Antenatal care
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Below are **20 detailed, high-quality, exam-oriented Antenatal Care (ANC) case scenarios** with **presentation → evaluation → investigations → diagnosis → management → counselling**.
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# **20 Detailed Case Scenarios – Antenatal Care**
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## **1. Early Booking Visit – Missed Period**
**Case:**
A 24-year-old primigravida presents with 6 weeks of amenorrhea, nausea, and breast tenderness.
**Evaluation:**
Vitals stable, UPT positive, mild pallor.
**Investigations:**
CBC, blood group/Rh, urine R/M, TSH, HIV/HBsAg/HCV, RBS. Early dating scan → CRL 6w2d.
**Diagnosis:**
Normal early pregnancy.
**Management:**
Start FA 400 µg/day, counsel diet, avoid teratogens, schedule next visit at 12 weeks.
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## **2. Severe Vomiting in Early ANC**
**Case:**
A 21-year-old at 8 weeks complains of excessive vomiting, dizziness.
**Investigations:**
CBC, electrolytes → hypokalemia; USG confirms viable pregnancy.
**Diagnosis:**
Hyperemesis gravidarum.
**Management:**
IV fluids, thiamine, antiemetics (ondansetron/metoclopramide), small frequent meals, follow-up in 3–5 days.
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## **3. Anaemia Detected on First Visit**
**Case:**
26-year-old G2P1 at 10 weeks, complaints of fatigue. Hb: 8.4 g/dL.
**Diagnosis:**
Moderate iron deficiency anaemia.
**Management:**
Oral iron 120 mg elemental/day, folic acid, deworming after 14 weeks, repeat Hb after 3 weeks. Evaluate stool for parasites.
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## **4. Rh-Negative Mother – First Visit**
**Case:**
28-year-old at 12 weeks. Blood group: B negative. Husband is B positive.
**Investigation:**
Indirect Coombs test (ICT) negative.
**Diagnosis:**
Un-sensitized Rh-negative pregnancy.
**Management:**
Give Anti-D 300 µg at 28 weeks + postpartum. Repeat ICT at 28 weeks. Counsel for bleeding risk.
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## **5. High BP at 16 Weeks**
**Case:**
32-year-old G3P2 presents at 16 weeks with BP 146/94 mmHg.
**Investigations:**
Urine protein negative, baseline LFT/KFT normal.
**Diagnosis:**
Chronic hypertension.
**Management:**
Start labetalol, low-dose aspirin (150 mg nightly till 36w), monthly growth scans from 28 weeks.
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## **6. Screening for Down Syndrome**
**Case:**
29-year-old at 11 weeks, wants screening for chromosomal defects.
**Management:**
Offer combined NT scan + dual marker (β-hCG + PAPP-A). If high risk → NIPT or CVS.
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## **7. Positive GDM Screen (24 Weeks)**
**Case:**
27-year-old at 25 weeks; OGTT: Fasting 96, 1-hr 182, 2-hr 165 mg/dL.
**Diagnosis:**
Gestational diabetes mellitus.
**Management:**
Diet counselling, glucose monitoring; if persistently high → insulin therapy. Doppler and growth monitoring from 32 weeks.
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## **8. Low Lying Placenta on Anomaly Scan**
**Case:**
G2 at 19 weeks; placenta is 1 cm from OS.
**Diagnosis:**
Low-lying placenta.
**Management:**
Avoid intercourse, avoid heavy exercise, repeat scan at 32 weeks.
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## **9. Fetal Anomaly Detection**
**Case:**
Woman at 20 weeks; anomaly scan: spina bifida.
**Management:**
Detail fetal anomaly scan, genetic counselling, MRI fetal spine, discuss prognosis, options including continuation/termination based on gestational age and legal guidelines.
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## **10. Low Maternal Weight Gain**
**Case:**
22-year-old at 24 weeks; total weight gain only 3 kg, SFH smaller by 3 cm.
**Investigation:**
Growth scan → EFW at 12th percentile, normal Doppler.
**Diagnosis:**
Constitutional small fetus vs early IUGR.
**Management:**
Nutritional counselling, protein intake, repeat growth scan after 2–3 weeks.
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## **11. Reduced Fetal Movements at 30 Weeks**
**Case:**
30-year-old at 30 weeks reports decreased fetal movements.
**Investigation:**
NST reactive, AFI normal.
**Diagnosis:**
Transient decreased perception.
**Management:**
Kick count charting, hydration, report if again reduced.
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## **12. Polyhydramnios at 28 Weeks**
**Case:**
AFI 26 cm at routine scan.
**Investigations:**
OGTT for GDM, anomaly scan for GI obstruction.
**Diagnosis:**
Mild polyhydramnios.
