The following plan forms the basis of antenatal care for women assessed as higher risk throughout their pregnancy, requiring referral to an Obstetric and/or Consultant physician. Not every woman will need to attend every appointment listed here. You may be seen by the Consultant or a member of their team, which may include a physician, sonographer or a specialist Lead Midwife for antenatal care.
Number of weeks
Following your positive pregnancy test
Reason for appointment
To register your pregnancy
Where and who will I see
Online booking form at www.nth.nhs.uk/maternityform
What will happen at this appointment
Details will be sent confidentially to our Midwifery teams who will allocate you to a midwife in your area. This can take up to two weeks
Prior to 10 weeks
Reason for appointment
Pre-Booking Session. (Information may be sent via post or email if unable to attend)
Where and who will I see
Community Midwifery Assistant, at the Community Midwifery Hub in your area.
What will happen at this appointment
Information session, supported by provision of leaflets regarding a range of issues such as Antenatal Screening choices, health eating, smoking etc.
8 to 10 weeks
Reason for appointment
Booking Visit
Where and who will I see
Midwife, at the community Hub in your area.
What will happen at this appointment
History taking and identification of risk factors indicating the need for a low or high risk maternity care pathway.
Counselling regarding screening tests for fetal anomalies and written consent obtained. A flu vaccine will be offered from booking to any point in your pregnancy if it is vaccine season.
Blood will be taken for first Antenatal screening. Scan appointments will be organised. (you will not receive a scan at this appointment)
FW8 certificate provided if required.
Identification of women receiving additional care. We will offer a test to monitor your Carbon Monoxide reading, this is especially relevant to women who smoke.
8 to 10 weeks: or as soon after booking as possible
Reason for appointment
Glucose tolerance test for women with identified as having had previous gestational diabetes. This may be repeated at 24 weeks
Where and who will I see
Maternity Health Care assistant. Maternity Day Assessment unit at your Hospital site.
What will happen at this appointment
You will be given full instructions on how this appointment will be conducted. You will be asked to fast from a specific time and stay in the unit for the whole of the time period required for this test.
10 weeks
Reason for appointment
Women with preexisting diabetes. Combined clinic appointment
Where and who will I see
Consultant obstetrician or a member of their team, Consultant physician and diabetes team. Women’s outpatients department.
What will happen at this appointment
Discussions on how diabetes/existing medical conditions can affect your pregnancy and options on how to reduce these.
Birth and early parenting Medication reviews. Individualised pathway planned, responsive to your needs. This could involve appointments every two weeks
11 to 14 weeks
Reason for appointment
Dating Scan/combined screening
Where and who will I see
Hospital Ultrasound Department.
What will happen at this appointment
During the scan the Ultra sonographer will explain any findings. Blood tests will be taken if first trimester screening is required.
12 weeks
Reason for appointment
Women assessed as higher risk for; Previous LSCS Twins Increased risk of preterm birth.
Where and who will I see
Booking details triaged and referred to appropriate clinic. Consultant obstetrician/multiple pregnancy team.
What will happen at this appointment
Meet the team. Discussion regarding risk factors and how to reduce them Identification of appropriate pathway and agreement on a management plan. Plan of schedule of ultrasound scans.
16 weeks: first appointment
Reason for appointment
MSS test
Where and who will I see
Midwife or Community Midwifery Assistant at the Maternity Hub or Women’s out patients.
What will happen at this appointment
Blood will be taken for the MSS test if requested or not eligible for the combined screening. Information regarding the test will be provided.
16 week: second appointment
Reason for appointment
First return visit.
Where and who will I see
Community Midwife and/or Consultant Obstetrician or a member of their team, at the Maternity Hub or Women’s out patients or SLM.
What will happen at this appointment
Review results of screening review, discuss and record the results of all screening tests.
Reassess planned plan of care for your pregnancy and risk assess to identify women who need additional care. Give information about ongoing care.
Record blood pressure and perform urinalysis and antenatal well-being check We will offer a test to monitor your Carbon Monoxide reading, this is especially relevant to women who smoke.
Your baby’s Growth Chart, produced following your scan will be reviewed and planning made for serial scans if required. Discussion regarding home assessment.
16 week: third appointment
Reason for appointment
Commencement of cervical length screening for women deemed at risk of pre-term labour. Commencement of two weekly scanning for identical twins.
Where and who will I see
Ultrasonographer Hospital Ultrasound Department. Midwife sonographer, Consultant obstetrician or a member of their team Women’s outpatients department.
What will happen at this appointment
The reason for the scans will be discussed with you by your Consultant obstetrician or one of their team.
Following your scans you may be asked to attend the antenatal day assessment unit for review, or attend and appointment with your obstetric team.
Your scan will be discussed, any questions answered and a new appointment arranged.
18 weeks
Reason for appointment
Continuance of cervical length screening for women deemed at risk of pre- term labour. Continuance of two weekly scanning for identical twins.
