Red Flags
- Severe vaginal bleeding, severe abdominal pain, persistent vomiting, severe headache, vision change, sudden swelling, reduced fetal movements — same-day maternity assessment[1]
- Suspected pre-eclampsia (BP ≥140/90 with proteinuria, severe headache, RUQ pain, swelling) — same-day obstetric review[1]
- Reduced fetal movements at any gestation ≥24 weeks — CTG and growth assessment within hours[1]
- Pre-existing maternal disease (diabetes, hypertension, cardiac, autoimmune, epilepsy, psychiatric) — joint specialist clinic from booking[1]
First-line treatment
Interventions
- Antenatal care schedule[1]Low-risk: 8–10 contacts (WHO 2016) — booking ≤12 weeks, then approximately 20, 26, 28, 32, 34, 36, 38, 40, 41 weeks. Higher-risk: more frequent, joint clinic
- Lifestyle and counselling[1]Smoking, alcohol, illicit drug cessation; balanced diet; safe foods (avoid raw/undercooked, unpasteurised dairy, high-mercury fish, excess caffeine); seatbelt above and below bump; mild–moderate exercise; sexual health
- Vaccination during pregnancy[1]Influenza (any trimester), Tdap (28–36 weeks) for whooping cough protection of newborn, COVID-19 per local schedule, RSVpreF (32+0 to 36+6 weeks) where available; do not give live vaccines in pregnancy
- Anti-D prophylaxis for RhD-negative women[1]Routine antenatal anti-D 1500 IU IM at 28 weeks (or 500–1500 IU at 28 + 34 weeks per local protocol); at any sensitising event; postpartum within 72 h if baby RhD-positive
First-line drug therapy
| Drug | Class | Adult | Paediatric | Notes |
|---|---|---|---|---|
| Folic acid[1] | B-vitamin | 400–500 µg PO daily preconception through 12 weeks; 5 mg/day in high-risk groups (prior NTD, diabetes, ASM, BMI ≥30, sickle cell, thalassaemia) | — | Reduces neural tube defect; widely available combined with iron in Indian government supply |
| Iron + folic acid[1] | Iron-folate combination | 100 mg elemental iron + 500 µg folic acid PO daily for at least 100 days from second half of pregnancy (Indian public health programme); higher dose for established anaemia | — | Universal supplementation in high-prevalence anaemia settings; switch to therapeutic dose for established IDA; intravenous iron if oral inadequate |
| Calcium supplementation[1] | Mineral supplement | 1.5–2 g elemental calcium PO daily from 20 weeks where dietary intake <600 mg/day | — | Reduces pre-eclampsia and severe outcomes; take separately from iron supplement to avoid absorption interference |
| Aspirin (for pre-eclampsia prevention)[1] | Antiplatelet (low-dose) | 150 mg PO at night from 12+0 to 36+0 weeks for women at high risk for pre-eclampsia | — | Prior PE, chronic HTN, T1/T2DM, autoimmune disease, twins, age ≥40, BMI ≥35, family history; combine with calcium where dietary intake low |
Folic acid[1]
B-vitamin
- Adult
- 400–500 µg PO daily preconception through 12 weeks; 5 mg/day in high-risk groups (prior NTD, diabetes, ASM, BMI ≥30, sickle cell, thalassaemia)
- Paediatric
- —
Reduces neural tube defect; widely available combined with iron in Indian government supply
Iron + folic acid[1]
Iron-folate combination
- Adult
- 100 mg elemental iron + 500 µg folic acid PO daily for at least 100 days from second half of pregnancy (Indian public health programme); higher dose for established anaemia
- Paediatric
- —
Universal supplementation in high-prevalence anaemia settings; switch to therapeutic dose for established IDA; intravenous iron if oral inadequate
Calcium supplementation[1]
Mineral supplement
- Adult
- 1.5–2 g elemental calcium PO daily from 20 weeks where dietary intake <600 mg/day
- Paediatric
- —
Reduces pre-eclampsia and severe outcomes; take separately from iron supplement to avoid absorption interference
Aspirin (for pre-eclampsia prevention)[1]
Antiplatelet (low-dose)
- Adult
- 150 mg PO at night from 12+0 to 36+0 weeks for women at high risk for pre-eclampsia
- Paediatric
- —
Prior PE, chronic HTN, T1/T2DM, autoimmune disease, twins, age ≥40, BMI ≥35, family history; combine with calcium where dietary intake low
Safety-net
- Attend every scheduled antenatal visit even if you feel well — many problems are silent and only picked up on routine screening[1]
- Reduced or absent fetal movements at any gestation ≥24 weeks — call your maternity unit immediately; do not wait until next appointment[1]
- Report bleeding, severe headache, vision changes, severe abdominal pain, persistent vomiting, fever, or sudden swelling — these need same-day review[1]
Referral criteria
- Pre-existing maternal disease, prior obstetric complication, or moderate-high-risk medicationJoint obstetric and relevant specialist preconception or early antenatal clinic[1]
- Suspected fetal anomaly on first-trimester or anomaly scanMaternal-fetal medicine and antenatal genetics[1]
- Mental health concerns including suicidal ideation, severe anxiety, eating disorder, intimate partner violencePerinatal mental health and social work[1]
- Antenatal complications (pre-eclampsia, diabetes, FGR, threatened preterm labour)Obstetric daycare or admission per condition[1]
Clinical summary
Schedule of antenatal visits, screening, supplementation, and risk-stratification across the three trimesters of pregnancy.