**Management:**
Treat GDM if present; fetal surveillance weekly NST after 34 weeks.
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## **13. Oligohydramnios at 32 Weeks**
**Case:**
AFI 4 cm.
**Investigations:**
Doppler → normal or abnormal?
**Diagnosis:**
Oligohydramnios.
**Management:**
Hydration, repeat AFI in 1 week; if Doppler abnormal or term → induction of labour.
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## **14. IUGR with Absent End-Diastolic Flow**
**Case:**
30-week scan shows EFW <10th percentile, AEDF in umbilical artery.
**Management:**
Steroid cover for fetal lungs, daily NST, twice-weekly Doppler, delivery at earliest sign of deterioration (often at 32 weeks).
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## **15. Breech Presentation at 36 Weeks**
**Case:**
G1 at 36w; fetus breech.
**Management:**
Offer external cephalic version (ECV) at 36–37 weeks if no contraindication. If unsuccessful: counsel for planned C-section.
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## **16. Pruritus at 34 Weeks**
**Case:**
G2 at 34 weeks with severe itching on palms/soles.
**Investigation:**
LFT, bile acids elevated.
**Diagnosis:**
Intrahepatic cholestasis of pregnancy (ICP).
**Management:**
Ursodeoxycholic acid, fetal monitoring weekly, planned delivery at 37 weeks.
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## **17. Preterm Labour Threat at 30 Weeks**
**Case:**
Contractions + mild cervix shortening.
**Management:**
Tocolytics (nifedipine), corticosteroids, screen & treat UTI, advise rest.
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## **18. Mild Vaginal Bleeding at 32 Weeks**
**Case:**
Painless bleeding.
**Evaluation:**
Avoid PV exam until placenta previa ruled out → USG: placenta previa type 3.
**Management:**
Hospitalization, avoid intercourse, steroids, planned CS at 36–37 weeks.
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## **19. Pregnancy-Induced Hypertension at 34 Weeks**
**Case:**
BP 150/100, urine protein +1, headache.
**Diagnosis:**
Preeclampsia.
**Management:**
Labetalol, MgSO₄ if severe, fetal monitoring, plan induction at 37w or earlier if severe features.
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## **20. Post-date Pregnancy (41 Weeks)**
**Case:**
Primigravida at 41 weeks, reactive NST, adequate AFI.
**Diagnosis:**
Post-term pregnancy.
**Management:**
Induction of labour at 41 weeks, continuous intrapartum monitoring.
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Below is a **complete, concise-but-exhaustive Antenatal Care (ANC) medical note** following your preferred pattern (definition → aims → schedule → investigations → supplements → danger signs → high-risk pregnancy → management protocols → counselling).
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# **ANTENATAL CARE — COMPLETE DETAILED MEDICAL NOTE**
## **1. Definition**
Antenatal care (ANC) is the structured, evidence-based clinical care provided to a pregnant woman from conception until delivery to ensure optimal maternal and fetal outcomes through screening, prevention, early detection and management of complications.
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## **2. Objectives / Aims**
* Ensure maternal well-being and monitor fetal growth & development
* Early identification of high-risk pregnancies
* Screening and prevention of maternal complications (anaemia, GDM, PIH, infections)
* Detect congenital anomalies & fetal abnormalities
* Provide nutritional supplementation & immunization
* Prepare mother for labour, breastfeeding & newborn care
* Reduce maternal and perinatal morbidity/mortality
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## **3. Recommended ANC Schedule (India/NHM & WHO 8-contact model)**
### **Traditional Indian 4-visit model**
1. **Visit 1:** <12 weeks
2. **Visit 2:** 14–26 weeks
3. **Visit 3:** 28–34 weeks
4. **Visit 4:** 36–40 weeks
### **WHO 8-Contact Model**
| Contact | Gestation | Key actions |
| ------- | --------- | --------------------------- |
| 1 | ≤12 w | Baseline eval, labs, dating |
| 2 | 20 w | Anatomy scan, BP, Hb |
| 3 | 26 w | GDM screening |
| 4 | 30 w | Growth, BP |
| 5 | 34 w | Growth, fetal wellbeing |
| 6 | 36 w | Presentation, birth plan |
| 7 | 38 w | Fetal monitoring |
| 8 | 40 w | Post-dates evaluation |
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## **4. Components of Each Visit**
### **History**
* LMP, cycle regularity → establish EDD
* Past obstetric history: abortions, LSCS, PPH, PIH, GDM
