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NICE cuts routine antenatal checks

New antenatal care guidelines from the National Institute for Clinical Excellence will drastically cut routine appointments for pregnant women.

The traditional model of 14 routine antenatal appointments is cut to nine or 10 for nulliparous women and six or seven in subsequent pregnancies.

But appointments must begin earlier in pregnancy and be more structured, NICE states.

The guidelines ­ which aim to ensure women receive similar antenatal care whether they are seen in general practices or hospitals ­ specify exactly what checks should be conducted at each routine appointment.

The woman's risk of pre-eclampsia should always be evaluated at the first opportunity, taking account of parity, age, family history, BMI and multiple pregnancy or pre-existing vascular disease. High-risk women should have more frequent appointments.

The guidance also makes recommendations on some controversial issues in antenatal care and sets out national standards to screen for conditions including Down's syndrome.

Antenatal care is an additional service under the new GP contract.

Antenatal care recommendations

 · 9 or 10 routine appointments for nulliparous women and 6 or 7 for other women

 · Women should only be weighed when it may alter management but symphysis-fundal height should be measured and plotted at each appointment

 · Routine auscultation of fetal heart not recommended unless woman requests it

 · Women should limit alcohol consumption to no more than one unit per day

 · All women should be offered screening for Down's syndrome with a test that provides a detection rate >60 per cent and a false positive rate <5 per="">

 · Routine screening for gestational diabetes mellitus should not be offered as the evidence does not support it and the danger of false positives is high

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