Your 28-week appointment: blood tests, anti-D and the RSV vaccine

Everyone is offered an appointment at 28 weeks, whether or not it’s your first baby. It’s a busy one, so here’s what the NHS and NICE say to expect.

Who has a 28-week appointment?

Everyone. The NHS lists the 28-week appointment for all pregnancies. If you’ve given birth before, NICE says some of the checks are new for you at 28 weeks, because you won’t have had a 25-week appointment.

What happens

The NHS says your midwife will ask about your health and wellbeing, and:

check your blood pressure and test your pee (urine)
measure your bump to check your baby’s growth
talk about your baby’s movements
ask about your mental health
go over any screening results
ask to do a blood test to check your health, iron levels and blood group
offer you an injection if your baby is at risk of rhesus disease
give you information about labour and birth, including newborn screening

You’ll also be offered the RSV vaccine around this time, and some people have a glucose test. There’s more on each below.

Bump, blood pressure and urine

These are the same checks as at your other appointments. NICE says your bump measurement is plotted on a growth chart, and you may be offered an ultrasound scan if it’s larger or smaller than expected. Your blood pressure and a dipstick test for protein in your pee check for pre-eclampsia. See urine tests and blood pressure checks and growth scans.

Blood tests for anaemia and antibodies

The NHS says your midwife will ask to do a blood test to check your health, iron levels and blood group. NICE says this is a full blood count and a check of your blood group and antibodies.

Iron and anaemia. This checks your iron levels and whether you’re anaemic. If your iron is low, your midwife or GP will talk to you about treatment. See anaemia and iron tests in pregnancy.
Blood group and antibodies. This looks for antibodies in your blood. If any are found, your midwife will explain what it means for you and your baby.

If you haven’t heard about your results, ask your midwife.

Anti-D if you’re rhesus negative

The NHS says you’ll be offered an injection at 28 weeks if your baby is at risk of haemolytic disease of the fetus and newborn, also called rhesus disease. This injection is anti-D, and NICE says it’s offered to women who are rhesus negative.

The NHS says that if you’re rhesus negative, your baby’s blood group will be tested using a sample of your blood. If your baby is rhesus negative too, there’s no risk of rhesus disease. If your baby is rhesus positive, you’ll be offered anti-D to stop your body making antibodies.

Ask your midwife what applies to you. See rhesus negative blood and the anti-D injection.

The RSV vaccine

The NHS says you should be offered the RSV vaccine around the time of your 28-week appointment. Having it as soon as possible from 28 weeks gives your baby the best protection, but it can be given later if needed, up until you go into labour. You should have it in every pregnancy, and it helps protect your baby for the first 6 months after they’re born.

The NHS says the most common side effects are mild and don’t last long, such as swelling or pain where the injection was given, a headache or an aching body. If you haven’t been offered it at 28 weeks or later, speak to your maternity service or GP surgery.

If you haven’t had your whooping cough vaccine yet, ask about it too. NHS Best Start in Life says it’s usually offered at around 20 weeks and you can have it from 16 to 32 weeks. See vaccines in pregnancy.

The glucose test, if you need one

Not everyone has this test. The NHS says that if you have a higher chance of gestational diabetes, you’ll be offered testing between 24 and 28 weeks. The NHS says you should be offered it if any of these apply to you:

you’re over 40
your BMI is above 30
you’ve had a baby who weighed 4.5kg (10lb) or more at birth
you had gestational diabetes in a previous pregnancy
one of your parents or siblings has diabetes
you’re of south Asian, Black, African-Caribbean or Middle Eastern origin, even if you were born in the UK
you’ve had a gastric bypass or other weight-loss surgery

The test is called an oral glucose tolerance test (OGTT) and takes about 2 hours. The NHS says you have a blood test in the morning when you haven’t had any food or drink for 8 to 10 hours. You’re then given a glucose drink, and after resting you have another blood test. Follow any instructions your hospital gives you.

If you had gestational diabetes before, the NHS says you’ll be offered the test earlier, soon after your booking appointment, and again at 24 to 28 weeks if the first result is normal. See gestational diabetes explained.

Starting to sleep on your side

NICE says your midwife should advise you to avoid going to sleep on your back after 28 weeks. The NHS says going to sleep on your back after 28 weeks has been linked to a higher risk of stillbirth.

NICE says your midwife should talk to you about ways to stay on your side while you sleep, such as using pillows. See sleeping position in pregnancy.

Getting ready for labour, birth and after

The NHS says your midwife will give you information about labour and birth, including newborn screening. NICE says this is also a time to talk about:

preparing for labour and birth, and recognising when labour has started
caring for and feeding your baby
vitamin K for your baby
looking after yourself after the birth, including pelvic floor exercises
changes in your mood and your mental health after the birth

See signs of labour, vitamin K for newborn babies and the newborn blood spot test.

Between appointments

Call your midwife or maternity unit straight away, day or night, if you’re worried about your baby’s movements or they slow down. NICE says you can contact maternity services at any time of day or night about this. See your baby’s movements in pregnancy.

Call your midwife or maternity unit straight away if you have signs of pre-eclampsia. The NHS lists a severe headache that doesn’t go away with simple painkillers, vision problems such as blurred vision or flashing lights, pain below your ribs, sudden swelling of your face, hands or feet, heartburn that doesn’t go away with heartburn medicines, being sick, or feeling very unwell. The NHS says to call 111 if you can’t reach your maternity unit. See high blood pressure and pre-eclampsia.

Questions people ask

Is the 28-week appointment for everyone?

Yes. The 25-week and 31-week appointments are for first babies, but the NHS lists the 28-week appointment for all pregnancies.

Will I have a glucose test at 28 weeks?

Only if you have a higher chance of gestational diabetes. The NHS says you’ll be offered testing between 24 and 28 weeks if so. Your midwife will tell you whether you need it.

What if I miss the RSV vaccine at 28 weeks?

You can still have it. The NHS says it can be given later if needed, up until you go into labour, but having it as soon as possible from 28 weeks gives the best protection. Speak to your maternity service or GP surgery.

Do I need anti-D if my baby is rhesus negative?

The NHS says that if your baby is rhesus negative, there’s no risk of rhesus disease. Ask your midwife what your results mean for you.

When should I start going to sleep on my side?

NICE and the NHS say to avoid going to sleep on your back after 28 weeks.