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OG8.6-7 | Nutrition and Vaccination in Pregnancy — SDL Guide (Part 3)
Self-Assessment
Having studied the principles and practice of nutritional and vaccination counselling in pregnancy, use the following questions to consolidate your understanding. These cover the factual recall expected at the KH (Knowledge and How) level for OG8.7 and the applied knowledge underpinning the SH skill for OG8.6. Work through each question before checking the answer. For the skill component, the best self-assessment is to role-play a 5-minute ANC counselling station with a colleague acting as the patient — aim to deliver all six counselling checklist steps accurately within the time limit without referring to notes. If you can answer every question below without hesitation and execute the counselling checklist fluidly in simulation, you are well-prepared for both the written examination and the OSCE. Pay particular attention to exact dose figures (elemental iron, folic acid, calcium) and the TT interval — these are the most frequently tested items in university examinations and viva voce assessments on antenatal care.
Key recall questions for self-assessment:
- What is the correct dose of the IFA tablet prescribed under NHM for pregnancy, and for how many days?
- What are the two categories of vaccines — and which category is safe in pregnancy?
- State the TT/Td schedule for: (a) a primigravida with no prior TT, (b) a multigravida who completed a full TT series 2 years ago.
- Which vaccines are absolutely contraindicated in pregnancy, and why?
- What are the IOM weight-gain targets for a normal-weight (BMI 22) pregnant woman?
- A patient refuses TT, citing fear that it will harm the baby. What is your response?
- What is the correct action when a patient reports black stools after starting IFA?
CLINICAL PEARL
The single commonest OSCE error in nutritional counselling stations is confusing the IFA dose: the standard NHM pregnancy tablet contains 60 mg elemental iron + 500 µg (0.5 mg) folic acid. The preconception/early-pregnancy tablet contains 0.4 mg folic acid with iron — do not quote the periconceptional-only dose as the pregnancy dose. Remember also that folic acid doses used in high-risk pregnancies (previous NTD, antiepileptic drug use) may go up to 4–5 mg/day on specialist advice — this is NOT the routine supplementation dose. On vaccination: the minimum interval between TT1 and TT2 is exactly 4 weeks (28 days), not 6 weeks, not 'as soon as possible'. This interval is tested in both written and viva examinations.
SELF-CHECK
A primigravida received TT1 at her first ANC visit at 10 weeks of gestation. She presents again at 20 weeks. She has NO previous TT immunisation record. When should TT2 have been given, and what should you do now?
A. TT2 should have been given at 20 weeks — give it now at 20 weeks as scheduled
B. TT2 should have been given at ≥14 weeks (≥4 weeks after TT1 at 10 weeks) — give it now at 20 weeks, as the minimum 4-week interval has been exceeded
C. TT2 cannot be given now as it is too late in pregnancy
D. Give both TT1 and TT2 today since the first dose was too early
Reveal Answer
Answer: B. TT2 should have been given at ≥14 weeks (≥4 weeks after TT1 at 10 weeks) — give it now at 20 weeks, as the minimum 4-week interval has been exceeded
TT2 should be given ≥4 weeks after TT1 — so the earliest TT2 should have been given was 14 weeks (10 + 4). At 20 weeks, the 4-week minimum has long been met. Give TT2 now. The ideal schedule is TT1 as early as possible and TT2 ≥4 weeks later and ideally before 36 weeks. It is NEVER too late to give TT2 in the second trimester — even in the third trimester, give it if not already done.