A structured, person-centred approach to identifying maternal, pregnancy, fetal and social factors that may require additional monitoring, investigation, specialist review or urgent referral.
Use a structured history, examination, appropriate investigations and ongoing reassessment. The exact screening package and referral thresholds should follow national and local protocols.
WHO's ANC model emphasizes repeated maternal and fetal assessment, preventive care, communication and timely detection of complications. citeturn0search0turn0search2
Pregnancy can change the assessment and management of pre-existing disease. Significant conditions should be identified early and reviewed according to current disease-specific guidance.
The exact referral pathway must follow the local health system, available transport, facility capability and clinical protocol. When an emergency is suspected, stabilization and emergency transfer should not be delayed by routine administrative processes.
| Urgency | Examples | General action |
|---|---|---|
| Emergency / immediate | Severe bleeding; severe abdominal pain; convulsions; loss of consciousness; severe breathing difficulty; shock or collapse; suspected major obstetric emergency; severe acute illness. | Arrange immediate emergency assessment and activate the local emergency/referral pathway. Do not delay transfer for routine screening. |
| Urgent / same-day assessment | New concerning pregnancy symptoms, markedly elevated blood pressure or symptoms suggestive of hypertensive disease, reduced/absent fetal movement after fetal movements are established, suspected infection with systemic symptoms, significant abnormal findings. | Contact or refer to an appropriate maternity/obstetric service promptly according to local protocol. |
| Priority specialist review | Important medical disease, significant previous obstetric history, multiple pregnancy, suspected fetal growth or structural concern, abnormal screening result, or another condition requiring higher-level monitoring. | Arrange timely specialist or higher-level antenatal assessment and maintain continuity until review. |
| Routine ANC with monitoring | No current emergency or significant risk identified after appropriate history, examination and investigations, with normal ongoing pregnancy assessment. | Continue scheduled antenatal care, preventive measures, education, surveillance and reassessment at subsequent contacts. |
Education should include clear safety-netting: what to watch for, where to go, and how quickly to seek help.
Examples include severe vaginal bleeding, severe abdominal pain, convulsions, loss of consciousness, severe difficulty breathing, collapse or shock, or other symptoms suggesting a serious acute illness. New or concerning pregnancy symptoms such as significant headache with visual symptoms, marked swelling with other concerning symptoms, fever with systemic illness, or significant reduction/absence of fetal movement after movements are established also require prompt assessment according to gestational age and local maternity protocols.
WHO recommends a minimum of eight antenatal contacts for routine ANC, with additional contacts or a modified schedule when clinical circumstances require. citeturn0search0turn0search23
| Contact | Timing | Risk-screening focus |
|---|---|---|
| 1 | First trimester / up to 12 weeks | Establish pregnancy history, gestational age, baseline maternal health, risk factors, investigations and referral needs. |
| 2 | 20 weeks | Reassess maternal health, pregnancy progress, fetal assessment and emerging risk factors. |
| 3 | 26 weeks | Continue maternal/fetal surveillance, preventive care and review of new symptoms or abnormal findings. |
| 4 | 30 weeks | Assess ongoing pregnancy wellbeing and review risks affecting late pregnancy and birth planning. |
| 5 | 34 weeks | Reassess maternal/fetal status and strengthen birth preparedness and complication readiness. |
| 6 | 36 weeks | Review late-pregnancy symptoms, fetal status, birth plan and referral arrangements. |
| 7 | 38 weeks | Continue surveillance, safety-netting and planning for birth and escalation if needed. |
| 8 | 40 weeks | Assess maternal/fetal wellbeing and plan ongoing management if birth has not occurred. |
Risk screening is a clinical reasoning process, not a checklist alone.
Collect relevant history, symptoms, examination findings and investigations systematically.
Distinguish normal pregnancy changes from findings that require additional assessment or escalation.
Use local referral pathways and match urgency to the clinical situation and facility capability.
Explain the concern, plan and warning signs clearly while maintaining dignity, privacy and informed participation.
Pregnancy risk screening is a structured process of identifying maternal, pregnancy, fetal and social factors that may require additional monitoring, investigation, specialist input or urgent referral. It is not the same as diagnosing a complication.
No. A risk factor indicates that closer observation or a different care pathway may be appropriate. Risk screening helps determine where additional assessment or referral may be needed.
Yes. Pregnancy is dynamic. A person initially considered low risk may develop a new symptom, abnormal finding or complication, so risk assessment should be repeated throughout antenatal care.
Severe vaginal bleeding, severe abdominal pain, convulsions, loss of consciousness, severe breathing difficulty, collapse, or other signs of a serious acute illness require urgent medical assessment. Other concerning symptoms should be assessed according to gestational age and local maternity protocols.
WHO recommends a minimum of eight antenatal contacts for routine care, beginning in the first trimester, with further contacts around 20, 26, 30, 34, 36, 38 and 40 weeks. Individual care may require additional contacts or a different schedule.
Referral connects a pregnant person to the level of care, investigation, specialist expertise or emergency treatment needed for the identified concern while maintaining communication and continuity of care.