Where and who will I see
Ultrasonographer or Midwife sonographer. Hospital Ultrasound Department.
What will happen at this appointment
Following your scans you may be asked to attend the antenatal day assessment unit for review, or attend and appointment with your obstetric team. Your scan will be discussed, any questions answered and a new appointment arranged.
20 to 22 weeks
Reason for appointment
Anomaly scan.
Scan for placental location if you have had a previous LSCS.
Potentially final of cervical length screening for women deemed at risk of pre-term labour.
Continuance of two weekly scanning for identical twins/
Where and who will I see
Ultrasonographer.
Hospital Ultrasound Department.
Women’s outpatients department.
What will happen at this appointment
This ultrasound scan can detect structural anomalies if present. This will include a detailed examination of the heart. You may be asked to return at a later date if we cannot complete the examination due to the position of the baby. The gender of your baby can be identified at this point if the baby is in the correct position. However, we cannot extend the length of the scan to determine this.
Following your scans you may be asked to attend the antenatal day assessment unit for review, or attend and appointment with your obstetric team.
Your scan will be discussed, any questions answered and a new appointment arranged.
24 weeks
Reason for appointment
Second return visit.
Where and who will I see
Community Midwife and/or Consultant Obstetrician, or a member of their team at the Maternity Hub or Women’s out patients.
What will happen at this appointment
Scan results will be reviewed. Risk assessment undertaken to ensure that the correct pathway is being followed. Rhesus status will be reviewed. Discussion regarding prophylactic Anti D therapy if required and appropriate information provided.
Palpation of fundal height, BP and urinalysis, and antenatal well-being check.
Employment and domestic arrangements will be discussed. Mat B1 can be provided if required.
We will offer a test to monitor your Carbon Monoxide reading, this is especially relevant to women who smoke.
Discussion regarding the monitoring of your baby’s movements.
24 to 28 weeks
Reason for appointment
Glucose tolerance test for women with identified as having had previous gestational diabetes, or identified risk factors.
Where and who will I see
Maternity Health Care assistant. Maternity Day Assessment unit at your Hospital site.
What will happen at this appointment
You will be given full instructions on how this appointment will be conducted. You will be asked to fast (not eat) from a specific time and stay in the unit for the whole of the time period required for this test.
24 weeks
Reason for appointment
Continuance of two weekly scanning for identical twins.
Commencement of four weekly scanning for non-identical twins.
Where and who will I see
Ultrasonographer.
Hospital Ultrasound Department Women’s outpatients department.
What will happen at this appointment
Following your scans you may be asked to attend the antenatal day assessment unit for review, or attend and appointment with your obstetric team.
Your scan will be discussed, any questions answered and a new appointment arranged.
26 weeks
Reason for appointment
Continuance of two weekly scanning for identical twins.
Where and who will I see
Ultrasonographer.
Hospital Ultrasound Department.
Women’s outpatients department.
What will happen at this appointment
Following your scans you may be asked to attend the antenatal day assessment unit for review, or attend and appointment with your obstetric team.
Your scan will be discussed, any questions answered and a new appointment arranged.
28 weeks
Reason for appointment
Third return visit.
Where and who will I see
Community Midwife and/or Consultant Obstetrician, or a member of their team/ SLM, Consultant Physician/Diabetes Nurse specialist for women with diabetes or complex medical conditions.
SLM following an approved pathway.
Community Midwifery Hub or woman’s outpatients as appropriate.
What will happen at this appointment
Second antenatal screening blood tests. You will be offered infection screening bloods again if declined previously, or a clinical need to repeat.
Measuring of fundal height, BP and urinalysis and Antenatal well-being check.
Discussions regarding rhesus status, if negative you will be offered prophylactic Anti D. This will usually be performed at this appointment or an alternative appointment will be offered.
Arrangements regarding Parent craft education will be discussed.
Women with gestational diabetes will be offered a retinal screening appointment.
Women requiring fetal growth surveillance will be offered ultrasound scanning if previous baby was <3rd centile. We will offer a test to monitor your Carbon Monoxide reading; this is especially relevant to women who smoke. Discussion regarding the monitoring of your baby’s movements.
28 weeks
Reason for appointment
Continuance of two weekly scanning for identical twins.
Continuance of four weekly scanning for non-identical twins.
Where and who will I see
Ultrasonographer.
Hospital Ultrasound Department Women’s outpatients department.
What will happen at this appointment
Following your scans you may be asked to attend the antenatal day assessment unit for review, or attend and appointment with your obstetric team.
Your scan will be discussed, any questions answered and a new appointment arranged.
30 weeks
Reason for appointment
Antenatal/Combined Clinic appointment
Where and who will I see
Consultant obstetrician, or a member of their team Consultant physician and diabetes team.
Women’s outpatients department.
