maternity Assessment/Triage and any inpatient care) and ensure correct pathway documented on BadgerNet
• Review and update Management Plan
• Midwife review @ 40 weeks OR if individualised plan indicates reappoint at 39 weeks for Membrane sweep**

**Comment from Dr Jane Richmond, Clinical Director, GG&C, Consultant Obstetrician and Gynaecologist, Queen Elizabeth University Hospital

 ‘The NICE guideline Inducing Labour (2021) recommends discussion and offer of a membrane sweep at antenatal visits after 39+0 weeks.  This should include discussion that membrane sweeping might make it more likely that labour will start without the need for additional pharmacological or mechanical methods of induction.

All low risk women can be offered a membrane sweep in community clinics from 39+0 weeks, following a risk assessment, with the offer of a further sweep if labour does not start spontaneously following the first sweep.’

Care:

• Enquire about overall wellbeing – physical and mental health – provide any appropriate self management advice or onward referral
• Antenatal examination – document on BadgerNet
  • Blood pressure
  • Urinalysis
  • Oedema
  • Palpate
  • Auscultate fetal heart
• Discuss the importance of fetal movements. Use teachback.
• Enquire of compliance with Healthy Start Vitamins, Oral Iron and Low Dose Aspirin (if required) and document on BadgerNet.
• Confirm woman has contact telephone numbers and knows when to use them
• Offer Membrane Sweep**
• Record Bishop Score on BadgerNet
• Confirm arrangements for Induction of Labour as per individualised plan
• Ongoing risk assessment (which may include the need to review care from previous appointments, or from attendance at Maternity Assessment/Triage and any inpatient care) and ensure correct pathway documented on BadgerNet
• Review and update Management Plan

**Comment from Dr Jane Richmond, Clinical Director, GG&C, Consultant Obstetrician and Gynaecologist, Queen Elizabeth University Hospital

 ‘The NICE guideline Inducing Labour (2021) recommends discussion and offer of a membrane sweep at antenatal visits after 39+0 weeks.  This should include discussion that membrane sweeping might make it more likely that labour will start without the need for additional pharmacological or mechanical methods of induction.

All low risk women can be offered a membrane sweep in community clinics from 39+0 weeks, following a risk assessment, with the offer of a further sweep if labour does not start spontaneously following the first sweep.’

Care:

• Enquire about overall wellbeing – physical and mental health – provide any appropriate self management advice or onward referral
• Antenatal examination – document on BadgerNet
  • Blood pressure
  • Urinalysis
  • Oedema
  • Palpate, measure and plot fundal height on BadgerNet if 2 weeks or more since last measurement
  • Auscultate fetal heart
• Review fundal height plot on Intergrowth chart and action accordingly.
• Discuss the importance of fetal movements.
• Enquire of compliance with Healthy Start Vitamins, Oral Iron and Low Dose Aspirin (if required) and document on BadgerNet.
• Confirm woman has contact telephone numbers and knows when to use them
• Offer Membrane Sweep** – discuss, give leaflet and arrange
• Discuss induction of labour for post dates +/- book IOL at hospital of choice (consider suitability for Outpatient IOL).
• Ongoing risk assessment (which may include the need to review care from previous appointments, or from attendance at Maternity Assessment/Triage and any inpatient care) and ensure correct pathway documented on BadgerNet
• Review and update Management Plan
• Midwife review @ 41 weeks if not scheduled IOL

**Comment from Dr Jane Richmond, Clinical Director, GG&C, Consultant Obstetrician and Gynaecologist, Queen Elizabeth University Hospital

 ‘The NICE guideline Inducing Labour (2021) recommends discussion and offer of a membrane sweep at antenatal visits after 39+0 weeks.  This should include discussion that membrane sweeping might make it more likely that labour will start without the need for additional pharmacological or mechanical methods of induction.

All low risk women can be offered a membrane sweep in community clinics from 39+0 weeks, following a risk assessment, with the offer of a further sweep if labour does not start spontaneously following the first sweep.’

Care:

• Enquire about overall wellbeing – physical and mental health – provide any appropriate self management advice or onward referral
• Antenatal examination – document on BadgerNet
  • Blood pressure
  • Urinalysis
  • Oedema
  • Palpate, measure and plot fundal height on BadgerNet if 2 weeks or more since last measurement
  • Auscultate fetal heart
• Review fundal height plot on Intergrowth chart and action accordingly.
• Discuss the importance of fetal movements. Use teachback.
• Enquire of compliance with Healthy Start Vitamins, Oral Iron and Low Dose Aspirin (if required) and document on BadgerNet.
• Confirm woman has contact telephone numbers and knows when to use them
• Offer Membrane Sweep**
• Record Bishop Score on BadgerNet
• Arrange Induction of Labour (consider suitability for Outpatient IOL). If induction declined, discuss and plan care for >42 weeks
• Ongoing risk assessment (which may include the need to review care from previous appointments, or from attendance at Maternity Assessment/Triage and any inpatient care) and ensure correct pathway documented on BadgerNet
• Review and update Management Plan

**Comment from Dr Jane Richmond, Clinical Director, GG&C, Consultant Obstetrician and Gynaecologist, Queen Elizabeth University Hospital

 ‘The NICE guideline Inducing Labour (2021) recommends discussion and offer of a membrane sweep at antenatal visits after 39+0 weeks.  This should include discussion that membrane sweeping might make it more likely that labour will start without the need for additional pharmacological or mechanical methods of induction.

All low risk women can be offered a membrane sweep in community clinics from 39+0 weeks, following a risk assessment, with the offer of a further sweep if labour does not start spontaneously following the first sweep.’