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GP Topicspregnancy-and-reproductive-health

GP · pregnancy-and-reproductive-health

Antenatal shared care

Also known as Antenatal care · Shared antenatal care · Pregnancy care GP

GP-fellowship guide to antenatal shared care: the visit schedule and what happens at each, booking bloods, first-trimester screening choices with cfDNA trial numbers (AUC 0.999 vs 0.958; false positives 0.06% vs 5.4%), the 24-28-week OGTT, anti-D at 28/34 weeks for rhesus-negative women, folate for neural tube defect prevention from the MRC Vitamin Study (72% protective effect), pertussis vaccination at 20-32 weeks (96% effectiveness in the first two months of life) and influenza any trimester, nausea of pregnancy first-line doxylamine-pyridoxine, warning-sign triage for reduced fetal movements and bleeding, weight gain by BMI, alcohol and smoking framing, and when the GP hands over to hospital.

high10 referencesUpdated 21 Aug 20265 min readVerification in progress

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Target exams

RACGP AKTRACGP KFPRACGP CCE

Red flags

  • Reduced fetal movements after 28 weeks is never a phone diagnosis — same-day CTG and ultrasound; these women carry increased stillbirth risk even with normal tests
  • PV bleeding in pregnancy is triaged by gestation and stability — placenta praevia means no digital examination until ultrasound excludes it
  • BP above 140/90 after 20 weeks with headache, visual change or right upper quadrant pain is pre-eclampsia until proven otherwise — escalate same day
  • Never miss the pertussis window — vaccination at 20-32 weeks protects ~96% of infants through their most dangerous first months
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Study tools

Your progress

Saved on this device.

Target exams

RACGP AKTRACGP KFPRACGP CCE

Red flags

  • Reduced fetal movements after 28 weeks is never a phone diagnosis — same-day CTG and ultrasound; these women carry increased stillbirth risk even with normal tests
  • PV bleeding in pregnancy is triaged by gestation and stability — placenta praevia means no digital examination until ultrasound excludes it
  • BP above 140/90 after 20 weeks with headache, visual change or right upper quadrant pain is pre-eclampsia until proven otherwise — escalate same day
  • Never miss the pertussis window — vaccination at 20-32 weeks protects ~96% of infants through their most dangerous first months
Key points
  • Antenatal shared care means the GP provides most routine visits — booking through to term — with hospital obstetric handovers at booking and around 28, 36 and 40 weeks; the GP owns screening, vaccinations, supplementation and common complaints.
  • First-trimester choice: cfDNA (NIPT) detects trisomy 21 with 100% sensitivity and 0.06% false positives versus 78.9% and 5.4% for standard combined screening in the NEXT trial.[10]
  • Folate 0.4–0.5 mg daily pre-conception to 12 weeks prevents neural tube defects: the MRC Vitamin Study showed a 72% protective effect (RR 0.28) in high-risk women.[4]
  • Pertussis vaccination at 20–32 weeks in EVERY pregnancy: maternal Tdap was 96% effective against infant pertussis in the first two months of life across 263,809 infants; influenza any trimester.[1]

Overview

Antenatal shared care puts the pregnancy's routine care in general practice while hospital obstetric services retain screening decisions, high-risk management and birth. The model works when both sides know their lane: the GP owns continuity, lifestyle work and early problem recognition; the hospital owns complex surveillance and delivery. Cochrane evidence cautions against thinning routine visits — a reduced-visit package in the WHO trial was associated with increased perinatal mortality on reanalysis — so shared care is not fewer checks, it is the same checks delivered by a different trusted clinician.[5]

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References10ShowHide
  1. [1]Hsiao A, Bartlett J, Fireman B, et al. Effectiveness of 5-pertussis-component tetanus, diphtheria, and acellular pertussis (Tdap(5)) vaccination in pregnancy at preventing infant pertussis Am J Obstet Gynecol, 2026.PMID 41276201
  2. [2]Amirthalingam G, Campbell H, Ribeiro S, et al. Optimization of Timing of Maternal Pertussis Immunization From 6 Years of Postimplementation Surveillance Data in England Clin Infect Dis, 2023.PMID 35959786
  3. [3]Campbell H, Gupta S, Dolan GP, et al. Review of vaccination in pregnancy to prevent pertussis in early infancy J Med Microbiol, 2018.PMID 30222536
  4. [4]MRC Vitamin Study Research Group Prevention of neural tube defects: results of the Medical Research Council Vitamin Study. MRC Vitamin Study Research Group Lancet, 1991.PMID 1677062
  5. [5]Hofmeyr GJ, Hodnett ED Antenatal care packages with reduced visits and perinatal mortality: a secondary analysis of the WHO antenatal care trial - Comentary: routine antenatal visits for healthy pregnant women do make a difference Reprod Health, 2013.PMID 23577750
  6. [6]Mangesi L, Hofmeyr GJ, Smith V, et al. Fetal movement counting for assessment of fetal wellbeing Cochrane Database Syst Rev, 2015.PMID 26467769
  7. [7]Heazell AE, Bernatavicius G, Roberts SA, et al. A randomised controlled trial comparing standard or intensive management of reduced fetal movements after 36 weeks gestation--a feasibility study BMC Pregnancy Childbirth, 2013.PMID 23590451
  8. [8]McBain RD, Crowther CA, Middleton P Anti-D administration in pregnancy for preventing Rhesus alloimmunisation Cochrane Database Syst Rev, 2015.PMID 26334436
  9. [9]Persaud N, Meaney C, El-Emam K, et al. Doxylamine-pyridoxine for nausea and vomiting of pregnancy randomized placebo controlled trial: Prespecified analyses and reanalysis PLoS One, 2018.PMID 29342163
  10. [10]Norton ME, Jacobsson B, Swamy GK, et al. Cell-free DNA analysis for noninvasive examination of trisomy N Engl J Med, 2015.PMID 25830321
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