What will happen at this appointment
Review of ongoing care. Medication review. Blood pressure recording and urinalysis. Antenatal well-being check.
Further blood tests may be offered. Review of second antenatal screening blood tests and actioning of results.
30 weeks
Reason for appointment
Continuance of two weekly scanning for identical twins.
Where and who will I see
Ultrasonographer.
Hospital Ultrasound Department.
Women’s outpatients department.
What will happen at this appointment
Following your scans you may be asked to attend the antenatal day assessment unit for review, or attend and appointment with your obstetric team.
Your scan will be discussed, any questions answered and a new appointment arranged.
32 weeks
Reason for appointment
Antenatal/Combined Clinic appointment.
Commencement of serial ultrasound scans for growth, if identified as at moderate risk for suspected growth retardation( if baby was <3rd centile this will have commenced at 28 weeks), raised BMI and smoking Continuance of two weekly scanning for identical twins Continuance of four weekly scanning for non-identical twins.
Where and who will I see
Consultant obstetrician or a member of their team Consultant physician and diabetes team.
Ultrasonographer or Midwife sonographer.
Community Midwifery Hub or woman’s outpatients as appropriate.
SLM following an approved pathway.
What will happen at this appointment
Review of ongoing care. Medication review.
Blood pressure recording and urinalysis.
Antenatal wellbeing check.
Further blood tests may be offered.
Review of second antenatal screening blood tests and auctioning of results.
You will commence receiving regular ultrasound scans for monitoring of fetal growth and amniotic fluid. This will be plotted on a graph and the results discussed with you. Your next scan appointment will be provided following review and plotting of your scan on your individualised chart.
34 weeks
Reason for appointment
Fourth return visit.
Where and who will I see
Community Midwife and/or Consultant Obstetrician, Consultant Physician/ or a member of their team Diabetes Nurse specialist for women with diabetes or complex medical conditions.
Community Midwifery Hub or woman’s outpatients as appropriate.
SLM for women with raised BMI, smoking with no other risk factors or women who have experienced previous SGA, following an approved pathway.
Women’s outpatients department.
What will happen at this appointment
Community Midwife to review second antenatal screen results if consultant review not required.
Measuring of fundal height, BP and urinalysis. Antenatal wellbeing check.
We will offer a test to monitor your Carbon Monoxide reading; this is especially relevant to women who smoke.
Discussion regarding the monitoring of your baby’s movements.
Birth planning appointment will be scheduled, and information provided to help with choices.
34 weeks
Reason for appointment
Continuance of two weekly scanning for identical twins.
Where and who will I see
Ultrasonographer.
Hospital Ultrasound Department.
What will happen at this appointment
Following your scans you may be asked to attend the antenatal day assessment unit for review, or attend and appointment with your obstetric team.
Your scan will be discussed, any questions answered and a new appointment arranged.
36 weeks
Reason for appointment
Antenatal/ Combined Clinic appointment.
Continuance of serial ultrasound scans for growth, if identified as at risk for suspected growth retardation.
Continuance of two/four weekly scanning for identical twins and nonidentical twins.
Where and who will I see
Consultant obstetrician or a member of their team Consultant physician and diabetes team.
Women’s Outpatients department.
SLM for women with raised BMI, smoking with no other risk factors or women who have experienced previous SGA, following an approved pathway.
What will happen at this appointment
Review of ongoing care. Medication review.
Blood pressure recording and urinalysis. Antenatal wellbeing check.
Further blood tests may be offered.
Review of second antenatal screening blood tests and actioning of results.
You may be offered a further scan for surveillance of fetal growth and levels of amniotic fluid, this will be reviewed and plotted on your individualised chart.
36+ weeks
Reason for appointment
Fifth, sixth and seventh return visit.
Birth plan appointment.
Where and who will I see
Community Midwife at Midwifery Hub or Home.
What will happen at this appointment
Blood pressure recording and urinalysis. Antenatal well-being check.
We will review all risk factors and discuss the choices available for place of birth.
Home assessment, if not already undertaken, will be performed.
38 weeks
Reason for appointment
Sixth return visit and/or Antenatal/ Combined Clinic appointment.
Continuance of two weekly scanning for identical twins.
Continuance of four weekly scanning for non-identical twins.
Where and who will I see
Consultant obstetrician or a member of their team.
Consultant physician and diabetes team.
Women’s outpatients department.
Ultrasonographer.
Hospital Ultrasound Department.
What will happen at this appointment
Blood pressure recording and urinalysis. Antenatal well-being check.
You may be offered a further scan for surveillance of fetal growth and levels of amniotic fluid, this will be reviewed and plotted on your individualised chart.
We will discuss your option for birth at this point. Any further appointments will be arranged on an individual basis past 38 weeks gestation.
Digital PDF document download
Antenatal pathway for women deemed of higher risk in pregnancy (398kB pdf)