OG8.1 | Antenatal Care Objectives and Risk Screening — Summary & Reflection

KEY TAKEAWAYS

Antenatal care is a structured clinical skill with five core objectives: accurate gestational dating, systematic complication screening, nutritional supplementation (IFA 60 mg iron + 500 µg folic acid + calcium 1.5–2 g/day), immunoprotection (Td1 and Td2 in the schedule), and birth preparedness. The WHO 2016 model recommends 8 ANC contacts; India's MOHFW minimum is 4 (ANC1–ANC4). The inverted pyramid of care operationalises risk stratification — most women enter at the universal primary care level, and only a risk-stratified minority are escalated to specialist or tertiary care. High-risk factors span four domains: demographic/social, obstetric history (the 'bad obstetric history'), medical comorbidities, and current pregnancy findings. Every ANC contact must screen for danger signs (severe headache, visual disturbance, bleeding, reduced fetal movements, convulsions, fever, severe abdominal pain) and counsel the woman and her family on birth preparedness. Systematic documentation in the MCP card ensures continuity of care. The pre-eclampsia threshold is BP ≥140/90 mmHg after 20 weeks; anaemia in pregnancy is Hb <11 g/dL (WHO).

REFLECT

Think about the case of Priya presented at the beginning of this module. She arrived at 32 weeks with severe pre-eclampsia and severe anaemia — conditions that were detectable weeks earlier. Now that you understand the ANC objectives and risk-screening framework, map out: (1) At which ANC contact should her hypertension have first been detected, and what action should have followed? (2) When should her IFA supplementation have started, and would it have prevented her anaemia? (3) What risk factors was she carrying (if any from demographic or obstetric categories) that should have flagged her for enhanced surveillance from booking? Applying the inverted pyramid retrospectively to a case is one of the most powerful ways to internalise why each element of ANC exists. Take five minutes to write your answers before you move on.