Antenatal care

Short Text

Routine care for the healthy pregnant woman

Introduction

This pathway covers routine antenatal care for all healthy pregnant women. Its ethos is that pregnancy is a normal physiological process and that any interventions offered should have known benefits and be acceptable to pregnant women. The pathway covers baseline clinical care of all healthy woman with an uncomplicated singleton pregnancy. It provides details about information to give to women at specific times during their pregnancy and the checks and tests that should be carried out at each antenatal appointment.
The pathway provides criteria for referral of women who need additional care during their pregnancy. It also links to the pathways on multiple pregnancy, and pregnancy and complex social factors.

Source guidance

The NICE guidance that was used to create the pathway.
Caesarean section. NICE clinical guideline 132 (2011)
Antenatal care: routine care for the healthy pregnant woman. NICE clinical guideline 62 (2008)
Intrapartum care: care of healthy women and their babies during childbirth. NICE clinical guideline 55 (2007)
Routine antenatal anti-D prophylaxis for women who are rhesus D negative. NICE technology appraisal guidance 156 (2008)
Laparoscopic cerclage for prevention of recurrent pregnancy loss due to cervical incompetence. NICE interventional procedures guidance 228 (2007)
Fetal cystoscopy for the diagnosis and treatment of lower urinary outflow tract obstruction. NICE interventional procedures guidance 205 (2007)
Fetal vesico-amniotic shunt for lower urinary tract outflow obstruction. NICE interventional procedures guidance 202 (2006)
Therapeutic amnioinfusion for oligohydramnios during pregnancy (excluding labour). NICE interventional procedures guidance 192 (2006).
Insertion of pleuro-amniotic shunt for fetal pleural effusion. NICE interventional procedures guidance 190 (2006)
Percutaneous laser therapy for fetal tumours. NICE interventional procedures guidance 180 (2006)
Percutaneous fetal balloon valvuloplasty for pulmonary atresia with intact ventricular septum. NICE interventional procedures guidance 176 (2006)
Percutaneous fetal balloon valvuloplasty for aortic stenosis. NICE interventional procedures guidance 175 (2006)

Quality standards

Quality statements

Effective interventions library

Successful effective interventions library details

Implementation

Costing support

Costing support includes national cost impact reports that summarise the national costs and savings and discuss the assumptions used; costing templates to assess the impact on local budgets; and costing statements when the impact is not significant or impossible to quantify at a national level.
Antenatal care: costing report
Pregnancy (rhesus negative women) - routine anti-D: costing report
Antenatal care: costing template
Intrapartum care: costing statement

Education tools

NICE has developed online learning modules, in collaboration with a range of providers, including BMJ Learning, to update knowledge on evidence and NICE guidance.
Antenatal care (complications of pregnancy): education tool

Slide sets

Slide sets provide a framework for discussion and assist in local dissemination of the guidance. The slides contain the key messages from NICE guidance and can be tailored for local presentations.
Antenatal care: slide set
Intrapartum care: slide set

Pathway information

Information for patients and the public

NICE produces booklets for patients and the public, called 'Understanding NICE guidance'. They summarise, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written a booklet for patients and the public explaining its guidance on each of the following topics.
Antenatal care
Intrapartum care
Routine antenatal anti-D prophylaxis for women who are rhesus D negative
Laparoscopic cerclage for prevention of recurrent pregnancy loss due to cervical incompetence
Fetal cystoscopy for the diagnosis and treatment of lower urinary outflow tract obstruction
Fetal vesico-amniotic shunt for lower urinary tract outflow obstruction
Therapeutic amnioinfusion for oligohydramnios during pregnancy (excluding labour)
Insertion of pleuro-amniotic shunt for fetal pleural effusion
Percutaneous laser therapy for fetal tumours
Percutaneous fetal balloon valvuloplasty for pulmonary atresia with intact ventricular septum
Percutaneous fetal balloon valvuloplasty for aortic stenosis

Patient centred care

Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. People should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If someone does not have the capacity to make decisions, healthcare professionals should follow the Department of Health's advice on consent and the code of practice that accompanies the Mental Capacity Act. In Wales, healthcare professionals should follow advice on consent from the Welsh Assembly Government. If the person is under 16, healthcare professionals should follow the guidelines in Seeking consent: working with children.

Updates to this pathway

6 April 2012 Cross references to epilepsy pathway and pregnancy and complex social factors pathway updated in Overview path (slug reference to node). Map reference node added on Overview path to pathway for women with pregnancy and complex social factors.

Supporting information

Glossary

Antenatal care

Antenatal care

Routine care for all pregnant women

View the 'Routine care for all pregnant women' path

Women needing additional care

Women needing additional care

Women with pre-existing conditions or risk factors

Women with pre-existing conditions or risk factors

Women with pre-existing conditions or risk factors

The pathway makes recommendations on baseline clinical care for all pregnant women. Pregnant women with the following conditions usually require additional care:
  • Renal disease
  • Psychiatric disorders (being treated with medication) (see the antenatal and postnatal mental health pathway)
  • Haematological disorders
  • Autoimmune disorders
  • Epilepsy requiring anticonvulsant drugs (see the epilepsy pathway)
  • Malignant disease
  • Severe asthma
  • Use of recreational drugs such as heroin, cocaine (including crack cocaine) and ecstasy
  • HIV or HBV infection
  • Obesity (body mass index 30 kg/m2 or above) or underweight (body mass index below 18 kg/m2) (see NICE public health guidance on weight management).
  • Higher risk of developing complications, for example, women aged 40 and older, women who smoke (see the smoking pathway)
A system of clear referral paths should be established so that pregnant women who require additional care are managed and treated by the appropriate specialist teams when problems are identified.

Implementation

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Antenatal care (complications of pregnancy): education tool

Source guidance

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Women who had problems in a previous pregnancy

Women who had problems in a previous pregnancy

Women who had problems in a previous pregnancy

Women who have experienced any of the following in previous pregnancies usually require additional care:
A system of clear referral paths should be established so that pregnant women who require additional care are managed and treated by the appropriate specialist teams when problems are identified.

Source guidance

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Diabetes in pregnancy pathway

View the 'Diabetes in pregnancy overview' path

Hypertension in pregnancy

Hypertension in pregnancy

Hypertension in pregnancy

NICE has produced a clinical guideline on hypertension in pregnancy.

Source guidance

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Multiple (twin or triplet) pregnancy pathway

View the 'Multiple pregnancy overview' path

Pregnancy and complex social factors pathway

View the 'Pregnancy and complex social factors overview' path

Interventional procedures for some complications in pregnancy

View the 'Interventional procedures for some complications in pregnancy' path

Paths in this pathway

Pathway created: November 2011 Last updated: April 2012

Copyright © 2012 National Institute for Health and Clinical Excellence. All Rights Reserved.

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