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.
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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
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]
References10ShowHide
- [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]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]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]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]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]Mangesi L, Hofmeyr GJ, Smith V, et al. Fetal movement counting for assessment of fetal wellbeing Cochrane Database Syst Rev, 2015.PMID 26467769
- [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]McBain RD, Crowther CA, Middleton P Anti-D administration in pregnancy for preventing Rhesus alloimmunisation Cochrane Database Syst Rev, 2015.PMID 26334436
- [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]Norton ME, Jacobsson B, Swamy GK, et al. Cell-free DNA analysis for noninvasive examination of trisomy N Engl J Med, 2015.PMID 25830321