2. Comparison between WHO and NICE recommendation of
antenatal visits
Comparison WHO NICE
Date of recommendation 2016 2021
Number of visits - 8 visits
No difference between
parous women and
nulliparous women.
- 7 visits for parous women.
- 10 visits for nulliparous.
Started in Up to 12 weeks Booking appointment 5-6
weeks of gestation
3. Comparison between WHO and NICE recommendation of
antenatal visits
Comparison WHO NICE
First contact activities The first contact up to 12 week include this
activity.
- History taking
Identification –menstrual history –intention
of present pregnancy- past obstetric and
gynecology history – medical history –
current medication – nutrition – social and
mental health – intimate partner violence
- Physical examination
General appearance – height and weight vital
signs- acute malnutrition –obstetric
examination measure symphysis fundal
height. Vaginal examination is not a routine
practice .
The first appointment(5 to 6 weeks)
include this activity.
- Taking a history
- Examinations and investigations
- Offer screening programmers for:
• HIV
• Syphilis
• Hepatitis B
• Sickle cell
• Thalassemia
4. Comparison between WHO and NICE recommendation of
antenatal visits
Comparison WHO NICE
First contact activities The following tests should be done for all
pregnant women
- Hb level, hematocrit, blood group, and Rh.
- Urine analysis .
- Testes for HIV, HBV, Syphilis.
- Selective or case specific screening is
recommended for gestational diabetes, Tb,
and group B streptococcus.
5. Comparison between WHO and NICE recommendation of
antenatal visits
Comparison WHO NICE
Second contact activities 20 weeks (2nd contact)
• Review the history, physical findings
and laboratory results at first contact
• Ask about fetal movement
• Enquire about any complaint or
concern
• Determine the gestational age
• Observe her general appearance
• Measure blood pressure
• Measure weight check for weight gain
• Look for pallor
• Measure arm for acute malnutrition
screening using MUAC
11+2 to 14+1 week scan appointment.
Update the woman’s antenatal records
with details of history, test results,
examination findings, medicines and
discussions.
Only at this appointment
Perform an ultrasound scan to
•Determine gestational age
•Detect multiple pregnancy
6. Comparison between WHO and NICE recommendation of
antenatal visits
Comparison WHO NICE
Second contact activities • Measure the uterine fundal height
• Listen for fetal heartbeat
• Perform ultrasound scanning
• Initiate iron-folate and calcium supplementation
and counsel on adherence
• Provide preventive chemotherapy(deworming)
• Check for other danger signs and symptoms
• Assess feeding practices and counsel on optimal
maternal nutrition; extra
• meal/feeding frequency, diet diversity, including
fruit and vegetables, animal source feeding.
• Assess for mental health and intimate partner
violence.
If the booking appointment
was not face to face, offer:
•To measure height, weight and
body mass index
•Blood tests for full blood
count, blood group and rhesus
D status.
7. Comparison between WHO and NICE recommendation of
antenatal visits
Comparison WHO NICE
Third contact activities 26 weeks ( 3rd contact)
• Conduct same activities as
week 20 except for ultrasound
scanning.
• Conduct urinalysis for
proteinuria and urine gram
stain.
• Test for gestational diabetes for
high-risk pregnant women.
16-week (14 to 18 weeks) appointment
Update the woman’s antenatal records with
details of history, test results, examination
findings, medicines and discussions.
New or only at this appointment:-
• Reassess the risk of pre-eclampsia and advise
those at risk to take aspirin.
• Repeat examinations and investigations.
• Update the history, ask the mother about:
• (Her general health and wellbeing, domestic
abuse, mental health,
• any other concerns she would like to discuss –
also ask her partner about this, if present.)
8. Comparison between WHO and NICE recommendation of
antenatal visits
Comparison WHO NICE
Fourth contact activities 30 weeks ( 4th contact)
• Conduct same activities as week 20
except for ultrasound scanning
• Repeat testing for syphilis and HIV
if earlier test results are negative
• Repeat Hb test
• Perform fetal wellbeing assessment
if there is a discrepancy between
fundal height
• and gestational age or if there is a
reduction in fetal movement
• Counsel on birth preparedness and
complication readiness
• Counsel on optimal breastfeeding
practices
18+0 to 20+6 week scan appointment.
Update the woman’s antenatal records with
details of history, test results, examination
findings, medicines and discussions.
Only at this appointment
Perform an ultrasound scan to:
• Screen for fetal anomalies
• Determine placental location.
If there are any unexpected results from
examinations or investigations
• Offer referral according to local pathways
and
• Provide information and support.
9. Comparison between WHO and NICE recommendation of
antenatal visits
Comparison WHO NICE
Fifth contact activities 34 weeks ( 5th contact)
• Repeat all activities done at 30
weeks
• Determine fetal presentation
• Test urine for proteinuria for
high-risk women
• Repeat testing for syphilis and
HIV if not done at 30 weeks
• Counsel on breastfeeding and
immunization
• Counsel on stimulation for early
childhood development
25-week appointment (nulliparous women
only)
• Update the woman’s antenatal records with
details of history, test results, examination
findings, medicines and discussions.
• Repeat examinations and investigations.
• Update the history, Ask the woman about:
• (Her general health and wellbeing,
domestic abuse, mental health any other
concerns she would like to discuss – also
ask her partner about this, if present)
• New at this appointment
• Discuss the baby’s movements with the
woman.
10. Comparison between WHO and NICE recommendation of
antenatal visits
Comparison WHO NICE
Sixth contact activities 36 weeks ( 6th contact)
• Conduct all activities done at 34
weeks
• Assess mental health
28-week appointment.
New or only at this appointment offer:
• A blood test for full blood count, blood group
and antibodies
• anti-D prophylaxis to rhesus-negative
women.
Discuss and give information on:
• preparing for labor and birth
• recognizing active labor
11. Comparison between WHO and NICE recommendation of
antenatal visits
Comparison WHO NICE
Seventh contact activities 38 weeks ( 7th contact)
• Conduct all activities done at
36 weeks
• Inquire any fears, myths,
worries about labor and
delivery
• Repeat Hb test
• Advise the pregnant woman on
fetal movement counting
31-week appointment (nulliparous women only)
• Update the history
• Continue discussions
• Repeat examinations and investigations
12. Comparison between WHO and NICE recommendation of
antenatal visits
Comparison WHO NICE
Eighth contact activities 40 weeks ( 8th contact)
• Repeat all activities done at 38
weeks
• Review fetal movement
counting
• Ultrasound scanning for fetal
wellbeing assessment
36-week appointment
Update the history
• Continue discussions
• Repeat examinations and investigations
New at this appointment
• To identify possible breech presentation, offer
abdominal palpation for women with a
singleton pregnancy.
13. Comparison between WHO and NICE recommendation of
antenatal visits
38-week appointment
40-week appointment (nulliparous women only)
41-week appointment – for women who have not yet given birth
