Routine antenatal care

Antenatal care can be delivered solely by a private obstetrician or hospital antenatal team, or as GP shared care with a local maternity service. Most low-risk pregnancies are suitable for shared care. Whatever the model, the GP’s early role — risk stratification, first-presentation investigations, and prompt referral — is what changes outcomes, and every pregnant patient benefits from ongoing GP contact even where formal shared care isn’t happening.

Regular antenatal care improves pregnancy outcomes for mother and baby by identifying potential problems early. All women should be advised to attend a health professional capable of assessing maternal and fetal risk by 10 weeks of pregnancy. For a nulliparous woman without complications, a schedule of ten visits should be adequate.

Look up the local pathway for anything risk-tier or referral specific. The full moderate/high-risk stratification tables, the public-referral triage categories, the named local services and the current visit schedule all live in HNE HealthPathways (Antenatal Care — Initial Visits and Routine Antenatal Care — GP Shared Care), and they change. This page covers the parts that don’t: what to test, what not to test, how to date the pregnancy, what to supplement and vaccinate, and what to escalate.

Referral timing

Refer every patient for a booking-in visit by 14 weeks, regardless of risk level — this is now universal (previously staggered by risk tier). All patients are encouraged to have at least three midwifery visits: a comprehensive booking-in visit before 14 weeks, one at 24–28 weeks, and one at 34–38 weeks.

Flag on the referral anything that mandates ongoing specialist antenatal care: increased pre-eclampsia risk on first-trimester screening, established fetal growth restriction risk, a VTE risk score above 3, or medical, gynaecological, obstetric or psychosocial complexity. See Pre-eclampsia/Hypertension in Pregnancy, VTE Prophylaxis, Thyroid Disease in Pregnancy and TORCH for those specific areas.

First trimester / first-presentation GP care

Assessment

• History and exam: risk-stratify against the local pathway; height/weight/BMI; BP; substance use history (AUDIT-C — HNE recommends alcohol screening at 3 points in pregnancy); review current medications for pregnancy safety; VTE risk (see VTE Prophylaxis in Pregnancy); oral health screening (refer to dentist if maternal oral screening tool score ≥1); vaccination status; perinatal mental health needs and Edinburgh Postnatal Depression Scale; domestic/family violence risk.
• Mental health and safety screening. Antenatal assessment should include an assessment of the mental health of the woman using the approach supported in your jurisdiction, generally the Edinburgh Postnatal Depression Scale in Australia, with further psychosocial risk assessment using a validated tool such as the Antenatal Risk Questionnaire. It should be explained to all women that asking about family violence is a routine part of antenatal care, and this should be done when the woman is alone.
• Establish the estimated delivery date (EDD) from LMP ± dating ultrasound:
  • Offer dating ultrasound 8+0–13+6 weeks if dates uncertain (before 6 weeks gives an inaccurate estimate).
  • Ultrasound at 6–13 weeks: use LMP if it agrees with ultrasound within 5 days; otherwise use ultrasound.
  • Ultrasound at 13–24 weeks: use LMP if within 10 days; otherwise use ultrasound.
  • If LMP uncertain or irregular cycles, use the ultrasound estimate.
  • A first-trimester ultrasound measurement of the fetus is the most accurate method to establish or confirm gestational age.
  • The estimated gestational age should be based on the crown-rump length measurement, which is accurate within 5 to 7 days up to 13 6/7 weeks gestation.
  • If the pregnancy is low-risk there is no need for an ultrasound before 12 weeks.