* Medical: HTN, DM, TB, epilepsy, cardiac disease
* Surgical: uterine surgeries
* Social: tobacco, alcohol, domestic violence
* Drug history & allergies
### **Examination**
* Weight, BMI, BP
* Pallor, edema, thyroid
* Breast exam (later visits)
* Obstetric:
* Symphysis-fundal height (SFH)
* Abdominal girth
* Fetal heart rate (FHR)
* Presentation, lie, engagement (after 36 w)
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## **5. Investigations**
### **Baseline (at first visit)**
* **Blood:** CBC, Hb, blood group & Rh, indirect Coombs (Rh-neg), RBS
* **Infections:** HIV, HBsAg, HCV, VDRL
* **Urine:** Routine + microscopy, urine culture
* **Thyroid:** TSH
* **Dating scan:** 6–10 weeks (CRL most accurate)
### **Second trimester**
* **Anomaly scan (18–22 weeks)**
* **GDM screening:** 75-g OGTT at 24–28 weeks
* Repeat Hb at 24–28 weeks
### **Third trimester**
* Growth scan (28–32 w)
* Doppler (if IUGR, PIH, diabetes)
* Repeat Hb, urine protein
* Group B Streptococcus (GBS) screening (36–37 weeks; region-dependent)
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## **6. Supplements (as per WHO/NHM guidelines)**
### **Folic Acid**
* **Dose:** 400 µg/day preconception → 12 weeks
* For previous NTD: 4 mg/day
### **Iron + Folic Acid**
* From **2nd trimester to 6 months postpartum**
* **Dose:** 60 mg elemental iron + 500 µg folic acid daily
* If anaemia: 120 mg elemental Fe daily
### **Calcium**
* **Dose:** 500 mg twice daily from 14 weeks → delivery
* Do not take iron & calcium together
### **Vitamin D**
* 600–1200 IU/day (or weekly 60,000 IU depending on policy)
### **TT/Tdap Immunization**
* **TT1:** At first ANC
* **TT2:** 4 weeks later
* **If fully immunized in last pregnancy:** only 1 booster
* Many countries: **Tdap at 27–36 weeks**
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## **7. Screening During Pregnancy**
### **Anaemia**
* Hb <11 g/dL → treat
* Evaluate causes & follow-up response
### **PIH / Pre-eclampsia**
* Check BP every visit
* Urine protein
* Red flags: headache, visual blurring, RUQ pain
### **GDM**
* 75-g OGTT at 24–28 weeks
* Fasting ≥92 mg/dL, 1-hr ≥180, 2-hr ≥153 mg/dL → GDM
### **Hypothyroidism**
* TSH each trimester
* Treat with levothyroxine
### **Fetal growth restriction**
* Track SFH, Doppler if lag
### **Congenital anomalies**
* NT/first trimester screen (optional)
* Anomaly scan 18–22 w
* Quadruple test 15–22 w
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## **8. Danger Signs in Pregnancy (Educate mother)**
* Vaginal bleeding
* Severe headache/visual disturbance
* Swelling of face/hands
* Decreased fetal movements
* High fever
* Leaking of fluid
* Convulsions
* Severe abdominal pain
* Breathlessness
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## **9. High-Risk Pregnancy Identification**
High risk if:
* Age <18 or >35
* Previous LSCS, PPH, preterm birth
* Medical disease: HTN, diabetes, epilepsy, cardiac disease
* Multiple gestation
* Placenta previa, abnormal presentations
* Severe anaemia
* Substance abuse
* Rh negative with sensitization
* Recurrent pregnancy loss
**Management:**
* More frequent visits
* Growth assessments + Doppler
* Specialist referral
* Early admission if needed
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## **10. Counselling in ANC**
### **Diet**
* Balanced diet with extra 350 kcal/day
* Iron-rich foods, proteins
* Avoid raw meat, unpasteurized milk
* Hydration
### **Lifestyle**
* No smoking/alcohol
* Moderate exercise
* Avoid heavy lifting, long standing
### **Sexual Activity**
* Safe unless placenta previa, bleeding, or risk of PTL
### **Breastfeeding Counselling**
* Begin from 2nd trimester
* Exclusive breastfeeding for 6 months
### **Birth Preparedness**
* Identify hospital
* Emergency transport
* Blood donor
* Warning signs
* Planning for labour
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## **11. Intrapartum Readiness (Late ANC)**
* Assess fetal presentation at 36 w
* Pelvic adequacy
* Birth plan documentation
* Indications for IOL (post-term, GDM, HTN)
* Counselling about labour stages
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## **12. Postnatal Planning**
* Contraception counselling
* Postnatal visit after 6 weeks
* Follow-up for anaemia, thyroid, BP
---
If you want, I can also generate:
✅ **15 case scenarios**
✅ **25 MCQs (HTML + CSS + JS in one file)**
✅ **Differential diagnoses + differential case scenarios**
✅ **Tags + titles**
Just tell me **“yes, give full package”**.