Obstetrics

Antenatal Care — Schedule & Investigations

Q: What investigations are done at first ANC visit?

Hb, CBC, blood group + Rh typing, urine routine (albumin/sugar/microscopy), VDRL, HIV (after counselling), HBsAg, blood sugar (random + OGTT if indicated), TSH if high-risk, USG dating scan in 1st trimester (ideally 11-13+6 weeks for NT scan).

Q: When is the gestational diabetes screen done?

At 24-28 weeks — Oral Glucose Tolerance Test (OGTT) with 75 g glucose. Fasting, 1-hour, and 2-hour plasma glucose measured. Diagnosis: fasting ≥ 92, 1-hour ≥ 180, or 2-hour ≥ 153 mg/dL. If positive, manage with diet, exercise, ± insulin. Oral hypoglycaemics (Metformin, Glyburide) used in selected cases.

Q: What is the Td vaccination schedule in pregnancy?

Td-1 early in pregnancy, Td-2 four weeks after Td-1 (minimum interval 4 weeks). If woman has received 2 TT/Td doses in past 3 years, only 1 Td booster in current pregnancy. Td replaced TT in 2018 to maintain adult diphtheria immunity. Given IM in upper arm.

Q: What are the danger signs in pregnancy?

Vaginal bleeding, severe headache, blurred vision, convulsions, severe abdominal pain, foul-smelling vaginal discharge, fever, reduced fetal movements, leakage of fluid per vaginum, swelling of face/hands, breathlessness at rest. Any of these requires immediate medical evaluation — could indicate abortion, ectopic, preeclampsia, eclampsia, abruption, placenta praevia, fetal distress, or infection.

By Dr. Sonu Lakeshar

Antenatal care (ANC) is the systematic care of pregnant women from conception to onset of labour. WHO 2016 revised the model from 4 visits to 8 contacts for uncomplicated pregnancies. India combines the WHO model with PMSMA (free doctor-led ANC on 9th of every month) and JSSK (free delivery) to deliver comprehensive maternal care.

On This Page

Overview & Schedule
Investigations
IFA & Td
Danger Signs
FAQs

Overview & WHO 8-Contact Schedule

WHO 2016 Focused ANC model recommends 8 contacts for uncomplicated pregnancy:

Contact 1: Up to 12 weeks (1st trimester)
Contact 2: 20 weeks
Contact 3: 26 weeks
Contact 4: 30 weeks
Contact 5: 34 weeks
Contact 6: 36 weeks
Contact 7: 38 weeks
Contact 8: 40 weeks

India's operational target: At least 4 ANC visits (Government of India), enhanced by monthly PMSMA visits. Each contact includes: BP, weight, fundal height, FHS, abdominal exam, urine (albumin/sugar), Hb, and danger sign screening. ASHA mobilises pregnant women from catchment area.

Investigations Schedule

At first ANC visit (Booking visit, ideally in 1st trimester):

Hb, CBC, blood group + Rh typing
Urine routine — albumin, sugar, microscopy
VDRL (syphilis screening)
HIV (after counselling)
HBsAg
Blood sugar — random + OGTT if indicated
TSH if symptoms or high-risk
Hepatitis C if high-risk
USG — dating scan in 1st trimester (ideally 11-13+6 weeks for NT scan)

At 16-20 weeks: USG anomaly scan (level 2) — to detect congenital malformations. Triple/quadruple marker if indicated.

At 24-28 weeks: OGTT (75 g glucose) for gestational diabetes mellitus screening. Repeat Hb.

At 32-36 weeks: Repeat Hb, urine. USG if indicated (growth, liquor, position). Group B Streptococcus screening (in selected cases).

At every visit: BP, weight, fundal height, FHS, presentation, urine albumin/sugar, danger sign screening.

IFA Supplementation & Td Vaccination

IFA: Daily 100 mg elemental iron + 500 mcg folic acid from first ANC visit, for 100 days during pregnancy, continued 180 days postpartum. Take on empty stomach with citrus juice. If Hb < 11 g/dL, double dose (1 BD). Add Albendazole 400 mg single dose in 2nd trimester for deworming.

Td vaccination (NIS): Td-1 early in pregnancy, Td-2 four weeks after Td-1 (minimum interval 4 weeks). If woman has received 2 TT/Td doses in past 3 years, only 1 Td booster in current pregnancy. Td replaced TT in 2018 to maintain adult diphtheria immunity.

Calcium supplementation: 1 g elemental calcium daily from first ANC visit — reduces risk of preeclampsia.

Vitamin A, Albendazole, deworming as needed.

Danger Signs in Pregnancy

Every pregnant woman must be counselled to seek immediate care if any of these danger signs appear:

Vaginal bleeding: At any time — abortion, ectopic, molar, placenta praevia, abruptio placentae
Severe headache: Possible preeclampsia
Blurred vision, photophobia: Severe preeclampsia
Convulsions: Eclampsia (emergency)
Severe abdominal pain: Abruption, ectopic, preterm labour, abruption
Foul-smelling vaginal discharge: Infection, chorioamnionitis
Fever: Infection, sepsis
Reduced fetal movements: Fetal distress — needs immediate CTG and USG
Leakage of fluid per vaginum: Premature rupture of membranes
Swelling of face/hands: Preeclampsia
Breathlessness at rest: Heart failure, severe anemia, pulmonary embolism

Frequently Asked Questions

What is the WHO recommended ANC contact schedule?

WHO 2016 Focused ANC model recommends 8 contacts for uncomplicated pregnancy: 1st at up to 12 weeks, then at 20, 26, 30, 34, 36, 38, and 40 weeks. India's operational target is at least 4 ANC visits, enhanced by monthly PMSMA visits on the 9th of every month.

What investigations are done at first ANC visit?

Hb, CBC, blood group + Rh typing, urine routine (albumin/sugar/microscopy), VDRL, HIV (after counselling), HBsAg, blood sugar (random + OGTT if indicated), TSH if high-risk, USG dating scan in 1st trimester (ideally 11-13+6 weeks for NT scan).

When is the gestational diabetes screen done?

At 24-28 weeks — Oral Glucose Tolerance Test (OGTT) with 75 g glucose. Fasting, 1-hour, and 2-hour plasma glucose measured. Diagnosis: fasting ≥ 92, 1-hour ≥ 180, or 2-hour ≥ 153 mg/dL. If positive, manage with diet, exercise, ± insulin. Oral hypoglycaemics (Metformin, Glyburide) used in selected cases.

What is the Td vaccination schedule in pregnancy?

Td-1 early in pregnancy, Td-2 four weeks after Td-1 (minimum interval 4 weeks). If woman has received 2 TT/Td doses in past 3 years, only 1 Td booster in current pregnancy. Td replaced TT in 2018 to maintain adult diphtheria immunity. Given IM in upper arm.

What are the danger signs in pregnancy?

Vaginal bleeding, severe headache, blurred vision, convulsions, severe abdominal pain, foul-smelling vaginal discharge, fever, reduced fetal movements, leakage of fluid per vaginum, swelling of face/hands, breathlessness at rest. Any of these requires immediate medical evaluation — could indicate abortion, ectopic, preeclampsia, eclampsia, abruption, placenta praevia, fetal distress, or infection.

Conclusion

ANC is the single most evidence-based intervention in maternal health — every contact reduces maternal and perinatal mortality. For UPSC CMS aspirants, the WHO 8-contact schedule, investigation timeline, and danger signs are highly testable OBG topics.

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