Investigations

• First presentation bloods: blood group + antibodies, FBC + ferritin, hepatitis B, hepatitis C, syphilis serology, HIV, rubella, varicella IgG, MSU M/C/S. Offer chlamydia screening if aged under 30 (raised from the previous <25 cutoff).
  • Where the blood group has already been performed it does not need to be repeated, however the antibody screen should be repeated at the beginning of each pregnancy.
  • All women should have their rubella antibody titre measured for each pregnancy, because levels may decline over time.
  • Syphilis testing should be performed by screening with a specific treponema pallidum assay, for example TPHA or TPPA, rather than RPR or VDRL, which are less likely to pick up latent infection.
  • Selective testing for Chlamydia and Gonorrhoea should be considered for those with known risk factors or who may be at increased risk according to local prevalence and for pregnant women younger than 30 years.
  • Midstream urine biochemical analysis and culture identifies asymptomatic bacteriuria.
  • As a minimum, all women should be screened for haemoglobinopathy with mean corpuscular volume, provided in the full blood examination, with electrophoresis or HPLC plus ferritin if the MCV is low.
• Diabetes: screening for Gestational Diabetes Mellitus is recommended in all pregnant women, using the approach endorsed by the local jurisdiction. If high risk for GDM (previous GDM, BMI≥30, first-degree relative with diabetes, age>35, PMOS/PCOS, previous macrosomia >4kg/90th centile, previous impaired glucose tolerance) — fasting glucose + HbA1c if ≤12 weeks; 75g OGTT if >12 weeks (unless a screening capillary glucose >7mmol/L, where fasting glucose + HbA1c is safer to avoid provoking severe hyperglycaemia). Previous bariatric/metabolic surgery needs an adapted capillary-glucose protocol instead of OGTT — see Gestational Diabetes.
• Tests not recommended routinely. Do not test Vitamin D levels in pregnancy as part of routine pregnancy screening, regardless of maternal risk factors. Routine serological screening for CMV infection in pregnancy is not recommended, though early pregnancy screening with CMV IgG may be considered for women who come into frequent contact with large numbers of very young children. Routine serological screening for toxoplasmosis infection in pregnancy is not recommended. Do not routinely test pregnant women for thyroid dysfunction.
• Other tests to consider: TSH if high risk for thyroid disease (personal/family history, symptoms, goitre, age>30, autoimmune disease history, pregnancy loss/preterm/infertility history, obesity BMI>40, amiodarone/lithium/high iodine load, ≥2 prior pregnancies, iodine-deficient area) — see Thyroid Disease in Pregnancy.
• Reproductive carrier screening (cystic fibrosis, spinal muscular atrophy, fragile X) — offer with non-directive pre-test counselling; Medicare-rebated for the female partner (MBS 73451), and for the male partner if a condition is detected in the female (MBS 73452) — simultaneous couple testing loses the male’s rebate.
• Fetal RhD non-invasive prenatal testing (RHD NIPT): offer to all RhD-negative women without preformed anti-D antibodies, collected from 12 weeks (up to 26 weeks) — detects fetal RhD status from maternal plasma, reducing unnecessary anti-D prophylaxis in women carrying an RhD-negative fetus.
• Cervical screening if due/overdue — safe at any stage of pregnancy; use a cytobroom, not an endocervical brush; colposcopy is safe in pregnancy; some spotting after the procedure is expected and harmless; patients may defer to the postnatal visit if preferred. See Cervical Screening.

Aneuploidy and morphology screening

• Dating ultrasound for all women (viability, accurate dating, multiple pregnancy, major anomaly).
• First trimester combined screening (cFTS), 11+0–13+6 weeks: maternal blood (free βhCG, PAPP-A, ± PlGF) 4–7 days before the nuchal translucency scan. The same scan measures uterine artery pulsatility index for pre-eclampsia risk, so choose a provider that offers pre-eclampsia screening and have the bloods sent to them directly. Locally, a risk greater than 1:100 is high risk (refer urgently) and 1:100–1:300 is intermediate — both go to maternal fetal medicine or a private obstetrician.
  • NIPT (cell-free fetal DNA): higher sensitivity than cFTS for trisomy 21/18/13 and sex chromosome aneuploidies, ~$450 out-of-pocket (not Medicare-rebated), from 10 weeks with no upper limit; still needs the 12-week morphology scan; a screening (not diagnostic) test — a high-risk result needs confirmation by CVS or amniocentesis.
  • Second trimester alternative: maternal serum quadruple test (AFP, βhCG, estriol, inhibin A) at 15–20 weeks — less sensitive than cFTS for trisomy 21, but also screens for neural tube defects.
  • Invasive testing: CVS from 11 weeks, amniocentesis from 15 weeks — both carry a small miscarriage risk.
• Arrange the morphology and placental ultrasound at 18–20 weeks for every patient, and repeat at 32 weeks if the placenta is low-lying. Women who decline aneuploidy screening should still be encouraged to have the 11–13+6 week scan for early fetal anatomy and pre-eclampsia risk. All women should be offered an obstetric ultrasound before 20 weeks’ gestation, and an ultrasound for fetal morphology and placental localisation is recommended usually at 20 weeks gestation.

Supplementation, lifestyle, and vaccination

• Folic acid: at least 400 microgram daily from ≥1 month pre-conception through the first 12 weeks; 5mg daily if malabsorption risk or increased neural tube defect risk (pre-existing diabetes, previous NTD-affected pregnancy/family history, BMI>30) — continue for 3 months either side of conception if on antiepileptics.
• Iodine 150 microgram daily and vitamin D 400 units daily, routinely, per RANZCOG. Supplement without testing, since RANZCOG advises against routine vitamin D level testing in pregnancy.
• Discuss smoking and alcohol cessation, nutrition, food safety, physical activity, and weight gain in pregnancy; consider referral to Get Healthy in Pregnancy. Where there is heavy or binge drinking, dependence, or other recent drug use, refer to a specialist substance-use-in-pregnancy service — and while awaiting that, give thiamine 100–300 mg to prevent Wernicke’s encephalopathy, prescribe folic acid 5 mg daily through the first trimester, and check and treat B12 deficiency.
• Vaccination (discuss at first visit, most given later): COVID-19 and influenza — any trimester; dTpa — mid 2nd to early 3rd trimester; RSV (Abrysvo) — 28–36 weeks (infant not protected unless born ≥2 weeks after maternal vaccination).

