The first visit
The longest visit, ideally before 10 weeks. It establishes the date, the risks and the plan.
- History: menstrual dates and certainty, obstetric history (each pregnancy, its outcome and complications), medical and surgical history, medications and supplements, family history (genetic, diabetes, hypertension, VTE), social history including intimate partner violence and substance use, mental health.
- Examination: blood pressure, weight and BMI, fundal height if the uterus is palpable, and a pelvic examination only if indicated (cervical screening due, symptoms).
- Dating: the last menstrual period if certain and cycles regular, otherwise the earliest ultrasound. A first-trimester scan that differs by more than 5 to 7 days from the dates re-dates the pregnancy, and the date is then fixed.
- Bloods and tests: the initial panel is listed on the Pregnancy page's testing view.
- Counselling: folic acid, nutrition, food safety (listeria), exercise, travel, work, the screening choices ahead, when to call.
The schedule
| Weeks | Visit | Focus |
|---|---|---|
| 8 to 10 | First visit | History, dating, initial bloods, counselling |
| 11 to 14 | Screening | Nuchal translucency and serum screen, or cell-free DNA from 10 weeks |
| 16 to 20 | Second visit | Quad screen if needed, anatomy scan booked, movement counselling |
| 18 to 22 | Anatomy scan | Structural survey, placenta, cervix |
| 24 to 28 | Glucose | Gestational diabetes screen, repeat CBC and antibodies, anti-D at 28 if Rh negative |
| 28 to 36 | Every 2 to 3 weeks | Blood pressure, urine, fundal height, movements, position from 34 |
| 36 | GBS and position | GBS swab, presentation, birth plan, labour signs |
| 37 to 41 | Weekly | Same checks; discuss induction at 41 |
A typical low-risk schedule; high-risk pregnancies are seen more often.
Common complaints and what to say
| Complaint | Reassure when | Look further when |
|---|---|---|
| Nausea and vomiting | First trimester, keeping fluids down, weight stable | Ketones, weight loss over 5 percent, cannot keep fluids down: hyperemesis |
| Reflux | Responds to antacids and position | Epigastric pain with hypertension: preeclampsia |
| Pelvic girdle pain | Mechanical, positional | Fever, urinary symptoms, contractions |
| Leg swelling | Bilateral, dependent, end of day | Unilateral, calf tenderness: DVT. Face and hands with high BP: preeclampsia |
| Headache | Tension-type, responds to paracetamol | New, severe, with visual change or BP rise after 20 weeks |
| Reduced movements | Never simply reassured over the phone | Every episode is assessed the same day |
Check
A patient at 9 weeks has a certain last menstrual period giving 9+3 weeks, regular cycles, and a scan today with a crown-rump length of 8+6 weeks. What is the due date based on?
Watch it done
Inspection, fundal height, lie, presentation, engagement and the fetal heart, in the order a clinician examines.
The four manoeuvres, filmed as a fetal health surveillance fundamental.