Antenatal Care Complete Guide 2025: Visits, Investigations, High-Risk Pregnancy, Supplements & Case Scenarios
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# ⭐ **25 Case Scenarios With Detailed Management (Antenatal Care)**
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## **1️⃣ Missed First ANC Visit at 20 Weeks**
A 22-year-old primigravida presents for her **first antenatal visit at 20 weeks**. No prior investigations.
### **Management**
* Full baseline tests (CBC, blood group & Rh, VDRL, HIV, HBsAg, HCV, TSH, urine R/M)
* Dating scan now unreliable → use **anomaly scan** + LMP for EDD
* Counsel regarding **regular ANC visits**
* Start **IFA** + **calcium**
* **OGTT at 24–28 weeks**
* **Tdap at 27–36 weeks**
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## **2️⃣ Severe Pallor at 28 Weeks**
G2P1 at 28 weeks: **Hb 6.8 g/dL**, symptomatic breathlessness.
### **Management**
* Classify as **severe anemia**
* **Hospital admission**
* Evaluate cause: ferritin, peripheral smear, stool for occult blood
* **Packed RBC transfusion**
* Start **parenteral iron** after stabilization
* Treat cause (e.g., deworming after 12 weeks)
* Monitor Hb every 2–4 weeks
* Plan delivery at equipped center
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## **3️⃣ GDM Detected**
28-year-old at 26 weeks: OGTT shows **2-hr value 168 mg/dL**.
### **Management**
* Diagnose **GDM**
* Start **medical nutrition therapy** + exercise
* **Home glucose monitoring**
* If fasting >95 or PP >140 → **Insulin therapy**
* Fetal growth scan every 4 weeks
* Avoid post-dates pregnancy → deliver by **38–39 weeks**
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## **4️⃣ High BP at 32 Weeks**
BP 148/96 mmHg + urine dipstick **1+ protein**.
### **Management**
* Diagnose **preeclampsia without severe features**
* Baseline labs: LFT, RFT, platelets, LDH, uric acid
* Start **labetalol or nifedipine**
* Fetal monitoring: NST, growth scan
* **Delivery at 37 weeks**
* Advise danger signs: headache, vision loss, epigastric pain
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## **5️⃣ Rh-Negative Mother at 28 Weeks**
O– mother; husband is Rh+. No sensitization profile done.
### **Management**
* Perform **Indirect Coombs Test (ICT)**
* If ICT negative → give **Anti-D 300 µg at 28 weeks**
* Repeat after delivery if baby is Rh+
* Counsel about events requiring Anti-D (bleeding, ECV, amniocentesis)
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## **6️⃣ Reduced Fetal Movements**
Woman at 34 weeks reports **decreased fetal movements**.
### **Management**
* Immediate **NST**
* If reactive → reassure + kick count chart
* If non-reactive → **BPP**, Doppler
* If Doppler abnormal → consider **delivery depending on gestational age**
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## **7️⃣ Hyperemesis Gravidarum**
10-week pregnant woman with **severe vomiting**, ketonuria, dehydration.
### **Management**
* Admit
* IV fluids (NS/RL) + **thiamine**
* Antiemetics: **doxylamine/pyridoxine**, ondansetron
* Correct electrolytes
* Consider **steroids** if refractory
* Rule out molar pregnancy via USG + β-hCG
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## **8️⃣ Supine Hypotension Episode**
At 30 weeks she collapses when lying flat for USG.
### **Management**
* Turn to **left lateral position**
* Reassure — benign
* Advise to avoid supine position
* Use left tilt during examinations
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## **9️⃣ Varicose Veins With Pain**
Pregnant woman at 28 weeks with painful, swollen lower-leg veins.
### **Management**
* Leg elevation
* Compression stockings
* Avoid prolonged standing
* Paracetamol for pain
* Symptoms resolve postpartum
28-week pregnant woman with tingling in thumb, index & middle finger.
### **Management**
* Wrist splinting (night)
* Hand elevation
* Avoid repetitive wrist movements
* If severe → **local steroid injection**
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## **1️⃣2️⃣ Bell’s Palsy**
Sudden left facial droop at 30 weeks.
### **Management**
* Start **Prednisolone** within 72 hours
* Lubricating eye drops + eye patch
* Reassure — most recover fully
* Differentiate from stroke (speech, limb weakness)
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## **1️⃣3️⃣ Backache in Pregnancy**
Chronic low back pain at 24 weeks.
### **Management**
* Posture correction
* Heat therapy
* Physiotherapy/core strengthening
* Maternity support belt
* Avoid NSAIDs
* Paracetamol if needed
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## **1️⃣4️⃣ Severe NVP (Non-Hyperemesis)**
Early pregnancy vomiting but no dehydration.
### **Management**
* Small frequent meals
* Ginger, vitamin B6
* **Doxylamine + pyridoxine**
* Avoid spicy/trigger foods
* Follow-up to ensure no progression to hyperemesis
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## **1️⃣5️⃣ Missed Tetanus Immunisation**
Primigravida at 34 weeks has **not received TT/Tdap**.
### **Management**
* Give **Tdap 27–36 weeks** (still OK at 34 weeks)
* Single dose protects mother + baby
* No need for TT if Tdap given
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## **1️⃣6️⃣ Teenage Pregnancy With Low BMI**
17-year-old, BMI 17.
### **Management**
* High-risk registration
* Nutritional rehabilitation (high-protein diet)
* Calcium + iron + multivitamins
* More frequent ANC visits
* Screen for anemia & infections
* Counsel about early warning signs
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## **1️⃣7️⃣ Obese Pregnancy (BMI 34)**
High BMI detected at 12 weeks.
### **Management**
* Counsel about **excessive weight gain**
* Recommended gain: **5–9 kg**
* Early OGTT (<16 weeks)
* Low-glycemic diet
* BP monitoring for preeclampsia
* Growth scans every 4 weeks in 3rd trimester
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## **1️⃣8️⃣ Multiple Pregnancy (Twins)**
Twin pregnancy at 18 weeks.
### **Management**
* Determine **chorionicity**
* More ANC visits
* Iron + protein supplementation
* Serial growth ultrasound every 4 weeks
* Aspirin prophylaxis for preeclampsia
* Delivery planning:
* TT at 12 weeks & 20 weeks OR
* **Tdap once between 27–36 weeks**
2. **Influenza (inactivated)** – any trimester
3. **Hepatitis B** if non-immune (0,1,6 months)
## **Contraindicated**
* MMR
* Varicella
* Live influenza (intranasal)
* HPV contraindicated during pregnancy
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# **9. Management of Common Pregnancy Discomforts**
