Obstetrics Handbook

1. ANC Visit Schedule

Gestational Age	Visit Frequency	What to Do
<12 weeks	First booking visit	History, examination, baseline investigations, folic acid, dating scan
14–16 weeks	Once	BP, weight, urine, start IFA & calcium
18–22 weeks	Once	Anomaly scan, routine ANC checkup
24–28 weeks	Once	OGTT, CBC, ANC review
28–32 weeks	Every 2–4 weeks	Growth monitoring, fetal wellbeing
32–36 weeks	Every 2 weeks	Presentation, growth assessment
≥36 weeks	Weekly	Delivery planning, labour preparedness

2. Baseline Investigations

Investigation	Purpose
CBC/Hb	Detect anemia
Blood Group & Rh Typing	Rh incompatibility risk
HIV	Screening
HBsAg	Hepatitis B screening
HCV	Hepatitis C screening
VDRL/RPR	Syphilis screening
Blood Sugar	Diabetes screening
TSH	Thyroid disorder screening
Urine Routine	Proteinuria, UTI
Urine Culture	Asymptomatic bacteriuria
Pap Smear	Cervical cancer screening

3. Ultrasound Schedule

Age	Ultrasound	Purpose
6–9 weeks	Dating Scan	Confirm viability, gestational age
11–13+6 weeks	NT Scan	Aneuploidy screening
18–22 weeks	Level-II Anomaly Scan	Congenital anomalies
28–32 weeks	Growth Scan	Growth assessment
36 weeks	Growth & Wellbeing Scan	Delivery planning

4. Antenatal Screening Tests

Gestational Age	Test
11–13+6 weeks	Dual Marker Test
11–13+6 weeks	Combined Aneuploidy Screening
24–28 weeks	75 g OGTT
28 weeks	Indirect Coombs Test (Rh-negative mother)

5. Folic Acid Schedule

Period	Dose
Preconception to 12 weeks	400 mcg OD
High-risk pregnancy	5 mg OD

6. Iron Supplementation

Age	Drug	Dose
14 weeks onward	Iron + Folic Acid	60 mg Iron + 500 mcg FA daily

7. Calcium Supplementation

Age	Drug	Dose
14 weeks onward	Calcium + Vitamin D	500 mg BD

8. Deworming Schedule

Age	Drug	Dose
After 14 weeks	Albendazole	400 mg single dose

9. Vaccination Schedule

Age	Vaccine	Dose
27–36 weeks	Tdap	Single dose
If not previously immunized	Td-1	First dose
4 weeks later	Td-2	Second dose

10. Rh-Negative Mother Protocol

Age	Action
Booking Visit	Blood Group & Rh Typing
28 Weeks	Indirect Coombs Test
28 Weeks	Anti-D Immunoglobulin 300 mcg IM
Within 72 hrs after birth	Anti-D Immunoglobulin

11. Follow-Up Assessment

Parameter	Check
Blood Pressure	Yes
Weight	Yes
Pallor	Yes
Pedal Edema	Yes
Urine Protein	Yes
Urine Sugar	Yes
Fetal Heart Rate	After viability
Fundal Height	After 20 weeks
Fetal Movements	After quickening

12. Repeat Investigations

Age	Investigation
24–28 weeks	CBC
24–28 weeks	OGTT
32–34 weeks	CBC
32–34 weeks	Urine Routine

13. Dietary Advice

Nutrient	Requirement
Extra Calories	350 kcal/day
Protein	70–75 g/day
Water Intake	2–3 L/day
Green Leafy Vegetables	Daily
Fruits	Daily
Milk & Dairy	Daily
Avoid Alcohol/Tobacco	Completely

14. Exercise Advice

Activity	Recommendation
Walking	30 minutes daily
Antenatal Yoga	If no contraindication
Pelvic Floor Exercises	Recommended
Heavy Weight Lifting	Avoid
Contact Sports	Avoid

15. Danger Signs Requiring Referral

Danger Sign
Vaginal bleeding
Leaking per vaginum
Severe abdominal pain
Severe headache
Blurring of vision
Convulsions
Reduced fetal movements
BP ≥140/90 mmHg
Fever
Breathlessness

16. Quick ANC Timeline

Week	Important Event
<12	Booking visit + Baseline tests + Folic acid
6–9	Dating scan
11–13+6	NT scan + Dual marker
14	Start Iron & Calcium
18–22	Anomaly scan
24–28	OGTT + CBC
27–36	Tdap/Td vaccination
28	Anti-D (Rh-negative mother)
28–32	Growth monitoring
32–34	Repeat CBC
36	Delivery planning
37–40	Weekly ANC visits