Systematic care of pregnant woman aimed at maintaining health, identifying risk, preventing complications.
History taking
- • LMP, EDD (Naegele), parity, prior pregnancies/outcomes
- • Current symptoms (nausea, bleeding, leaking, fetal movements)
- • Medical/surgical/family history; medications; allergies; vaccinations
- • Social: nutrition, smoking, alcohol, domestic violence screening
Examination
- • BP, weight, BMI, pallor, oedema
- • Abdominal: fundal height (after 12 wk), Leopold maneuvers (after 28 wk), fetal heart
- • Per speculum/vaginal as indicated
Red flags
- • Severe headache, blurred vision, epigastric pain (pre-eclampsia)
- • Bleeding, leaking, decreased fetal movements
- • Fever, severe vomiting
Differential diagnosis
- • Threatened miscarriage, ectopic, gestational HTN, anaemia, GDM, antepartum haemorrhage
Recommended investigations
- • First visit: CBC, blood group/Rh, urinalysis, HIV, VDRL, HBsAg, RBS/OGTT, TSH
- • USG: dating (8–12 wk), NT/anomaly (11–14, 18–22 wk)
- • OGTT 24–28 wk, anti-D antibody screen Rh-negative
Diagnosis
- • Confirm pregnancy with urine/serum hCG; date by LMP + early USG
Initial treatment / management
- • ≥4 ANC visits (WHO recommends 8); ideally monthly until 28 wk, fortnightly to 36 wk, weekly thereafter
- • Folic acid 400 µg preconception–12 wk (5 mg if high risk)
- • Iron 60 mg + Folic acid 500 µg daily from 14 wk
- • Calcium 1 g/day; vaccinations (Tdap 27–36 wk, influenza)
- • Anti-D at 28 wk if Rh-negative
Prescription examples
- • Tab Folic Acid 5 mg PO OD (until 12 wk)
- • Tab Iron + Folic Acid 60 + 500 mcg PO OD from 14 wk
- • Tab Calcium 500 mg PO BD
- • Tab Doxinate (Doxylamine + Pyridoxine) PO HS for nausea
Follow-up advice
- • Each visit: BP, weight, fundal height, fetal heart, urine dipstick
- • Schedule USG, OGTT, Tdap as per gestational age
Patient counselling
- • Nutrition, weight gain, exercise, sleep, hygiene
- • Danger signs and where to seek emergency care
- • Birth preparedness, breastfeeding, contraception postpartum
Referral criteria
- • High-risk pregnancy: HTN, diabetes, anaemia, multiple gestation, prior CS, age extremes
- • Suspected pre-eclampsia, IUGR, malpresentation
Clinical pearls
- • BP ≥140/90 after 20 wk + proteinuria = pre-eclampsia; urgent referral
- • Universal screening for GDM at 24–28 wk in India (DIPSI/IADPSG)
References
- • WHO Recommendations on Antenatal Care 2016
- • FOGSI-GoI Maternal Health Guidelines
Educational outpatient guide — verify against local guidelines before clinical use.
