Antenatal Care

ANC Basics - Stork's Starter Kit

• Definition: Systematic supervision (medical & nursing) of a woman during pregnancy, from conception until labor onset.
• Aims: Promote, protect, and maintain the health of mother & baby; detect high-risk cases early; educate on safe childbirth & parenting.
• Objectives: Reduce maternal & perinatal mortality/morbidity; ensure a healthy pregnancy outcome and positive childbirth experience.
• Key Principle: Individualized, risk-based, and timely care.

⭐ WHO recommends a minimum of 8 ANC contacts, with the first contact in the first trimester (before 12 weeks gestation).

ANC Visits - Bump's Checkpoint Charlie

• Goal: Monitor maternal/fetal health, manage complications.
• WHO Minimum (Low-Risk): 4 visits.
  • 1st: <12 wks (Booking visit)
  • 2nd: 14-26 wks
  • 3rd: 28-34 wks
  • 4th: 36-40 wks
• Revised WHO (2016): 8 contacts.
  • 1st: <12 wks
  • 2nd Tri: 20, 26 wks
  • 3rd Tri: 30, 34, 36, 38, 40 wks
• Key Actions at Visits:
  • History, Weight, BP, Pallor, Edema.
  • Abdominal exam: Fundal height, FHS, Fetal lie (later).
  • Key Investigations: Hb, Urine, Blood group, HIV, VDRL, HBsAg.
  • TT immunization, IFA supplementation.
  • Counselling: Nutrition, Rest, Danger signs, Birth preparedness.

⭐ At least one ANC visit should be attended by the husband/partner for counselling on shared responsibilities and birth preparedness planning.

ANC Interventions - Mom-To-Be Medley

• Immunization (Td Vaccine)
  • Td-1: Early in pregnancy.
  • Td-2: 4 weeks after Td-1.
  • Td-Booster: One dose, if received 2 Td doses in a pregnancy within the last 3 years.
• Nutritional Supplementation
  • Iron & Folic Acid (IFA):
    • Prophylaxis: One tablet daily (elemental iron 100 mg + folic acid 500 µg) for at least 100 days, starting after first trimester (from 4th month).
    • Therapeutic (Anemia Hb < 11 g/dL): Two tablets daily.
  • Calcium: 500 mg elemental calcium daily (or 1g calcium carbonate) from 2nd trimester.
  • Albendazole (Deworming): 400 mg single dose, 2nd trimester (after 1st trimester).
• Counselling & Health Education
  • Nutrition: Balanced diet, additional energy (+350 kcal/day) & protein (+22 g/day). Importance of hydration.
  • Hygiene, Rest, Exercise: Personal hygiene (handwashing, breast care), adequate rest, light exercise.
  • Danger Signs Recognition: Vaginal bleeding, severe headache/blurred vision, convulsions, fever, ↓fetal movements.
  • Birth Preparedness & Complication Readiness (BPCR): Identify skilled birth attendant, health facility, transport, finances.
  • Family Planning (Postnatal): Information on postnatal family planning options.
  • Delivery & Breastfeeding: Benefits of institutional delivery & early initiation of breastfeeding.

⭐ IFA supplementation: At least 100 days of 100 mg elemental iron + 500 µg folic acid, starting after the first trimester, is crucial for preventing maternal anemia and adverse birth outcomes.

High‑Risk Approach - Trouble Spotters

Identifies pregnancies at ↑ risk for adverse outcomes for timely intervention.

• Screening: History (medical, obstetric, social), exam, investigations.
• Key Risk Indicators:
  • Maternal Demographics:
    • Age: <18 yrs or >35 yrs.
    • Parity: Nullipara, Grand multipara (≥5).
    • Height: <145 cm.
    • BMI: <18.5 or >25 kg/m² (pre-pregnancy).
  • Past Obstetric History:
    • Recurrent abortions (≥3), stillbirth, neonatal death.
    • Previous C-section, instrumental delivery, APH/PPH.
    • History of preterm labor, IUGR, congenital anomaly.
  • Current Pregnancy Complications:
    • Anemia: Hb <11 g/dl (severe <7 g/dl).
    • Hypertensive disorders (PIH, pre-eclampsia).
    • Gestational Diabetes Mellitus (GDM).
    • Multiple pregnancy, malpresentation, Rh-negative status.
    • Bleeding in pregnancy.
  • Medical Conditions: Cardiac, renal, epilepsy, HIV, asthma.

⭐ A woman with any previous perinatal loss (stillbirth or neonatal death) is considered high-risk from the start of any subsequent pregnancy.

High‑Yield Points - ⚡ Biggest Takeaways

• Minimum 4 ANC visits are key; Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) provides free ANC on the 9th of each month.
• First ANC visit ideally within 12 weeks (first trimester).
• Two Tetanus Toxoid (TT) doses or one booster, 1 month apart.
• Daily IFA supplementation (100 mg iron, 500 mcg folic acid) for at least 100 days from the second trimester.
• GDM screening with 75g OGTT at 24-28 weeks of gestation.
• Average pregnancy weight gain is 11-13 kg; varies with pre-pregnancy BMI.
• Identify and manage high-risk pregnancies promptly for referral and specialized care.