Knowledge Area 5 | Antenatal Care

Knowledge Area 5 | Antenatal Care

(Aligned with RCOG Core Curriculum 2019)

Antenatal Care is one of the broadest and most clinically integrative areas within obstetrics. According to the current RCOG curriculum framework, antenatal care is not limited to routine visits—it encompasses:

• Pre-pregnancy counselling
• Risk assessment and stratification
• Screening and diagnosis of fetal and maternal conditions
• Surveillance of high-risk pregnancies
• Prevention of adverse outcomes
• Preparation for birth and postnatal transition

It links directly with Maternal Medicine, Fetal Medicine, Infections, Genetics, Public Health, and Obstetric Emergencies.

Foundations of Antenatal Care

• Core Aim: To optimise maternal and fetal outcomes through risk identification, prevention, surveillance, and timely intervention.
• Pregnancy may begin as low risk but evolve into high risk. The clinician must continuously reassess.

Pre-Pregnancy & Pre-Conception Counselling

• Key Components: Optimisation of chronic medical conditions; Medication review (teratogenicity risk); Folic acid (high vs standard dose); BMI optimisation; Smoking and alcohol cessation; Genetic counselling if indicated; Vaccination review
• This overlaps significantly with maternal medicine.

Booking Visit & Initial Risk Assessment

• The booking appointment establishes:
  • Maternal Baseline: BMI; Blood pressure; Past obstetric history; Thromboembolism risk; Mental health history; Safeguarding concerns
  • Baseline Investigations: FBC; Blood group & antibodies; Hb electrophoresis (if indicated); Infection screening (HIV, HBV, syphilis); Urine culture; Screening for haemoglobinopathies
• This stage determines low-risk vs consultant-led care.

Screening in Pregnancy

• Aneuploidy Screening: Combined screening (11–13+6 weeks); Cell-free DNA testing
• Fetal Anomaly Screening: 20-week anomaly scan; Fetal echocardiography when indicated
• National programme: NHS Fetal Anomaly Screening Programme

Routine Antenatal Care

• Includes structured follow-up visits: BP monitoring; Urine testing; Symphysis–fundal height (low risk); Growth scans (high risk); Fetal movement education; Vaccination (pertussis, influenza)
• Relevant topics: Hyperemesis gravidarum; Vitamin D supplementation; Constipation; Drug prescribing in pregnancy

Social & Cultural Determinants of Health

• Strongly emphasised in curriculum under safeguarding & equality. This is now a high-priority curriculum theme.
• Complex Social Factors: Domestic violence; Substance misuse; Asylum seekers; Teenage pregnancy
• Female Genital Mutilation
• Perinatal Mental Health

Obesity & Advanced Maternal Age

• Increasingly examined.
• Obesity risk stratification; VTE prophylaxis; GDM screening
• Very advanced maternal age risks

High-Risk Pregnancy Surveillance

• Multiple Pregnancy
• Fetal Growth Restriction (FGR): Umbilical artery Doppler; MCA Doppler; Serial growth scans
• Alloimmunisation: Anti-D prophylaxis; Antibody monitoring
• Malpresentation: ECV counselling; Breech management planning

Preterm Birth Prevention

• A major focus area for exam.
• Includes: Cervical length screening; Cerclage; Progesterone; Antenatal corticosteroids; Magnesium sulphate for neuroprotection

Infections in Pregnancy

• Extensive curriculum component.
• Includes: Varicella; CMV; HIV; Malaria; Sepsis; Group B Streptococcus; COVID-19
• Must understand: Screening vs treatment; Vertical transmission; Vaccination safety

Stillbirth & Intrauterine Death

• Focus: Prevention strategies; Care in subsequent pregnancy; Induction protocols

Antepartum Haemorrhage

• These are antenatal diagnoses requiring delivery planning: Placenta previa; Placenta accreta spectrum; Vasa previa

Obstetric Emergencies (Antenatal Context)

• Although overlapping with intrapartum care, antenatal preparation is critical: Maternal collapse; Sepsis; Blood transfusion; Cord prolapse; Shoulder dystocia counselling
• MEOWS chart familiarity is essential.

Genetic Medicine & Fetal Therapy

• Modern curriculum increasingly includes: Chromosomal microarray; Preimplantation genetic testing; Fetal MRI; In-utero surgery (e.g., spina bifida repair)
• Requires understanding of counselling principles.

Final Words

• Do not memorise passively.
• Build algorithmic thinking.
• Practise SBAs & EMQs repeatedly.
• Cross-link with Maternal Medicine and Labour modules.
• Always ask: What is the risk? What is the surveillance? What is the intervention threshold?

All the reading material, along with comprehensive summaries, is provided in our courses.