Why the Booking Visit Is High-Yield
The antenatal booking visit is the foundational encounter of every pregnancy, ideally completed by 10 weeks' gestation, and it is a frequently examined station because it combines history taking, risk stratification, and patient counselling in a single structured encounter. Examiners want to see a systematic approach that correctly identifies which patients need consultant-led rather than midwife-led care.
💡 Tip
Before you start, note the gestational age given in the brief. If it's later than 10 weeks, acknowledge this and mention catching up on any missed screening windows, examiners like to see this awareness.
Structuring the Booking History
🧠 Mnemonic
OPQRST-MOM is not standard, instead use this booking-specific structure:
- Obstetric history (previous pregnancies and outcomes)
- Present pregnancy details (LMP, EDD, symptoms)
- Quick past medical/surgical history
- Risk factors (pre-existing conditions)
- Social history (SADMA plus domestic abuse enquiry)
- Treatment (drug history and allergies)
- Menstrual and gynaecological history
- Obesity/BMI and baseline observations
- Mental health history
Confirming Dates
- "When was the first day of your last period, and are your cycles usually regular?"
- Calculate the estimated due date using Naegele's rule: LMP + 7 days, − 3 months, + 1 year.
- "Have you had a dating scan, or would today's estimate be based on your last period?"
💎 Clinical Pearl
An early dating ultrasound (ideally 10–13+6 weeks) is more accurate than LMP-based dating, especially with irregular cycles, and is used to confirm gestational age if the discrepancy is more than 5–7 days.
Obstetric History, Use Gravida and Para Correctly
💎 Clinical Pearl
Gravida (G) = total number of pregnancies, including the current one, regardless of outcome.
Para (P) = number of pregnancies carried beyond 24 weeks (live or stillborn), written as P (term deliveries)+(losses before 24 weeks, e.g. miscarriages or terminations).
Example: A woman in her third pregnancy, having had one term delivery and one miscarriage, is G3 P1+1.
For each previous pregnancy, ask about:
- Mode of delivery (vaginal, instrumental, caesarean, and why)
- Gestation at delivery (term, preterm)
- Birth weight and any neonatal complications
- Any complications, pre-eclampsia, gestational diabetes, postpartum haemorrhage, perineal trauma
Risk Stratification, The Core Purpose of Booking
The entire point of the booking history is to identify who needs consultant-led care rather than midwife-led (low-risk) care. Systematically screen for:
| Category | Key questions |
|---|---|
| Pre-existing medical conditions | Diabetes, hypertension, epilepsy, cardiac disease, asthma, thyroid disease, mental health conditions, autoimmune disease |
| Previous obstetric complications | Pre-eclampsia, gestational diabetes, preterm birth, stillbirth, postpartum haemorrhage, caesarean section |
| Current pregnancy risk factors | Multiple pregnancy, BMI >35 or <18, maternal age <18 or >40, smoking, alcohol/substance use |
| Social risk factors | Domestic abuse, safeguarding concerns, lack of social support, non-English speaking without an interpreter, asylum seeker/undocumented status |
⚠️ Red Flag
Always ask about domestic abuse directly and in private, without the partner present, even if they seem supportive. Use a direct, normalised question: "We ask all women this at booking, as some women experience abuse at home, is this something that happens to you?" Pregnancy is a recognised period of increased risk for domestic violence to begin or escalate.
Medical, Surgical, and Drug History
- "Do you have any ongoing medical conditions, diabetes, high blood pressure, epilepsy, thyroid problems?"
- "Any previous surgery, particularly on your womb or cervix?"
- "What medications are you currently taking, including anything over the counter or herbal?"
- "Are you taking folic acid? Vitamin D?"
💎 Clinical Pearl
Folic acid 400 micrograms daily is recommended from before conception until 12 weeks, to reduce neural tube defect risk. Higher dose (5mg) is required for women with epilepsy, diabetes, BMI >30, a previous NTD-affected pregnancy, or on antiepileptic medication.
Family History
- "Any family history of diabetes, high blood pressure in pregnancy, twins, or inherited conditions?"
- Screen for consanguinity if relevant, as this raises the risk of recessive genetic conditions.
Social History, Use SADMA Plus
- Smoking status, offer referral to stop-smoking services if positive
- Alcohol, advise complete abstinence during pregnancy (no safe known limit)
- Drugs, recreational and prescribed, non-judgementally
- Mental health, past and current, including previous postnatal depression or psychosis
- Abuse, domestic violence screening as above
- Occupation and any exposure risks; housing and support at home
Baseline Observations and Investigations Offered at Booking
- Blood pressure and urinalysis (baseline for later comparison, e.g. pre-eclampsia screening)
- BMI calculation
- Booking bloods: FBC, blood group and antibody screen, haemoglobinopathy screen, rubella immunity, HIV, hepatitis B, syphilis serology
- Urine culture for asymptomatic bacteriuria
- Down's syndrome screening discussion (combined test at 11–13+6 weeks, or quadruple test if later booking)
- Dating/nuchal translucency scan arranged
💡 Tip
If asked "what would you screen for at booking that you wouldn't in a routine GP appointment?", the answer examiners want is the infectious disease screen (HIV, hepatitis B, syphilis) and haemoglobinopathy screen, since these have direct implications for managing the pregnancy and protecting the baby, and are offered to all women regardless of perceived risk.
Closing the Booking Visit
- 1Summarise the plan: booking bloods, dating scan, screening choices, and follow-up schedule.
- 2Explain the antenatal care pathway: routine appointment schedule (more frequent if high-risk), 20-week anomaly scan.
- 3Give lifestyle advice: diet, food safety (avoiding unpasteurised cheese, raw eggs, high-mercury fish, alcohol), exercise, and smoking cessation support if relevant.
- 4Safety-net: "Please contact your midwife or maternity unit urgently if you have any bleeding, severe abdominal pain, reduced fetal movements later on, or severe headaches with visual disturbance."
Frequently Asked Questions
"What makes a pregnancy 'high risk' requiring consultant-led care rather than midwife-led care?"
Pre-existing medical conditions (diabetes, cardiac disease, epilepsy), previous obstetric complications (pre-eclampsia, stillbirth, three or more preterm births), current pregnancy complications (multiple pregnancy, placenta praevia), and significant social risk factors (safeguarding concerns, substance misuse) all warrant consultant-led care rather than routine midwife-led pathways.
"When is the combined test for Down's syndrome screening performed, and what does it measure?"
Between 11 and 13+6 weeks' gestation, combining nuchal translucency ultrasound measurement with maternal serum beta-hCG and PAPP-A levels, alongside maternal age, to calculate a risk score for trisomy 21, 18, and 13.
"Why is asymptomatic bacteriuria treated in pregnancy when it wouldn't be outside pregnancy?"
Untreated asymptomatic bacteriuria in pregnancy carries a significantly increased risk of progressing to pyelonephritis and is associated with preterm labour and low birth weight, so it is actively screened for and treated with antibiotics even without symptoms.