Synopsis
Complete an early, consent-based booking assessment that identifies maternal, fetal and social risk, offers national screening on time and closes every result pathway.
- Offer the first antenatal booking appointment by 10+0 weeks; when referral occurs after 9+0 weeks, offer an appointment within 2 weeks if possible.
- Plan 10 routine antenatal appointments for a nulliparous pregnancy and 7 for a parous pregnancy, adding or lengthening contacts for clinical, communication, social or emotional need.
- At the first face-to-face contact record height, weight and BMI, blood pressure, urine protein, full blood count, ABO group, RhD type and red-cell antibody status.
- Offer, after information and consent, screening for HIV, syphilis and hepatitis B, sickle cell and thalassaemia, trisomies and the 20-week fetal anomaly programme; each component can be accepted or declined.
- Obtain a midstream urine culture early because asymptomatic bacteriuria is not reliably excluded by symptoms or dipstick alone and treatment reduces pregnancy complications.
- Use structured history to assess previous obstetric outcomes, medical and mental-health conditions, medicines, VTE, pre-eclampsia, diabetes, fetal-growth and inherited-disease risk.
- Arrange a private one-to-one discussion for domestic abuse, safeguarding, substance use, FGM and mental health; never use a partner or family member as the interpreter for sensitive enquiry.
- Screening is a choice and not a guarantee: explain possible results, follow-on tests and time limits, record decisions and run a failsafe until every accepted test has a documented outcome.
Key red flags
Sustained blood pressure of 160/110 mmHg or higher requires urgent same-day secondary-care assessment based on the complete clinical picture.
Pain, bleeding, syncope, shoulder-tip pain or peritonism before pregnancy location is known requires urgent early-pregnancy assessment.
Fever, rigors, respiratory compromise, confusion or haemodynamic abnormality suggests infection or another acute illness that supersedes routine screening.
Active suicidal thoughts, psychosis, mania, severe self-neglect or abrupt withdrawal from dependence-forming substances needs immediate specialist evaluation.
Disclosure of current violence, strangulation, sexual assault, coercive control or danger to a child requires private safety assessment and local safeguarding action.
Known major red-cell antibodies, a previous severely affected pregnancy or a serious inherited condition in either parent warrants early specialist referral rather than waiting for standard result review.
Investigation priorities
Identify anaemia, abnormal red-cell indices and thrombocytopenia early enough for investigation and treatment.
Management branches
A person first enters maternity care, whether early or after the usual booking window.
- Confirm gestation, history, medicines, allergies and prior obstetric outcomes, then measure BMI, blood pressure and urine protein with consent.
- Assess VTE, pre-eclampsia, diabetes, fetal-growth, inherited-condition, mental-health and social risks and allocate each positive finding to a named pathway.
- Agree the routine or enhanced appointment schedule, communicate urgent contact routes and share relevant information with primary and specialist care after discussion.