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This is a clinician-written, evidence-based summary aligned to the 2026 MLA Content Map. It is intended for medical students and junior doctors preparing for the UKMLA. Always cross-reference with NICE guidance, local protocols, and clinical judgement.
Key points
- Booking appointment ideally by 10 weeks: full history, risk assessment, booking bloods (FBC, blood group, Rh status, antibodies, infection screen)
- Folic acid 400 mcg daily from preconception to 12 weeks (5 mg if high-risk: epilepsy, diabetes, BMI >30, previous NTD)
- Dating scan at 10–13+6 weeks (combined screening for Down syndrome offered)
- Anomaly scan at 18–20+6 weeks
- Routine anti-D prophylaxis at 28 weeks for Rh-negative women
- Minimum 10 appointments for nulliparous, 7 for multiparous women
Overview
Normal pregnancy lasts approximately 40 weeks from the last menstrual period. Antenatal care is a structured programme of clinical assessments, screening tests, and health promotion designed to identify complications early and optimise outcomes for mother and baby. In the UK, NICE NG201 provides the framework for routine antenatal care. Care is midwife-led for low-risk pregnancies, with obstetric input when risk factors or complications arise. The booking appointment is the cornerstone, establishing a baseline and identifying women who need enhanced surveillance.
Epidemiology
Approximately 640,000 births occur in England and Wales annually. The majority of pregnancies are uncomplicated. Mean maternal age at first birth is approximately 29 years, with increasing proportions of women giving birth over 35. The UK perinatal mortality rate is approximately 5.5 per 1,000 births. Early booking (before 10 weeks) is associated with better outcomes and more timely screening. Approximately 45% of pregnancies in the UK are unplanned.
Clinical Features
Symptoms
Amenorrhoea — the hallmark first symptom of pregnancy
Nausea and vomiting — typically weeks 6–12, resolves by 16 weeks in most
Breast tenderness and enlargement
Urinary frequency — from uterine pressure on bladder in first and third trimesters
Fatigue — especially in the first trimester
Quickening — first perception of fetal movements, typically 18–20 weeks (earlier in multiparous)
Vaginal bleeding at any stage
Reduced fetal movements after 28 weeks
Signs
Positive urinary pregnancy test (hCG detectable from ~4 weeks gestation)
Uterus palpable abdominally from 12 weeks; at umbilicus at 20 weeks
Fetal heart auscultable by Doppler from 10–12 weeks
Symphysis-fundal height measured from 24 weeks (in cm, approximates gestation in weeks)
Linea nigra, striae gravidarum, palmar erythema — normal physiological changes
Investigations
First-line
Booking bloodsFBC (anaemia), blood group and Rh status, antibody screen, hepatitis B, HIV, syphilis serology, haemoglobinopathy screen
Urine dipstickAt every appointment — proteinuria (pre-eclampsia) and glycosuria (gestational diabetes)
BP measurementAt every appointment — baseline and monitoring for pregnancy-induced hypertension
Dating ultrasound10–13+6 weeks — confirm viability, gestation, number of fetuses, nuchal translucency if combined screening accepted
Second-line
Combined screening for Down syndrome11–13+6 weeks: nuchal translucency + beta-hCG + PAPP-A. Quadruple test if late booking (15–20 weeks)
Anomaly scan18–20+6 weeks — structural survey of fetal anatomy
OGTTAt 24–28 weeks if risk factors for gestational diabetes (BMI >30, previous GDM, family history, South Asian/Black/Middle Eastern ethnicity)
Group B StreptococcusNot routinely screened in the UK — test if incidental finding or previous affected pregnancy
Specialist
NIPT (Non-invasive prenatal testing)Cell-free fetal DNA screening for trisomy 21, 18, 13 — offered as a contingent test or privately
Amniocentesis / CVSDiagnostic testing if screening high-risk — CVS from 11 weeks, amniocentesis from 15 weeks
Management
NICE NG201 (Antenatal care), 20211
Preconception and early pregnancy
- Folic acid 400 mcg daily from preconception to 12 weeks (5 mg if high-risk)
- Vitamin D 10 mcg (400 IU) daily throughout pregnancy and breastfeeding
- Advise smoking cessation, alcohol avoidance, healthy diet
- Avoid vitamin A supplements and liver products (teratogenic)
- Advise on food safety: avoid unpasteurised cheese, raw/undercooked meat, pâté
2
Routine antenatal schedule
- Booking appointment by 10 weeks — full history, risk assessment, booking bloods, BMI
- Dating scan 10–13+6 weeks
- Anomaly scan 18–20+6 weeks
- BP and urine at every appointment
- SFH from 24 weeks (plotted on customised growth chart)
- Anti-D at 28 weeks if Rh-negative
- Minimum 10 appointments (nulliparous) or 7 (multiparous)
3
Third trimester
- Discuss birth plan, infant feeding, and vitamin K for the newborn
- Offer membrane sweep at 40 weeks (nulliparous) or 41 weeks (multiparous)
- Induction offered at 41+0 to 42+0 weeks if not delivered
- Advise sleeping on side from 28 weeks (potential stillbirth risk reduction)
- Discuss fetal movements — contact maternity unit immediately if reduced after 28 weeks
Complications
- Gestational diabetes: Screened by OGTT at 24–28 weeks if risk factors present
- Pre-eclampsia: Monitored by BP and urine at every appointment — aspirin prophylaxis if high risk
- Anaemia: FBC checked at booking and 28 weeks — treat iron deficiency with oral ferrous sulphate 200 mg BD-TDS
- Venous thromboembolism: Pregnancy is a hypercoagulable state — risk-assess at booking for LMWH prophylaxis
- Mental health: Screen for depression and anxiety at booking and postnatally — refer as needed
UKMLA Exam Tips
- 1Folic acid 400 mcg standard dose; 5 mg for epilepsy, diabetes, BMI >30, previous NTD — very commonly tested
- 2Dating scan is done at 10–13+6 weeks, anomaly scan at 18–20+6 weeks
- 3Anti-D is given at 28 weeks to all Rh-negative women — prevents haemolytic disease of the newborn
- 4Combined screening (NT + beta-hCG + PAPP-A) is offered at 11–13+6 weeks for Down syndrome
- 5ACEi, ARBs, statins, warfarin, retinoids, tetracyclines, and methotrexate are all CONTRAINDICATED in pregnancy
- 6SFH in cm should approximately equal gestational age in weeks from 24 weeks
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