Clinical Practice Guidelines Antenatal care - Module I

7. Clinical assessments

Page last updated: 02 April 2013

A range of clinical assessments is carried out to promote and enhance the physical and emotional wellbeing of a woman and her baby during pregnancy. This chapter discusses:

  • assessments that are offered to all women early in the antenatal period or whenever they first seek antenatal care — gestational age assessment, calculating body mass index (BMI), measuring blood pressure and detecting proteinuria; and
  • interventions to reduce symptoms of conditions common in the first trimester — nausea and vomiting and constipation.
Recommendations are based on evidence about the accuracy of assessments in predicting complications in pregnancy and the effectiveness of interventions in reducing symptoms. The advice in the table below is derived from the systematic reviews conducted to inform these Guidelines or sourced from the NICE guidelines and relevant Australian guidelines.

Table 7.1: Summary of advice for women about common conditions and assessments in the first trimester

Clinical assessments Clinical assessments
Evidence
Anaemia*

Assessing haemoglobin level enables women to receive treatment if anaemia is detected.
Grade B*
Blood group Identifying blood group and rhesus D status is important to prevent haemolytic disease of the newborn.**
Grade B*
Gestational age Ultrasound scanning is most accurate in determining gestational age between 8 and 14 weeks of pregnancy. After 24 weeks of pregnancy, the date of the last menstrual period is used.
Grade B
Weight and height Calculation of body mass index allows appropriate advice about nutrition and physical activity to be given early in pregnancy.
Grade B
Blood pressure Measuring blood pressure allows identification of women who have chronic hypertension and may require additional monitoring during pregnancy.
Grade B
Proteinuria Testing women for proteinuria identifies existing kidney disease or urinary tract infection.
Grade B
Breast examination* Routine breast examination during antenatal care is not recommended.
Grade A*
Pelvic examination* While pelvic pain can be debilitating and distressing, routine antenatal pelvic examination is not recommended.
Grade B*
Psychosocial factors Assessment of psychosocial factors aims to identify women who are more vulnerable to mental health disorders during pregnancy.
CBR
Depression Detecting symptoms of depression enables suitable follow-up.
Grade B
Anxiety Anxiety, either alone or with depression, is common in pregnancy.
CBR
Domestic violence All women are asked about domestic violence during pregnancy to enable access to additional support and care.
Grade B
Common conditions Common conditions
Evidence
Nausea and vomiting Although distressing and debilitating for some women, nausea and vomiting usually resolves spontaneously by 16 to 20 weeks pregnancy and is not generally associated with pregnancy complications.
PP
Nausea and vomitingDiscontinuing iron-containing multivitamins may be advisable while symptoms are present.
PP
Constipation Increasing dietary fibre intake and taking bran or wheat fibre supplements may relieve constipation.
Grade C
ConstipationStimulating laxatives are more effective than preparations that add bulk but are more likely to cause diarrhoea or abdominal pain
Grade C
Heartburn* Heartburn may be improved through maintaining upright positions, especially after meals, sleeping in a propped up position, having small frequent meals, and reducing high-fat foods and irritants such as caffeine. Antacids may also be considered for relieving heartburn.
PP*
Haemorrhoids* Haemorrhoids may be improved by increasing fibre in the diet and drinking plenty of water. If clinical symptoms remain troublesome, standard haemorrhoid creams can be considered.
PP*
Varicose veins* Varicose veins will not cause harm to the woman or baby. Compression stockings can improve symptoms but will not prevent varicose veins.
Grade A*
Vaginal discharge* An increase in vaginal discharge is common during pregnancy. If it is associated with itch, soreness, offensive smell or pain on passing urine, there maybe an infective cause and investigation should be considered.
PP*
Backache* Exercising in water, massage therapy and group or individual back care classes might help to ease backache during pregnancy.
Grade A*
Pelvic pain* There is little evidence on treatments for symphysis pubis dysfunction. Many medicines for relief of bone and joint pain may not be appropriate for use in pregnancy.
Future research required*
Carpal tunnel syndrome* There is little evidence on treatments for carpal tunnel syndrome. Many medicines for relief of bone and joint pain may not be appropriate for use in pregnancy.
Future research required*

* Advice on these assessments or conditions is sourced from NICE (2008) Antenatal Care. Routine Care for the Healthy Pregnant Woman. National Collaborating Centre for Women’s and Children’s Health. Commissioned by the National Institute for Health and Clinical Excellence. London: RCOG Press.
** Antenatal prophylaxis for women who are RhD negative is discussed in NBA (2003) Guidelines on the Prophylactic use of Rh D Immunoglobulin (anti-D) in Obstetrics. Canberra: National Blood Authority.