Weight stigma in antenatal care

Weight stigma is pervasive in the medical system and can push pregnant people in larger bodies away from care. GPs experienced in non-stigmatising maternity care offer these practical recommendations:

• Weighing. Regular weighing has no evidence of an effect on clinical outcomes. Keep the scales hidden and weigh only if the woman requests it.
• Language. Using non-stigmatising language is important, because inappropriate words can, often unintentionally, have a detrimental impact; prefer neutral terms such as ‘larger-bodied’ over clinical labels like ‘overweight’ and ‘obesity’.
• Documentation. Use documentation to advise other clinicians not to discuss the woman’s weight without her explicit consent.
• Reflection. Take time for critical reflection on your own background and beliefs about larger-bodied people and how these might affect your behaviour in practice.
• Guidelines. Maternity guidelines should use accurate representation of risk, emphasising absolute rather than relative risk for larger-bodied women.

Care after 12 weeks — brief overview

(For context only — most GPs handing over to shared/specialist antenatal care won’t be delivering these visits themselves.) The Department of Health recommends 10 antenatal visits for a first pregnancy, 7 for subsequent pregnancies. A typical GP shared-care pattern:

Stage	Who	Focus
14–16 weeks	Maternity hospital	Booking-in visit (midwife ± obstetrician); review first-trimester screening and first-presentation bloods
20–22 weeks	GP	Antenatal check (below); review morphology scan; order 2nd-trimester bloods for 26 weeks (Hb/ferritin, repeat syphilis serology, 75g GTT if not already tested, BGA if Rh-negative or antibody history)
26–28 weeks	Maternity hospital	Antenatal check; review 2nd-trimester bloods; anti-D at 28 weeks if Rh-negative; pertussis (dTpa) and RSV vaccine windows
32 weeks	GP	Antenatal check; stillbirth/FGR risk reassessment
34 weeks (primip)	GP	Antenatal check; FBC, iron studies, GBS swab, syphilis serology ahead of 36 weeks; stillbirth risk recheck
36 weeks	Maternity hospital	Antenatal check; anti-D if due; review 36-week bloods
38 & 40 weeks	GP	Antenatal check; labour/birth planning; urgent referral if non-cephalic presentation

The “antenatal check” performed at each visit: BP (correct technique — both arms at first visit, cuff at heart level, large cuff if arm circumference >33cm); dipstick proteinuria (all patients at the first visit, then only if pre-eclampsia risk factors or symptoms — see Pre-eclampsia/Hypertension in Pregnancy); fundal height from 24 weeks (a discrepancy over 3cm from dates should prompt ultrasound for growth, AFI and Doppler, plus GTT and TORCH screen if indicated); fetal heart rate from 16 weeks (abnormal if <110 or >160bpm); presentation from 36 weeks; weight.

It is recommended that the fundal height measurement is plotted on a customised antenatal growth chart and that early pregnancy risk selection is undertaken for fetal growth restriction with serial scanning recommended for women with specific risk factors. All women should have a directed clinical assessment at each antenatal visit, with a focus on general wellbeing and early diagnosis of pregnancy complications. Advise side-sleeping from 28 weeks, and hold a labour and birth discussion by 36 weeks.

Stillbirth risk / Safer Baby Bundle: reassessed at each visit from ~28 weeks, addressing 5 modifiable elements — smoking cessation, detecting fetal growth restriction, patient awareness of decreased fetal movements, maternal safe sleep position (side-sleeping) in late pregnancy, and shared decision-making about birth timing for patients with stillbirth risk factors (extremes of maternal age, FGR/ pre-eclampsia risk, diabetes/hypertension, multiple pregnancy, post-term, smoking/ substance use, prior stillbirth, nulliparity, poor antenatal engagement, and others).

Escalate urgently at any visit for

• Decreased/absent fetal movements, or no fetal heartbeat detected (>18–24 weeks)
• Vaginal bleeding and/or abdominal or pelvic pain
• Suspected pre-eclampsia: BP≥140/90, persistent headache unrelieved by paracetamol, visual disturbance, epigastric pain, or significant new oedema
• Suspected obstetric cholestasis (itch without rash, abnormal LFTs/bile acids)
• Non-cephalic presentation from 36 weeks if planning vaginal birth

Source (local): Antenatal Care — Initial Visits and Routine Antenatal Care — GP Shared Care, Community HealthPathways Hunter New England, both last updated 12 August 2026 (registry: hne-healthpathways-antenatal-care-initial-visits, hne-healthpathways-antenatal-care-gp-shared-care-2026; verified 2026-08-31). Risk tiers, referral triage timings and named local services deliberately left to those pathways rather than reproduced here.