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OG8.1-10 | Antenatal Care — Assignment
CLINICAL SCENARIO
You will analyse a structured clinical vignette describing a woman attending her first antenatal care visit, and produce a written case report that integrates obstetric history-taking, clinical examination findings, risk stratification, investigation planning, and nutritional counselling. This assignment develops your ability to translate classroom knowledge of ANC principles into a systematic clinical write-up — the core competency assessed in OG8.1–OG8.4, OG8.6, and OG8.8.
Instructions
Read the following vignette carefully, then complete all five sections as instructed.
Clinical Vignette:
Sunita, a 27-year-old woman, presents to the primary health centre for her first antenatal visit at an estimated gestational age of 10 weeks. She is a homemaker, vegetarian, and lives in a semi-urban area. Her last menstrual period was 15 March (regular 28-day cycle). This is her third pregnancy: her first pregnancy ended in a spontaneous abortion at 10 weeks, three years ago; her second pregnancy resulted in a normal vaginal delivery at term, 18 months ago, with no complications. The baby weighed 3.2 kg at birth and is alive and well. She has no chronic medical illnesses and no known drug allergies. Her current weight is 54 kg and her height is 158 cm. On examination: BP 126/80 mmHg, pulse 88/min, mild pallor noted on conjunctival inspection, no pedal oedema. Abdominal examination shows a uterus just palpable above the symphysis pubis. She has not started any supplements and has not had any investigations in this pregnancy.
Length: 1000–1400 words across all five sections. Aim for approximately 200–280 words per section. Prioritise clinical reasoning over enumeration.
What to Submit
Section 1: Obstetric History and EDD Calculation
Guidance: Present a structured obstetric history using the GPA system. Calculate the EDD using Naegele's rule (show your working). State her gestational age at presentation. Identify at least two elements from her obstetric history that require further exploration at this visit and explain why each element is clinically significant.
Section 2: Risk Stratification and ANC Planning
Guidance: Based on the history and examination, identify ALL high-risk and moderate-risk features present in this pregnancy. Apply the inverted pyramid of care: state whether this woman can be managed at the primary health centre, or whether referral is needed and at what level. Propose a minimum ANC visit schedule for her pregnancy with the rationale for each scheduled contact, using the WHO 2016 8-contact model as the baseline.
Section 3: Clinical Examination Interpretation
Guidance: Interpret the examination findings in the vignette. Calculate her BMI and classify it. Comment on the significance of conjunctival pallor and outline the next diagnostic step. Describe what you would assess at this gestational age during obstetric abdominal examination and what findings would be expected at 10 weeks. Explain what the SFH would be expected to measure at 20, 28, and 36 weeks and the formula that underpins this.
Section 4: Investigation Plan
Guidance: Construct a first-visit investigation plan for Sunita. For each investigation, state the specific clinical indication based on her history/findings, and the result threshold that would change management. Include at minimum: haemoglobin/CBC, blood group and Rh typing, urine analysis, blood glucose (DIPSI or IADPSG — state which you use and why), VDRL, and relevant ultrasound. Do not list investigations without clinical justification.
Section 5: Nutritional and Supplementation Counselling
Guidance: Provide structured nutritional counselling for Sunita covering: (1) the NHM IFA supplementation regimen with precise dose, (2) calcium supplementation indication and dose, (3) dietary advice appropriate for a vegetarian woman in her first trimester, and (4) weight gain targets using the IOM 2009 recommendations for her BMI category. Acknowledge any cultural or socioeconomic sensitivity issues in your counselling approach.
Grading Rubric — Antenatal Care Case Report Rubric
| Criterion | Points | Full-marks descriptor |
|---|---|---|
| Obstetric History and EDD (accuracy of GPA notation, Naegele's rule calculation, identification of clinically significant history elements) | 20 pts | GPA notation is correct, EDD calculated accurately with working shown, gestational age stated, two clinically significant history elements identified with clear reasoning. |
| Risk Stratification and ANC Planning (identification of risk factors, appropriate use of inverted pyramid, evidence-based visit schedule) | 20 pts | All relevant risk factors identified, inverted pyramid correctly applied with referral decision justified, WHO 8-contact schedule adapted with rationale for each contact. |
| Clinical Examination Interpretation (BMI calculation and classification, interpretation of pallor, expected SFH at key gestations) | 20 pts | BMI correctly calculated and classified, pallor interpreted with appropriate next step, SFH at 20/28/36 weeks stated correctly with physiological basis explained. |
| Investigation Plan (appropriate test selection, correct protocol named (DIPSI vs IADPSG), clinical justification for each test) | 20 pts | All required investigations listed, DIPSI or IADPSG named with threshold stated and reason for choice explained, each investigation has a specific clinical indication and management-relevant threshold. |
| Nutritional and Supplementation Counselling (precise IFA dose, calcium supplementation, vegetarian-appropriate dietary advice, IOM weight gain targets, counselling approach) | 20 pts | IFA dose stated precisely (60 mg iron + 500 µg folic acid for 180 days), calcium supplementation with dose included, dietary advice vegetarian-appropriate with specific food sources, IOM weight gain target calculated for her BMI category, cultural/socioeconomic sensitivity acknowledged. |
PEER REVIEW
Review your peer's case report using the five rubric criteria above. For each criterion: (1) identify one specific strength in their response, (2) identify one specific gap or error (if any), and (3) suggest a concrete improvement. Write your peer review as structured paragraphs (one per criterion). Aim for 300–400 words total. Be specific: quote or paraphrase the relevant section of their work when giving feedback. Avoid vague comments such as 'good work' without explanation.