Routine Antenatal Assessments

Routine Antenatal Assessments - First Steps First

• History Taking:
  • LMP, EDD calculation (Naegele's rule).
  • Obstetric history (GTPAL), medical, surgical, family history.
• Clinical Examination:
  • Vitals (BP, Wt, Ht), general physical (pallor, edema), systemic exam.
  • Obstetric: P/A (fundal height if >12 wks), P/V (if indicated).
• Baseline Investigations:
  • Hemoglobin (Hb), Blood group & Rh typing.
  • Urine: Routine/Microscopy, Culture.
  • Serology: HIV, HBsAg, VDRL/RPR.
  • Random Blood Sugar (RBS) or Glucose Challenge Test (GCT).
• Dating Ultrasound (USS):
  • Ideally 6-9 weeks: confirms viability, accurate dating (CRL), number of fetuses.
  • Nuchal Translucency (NT) scan option at 11-13.6 weeks.
• Counseling:
  • Nutrition, weight gain, folic acid supplementation.
  • Warning signs, antenatal visit schedule, tetanus toxoid immunization.

⭐ Folic acid (400 mcg/day; 5 mg for high-risk) initiated pre-conceptionally or ASAP to prevent Neural Tube Defects (NTDs).

Routine Antenatal Assessments - Bump Watch Continues

• Goal: Healthy mother & baby.
• Initial Visit (Booking ~8-12 wks):
  • Hx (LMP, EDD ($LMP + 9M + 7D$)), Exam (Wt, BP, FH).
  • Labs: Hb, BG-Rh, HIV, HBsAg, VDRL, RBS, Urine.
  • Dating USG (6-9 wks CRL).
• Follow-up Visit Frequency:

• Key Gestational Assessments:
  • Each visit: Wt, BP, FH, FHS, FM, Urine alb/sugar.
  • 11-14 wks: NT scan, Dual marker.
  • 18-20 wks: Anomaly Scan (TIFFA).

  ⭐ TIFFA (18-20 wks) detects major fetal structural anomalies.

  • 24-28 wks: GDM screen, Hb. Rh(-): ICT.
  • 32-36 wks: Growth scan (opt). GBS screen (35-37 wks).

Routine Antenatal Assessments - Test Fest Time

• Booking Visit (<12 wks):
  • Hx, Exam (BP, Wt), EDD (Naegele: LMP - 3mo + 7d + 1yr).
  • Labs: Hb, Blood grp/Rh, HIV, HBsAg, VDRL/RPR, RBS, Urine R/M, C/S.
• Visit Freq: 📌 4-2-1 Rule: Q4W till 28 wks → Q2W 28-36 wks → Q1W from 36 wks.
• Routine Checks (Each Visit): BP, Wt, Fundal Ht, FHS, Urine Alb/Sugar.

⭐ Anomaly scan (TIFFA) is ideally performed between 18-20 weeks gestation for detecting major structural fetal abnormalities.

Routine Antenatal Assessments - Baby's Report Card

• Goal: Monitor maternal & fetal health, early detection of complications.
• Initial Visit (Booking):
  • History: LMP, EDD (📌 Naegele's: $LMP + 9 \text{ months} + 7 \text{ days}$), Obstetric Hx.
  • Exam: General, Systemic, Obstetric.
  • Labs: Hb, Blood group/Rh, VDRL, HBsAg, HIV, Urine R/M, RBS.
• Follow-up Visits:
  • Schedule: Q4W up to 28w → Q2W 28-36w → Q1W >36w.
  • Checks: Wt, BP, SFH, FHS, Fetal Movements, Urine Alb/Sugar.
• Key Investigations Timeline:

![Fetal anomaly scan ultrasound](https://ylbwdadhbcjolwylidja.supabase.co/storage/v1/object/public/notes/L1/Obstetrics_and_Gynecology_Prenatal_Care_Routine_Antenatal_Assessments/0c841665-f18e-4630-8ba2-6c576801c256.jpg)
> ⭐ The anomaly scan (Level II USG) around **18-20 weeks** is crucial for detecting major structural fetal abnormalities.

High‑Yield Points - ⚡ Biggest Takeaways

• First antenatal visit: ideally first trimester for baseline investigations & risk stratification.
• Regular BP checks: vital for early detection of hypertensive disorders.
• Fundal height: correlates with gestational age, especially post 20 weeks.
• Anomaly scan (TIFFA): crucial at 18-20 weeks for fetal structural defects.
• Iron & Folic Acid (IFA): routine supplementation prevents anemia & neural tube defects.
• Tetanus Toxoid (TT): two doses prevent maternal & neonatal tetanus.
• GDM Screening: OGTT mandatory for detecting Gestational Diabetes.