This document outlines the protocol for antenatal clinic visits. It recommends that pregnant women have at least 4 checkups - in the first, second, and third trimesters and between 36 weeks and term. The first visit includes registration, history taking, examinations, and basic investigations. Subsequent visits monitor weight, blood pressure, fetal growth and position. Investigations are repeated as needed. The protocol advises on nutrition, rest, medication, symptoms to report, and maternal risk factors identified during antenatal care.

1. ANTENATAL CLINIC
PROTOCOL
Prof. M.C. Bansal
MBBS.,MS. FICOG ., MICOG.
Ex . Principal & controller
Jhalawar Medical College &
Hospital &
M.G.M.C & Hospital . Sitapura ., Jaipur
.

2. Ante Natal Clinic--
Protocol
1. It helps in early identification of complications of
pregnancy in time and their management.
2. Ensures healthy outcomes for the mother and
her baby.
3. Provides opportunity to council regarding
immunization, diet supplementation during
pregnancy and lactating period, motivation for
breast feeding and contraception , patient
education about mother craft.

3. When and how frequent
patient should come for
check up?
• Registration: -As early as pregnancy is
suspected /diagnosed.
• At least 4 Antenatal Visits during all 3 trimesters.
• 1st ANC ---in first trimester i.e. first 12 weeks of
pregnancy.
2nd ANC –between 14-26 weeks.
3rd ANC –between 28 and 34 weeks .
4th ANC—between 36 weeks and term.
Ideally ANC visit once a month till 28 weeks , then
every fortnight in 28-34 weeks and once a week
after wards till delivery.

4. First ANC Visit
• Pregnancy Detection by clinical examination
/urinary pregnancy test.
• ANC Registration ,filling the ANC card and safe
motherhood booklet of every pregnant women
after patient interrogation , detailed menstrual ,
LMP , Obstetrical , personal, family history & any
pre-existing medical/surgical diseases and their
drug therapy.

5. First Visit-
Clinical Examination-
General Examination-
Height, weight , calculate BMI , pallor, edema,
B.P., jaundice , lymph node enlargement ,
cyanosis , clubbing or koilonychia etc.
Systemic -
CVS , Respiratory , locomotive
Obstetrical---Per abdominal if gravid uterus is
palpable above symphysis pubis , PS & PV when
indicated.

6. First visit-
Investigations-
• Hb gm %
• CVC
• Urine Examination—Albumin ,Sugar ,
Microscopic.
• ABO Rh Grouping—if Rh negative husband’s
ABO Rh grouping .
• VDRL
• HIV counseling and screening.
• HBsAg
• Random Blood Glucose.
• USG / TVS Not as routine but only when
indicate on obstetrical grounds.

7. Information for
Pregnant woman and
her family
• Encourage institutional delivery ,Ensure delivery
by qualified , trained ,experienced labour room
nurse or resident doctor.
• Explain entitlement under JSY.
• Identify nearest PHC / FRU for delivery.
• Early identification of high risk / BOH pregnancy
to be attended in district hospital or medical
college hospital.
• Pre-identification of referral , transport and blood
donor.
• Insist upon regular ANC visits.

8. Therapeutic --Advise
• Tab. Folic Acid 5mg once a day.
• Inj. T. T0x0id 0.5ml –1st dose ; 2nd dose to be
repeated after 6 weeks,
• Avoid self medication.
• For any illness / symptom consult your
obstetrician before exposing yourself to any
scanning , drugs, chemicals.
• Eat small amount of food at 4-6 times. Avoid
preserved food, synthetic drinks, smoking ,
alcohol.
• Consume plenty of fresh fruits and
vegetables.
• Take rest in left lateral side for 2hrs after mid
day meal and 8 hrs at night.
• For troublesome nausea & vomiting -Take anti
emetic tab as per advise of the obstetrician.

9. • Decide to continue / discontinue any
medication which patient is taking for pre
pregnancy diseases like asthma , epilepsy ,
heart disease, renal hypertension, obesity,
liver disease. cancer etc.
• Stress to maintain dental , oral , whole body &
private parts hygiene.
• Avoid taking Pica- like clay , lime , chalk etc.
• Avoid exposure to insecticides , fertilizers &
industrial chemical fumes at the work site.

10. Subsequent visits
• On every visit - Ask for any complain.
• Record all findings of physical examination-
Weight , anemia ,edema, B.P.
• Abdominal Examination---Height of uterus ,
do all grips and note down Presentation ,
Position, Free floating /Fixed or engaged
presenting part , foetal movements ,foetal
heart ( rate and rhythm ) any uterine irritability
, uterine tenseness , tenderness , any over
distension of uterus to early detection of
pleural pregnancy / poly hydramnios. Do
Breast examination.
• Correlate and compare your physical findings
with previous records and reports.

11. Fundal height at different gestational
period

12. Measurement of distance between upper limit
of uterus and superior border of symphysis
pubis

13. Fundal grip

14. Umbilical grip

15. Obstetrical grips

16. Location of fetal heart in different
presentations

17. Different fetal presentations

18. Subsequent Visits-
• Investigations- Repeat Hb ., Urine –albumin
and sugar.
• Blood Sugar at 28 and 34-36 weeks to
diagnose gestational / pre diabetic mother.
• USG---- 18weeks to rule out / confirm any
congenital anomaly. Correlate its findings with
physical examination and previous USG.
• Repeat USG as and when indicated or at 34-
36 weeks. Color Doppler as and when
required.

19. Subsequent Visits-
• 2nd dose of T. Toxoid.
• Start Iron 100 mg + folic acid tab every day
after 14 weeks or when nausea & vomiting
stops , continue till term .
• Tab. Calcium Citrate 1200 mg / day.
• Protein supplementation

20. Subsequent Visit-
• When to report to hospital-
Any Bleeding PV, watery discharge PV , pain
abdomen, fever , unable to feel fetal
movements , yellow coloration of eyes or urine
, swelling of feet, headache, pain in
epigastrium , fits , unconsciousness , fainting
attacks , excessive vomits or loose motions
etc.

22. Maternal Risk Factors Detected during
ANC (USA 2001)
Risk Factor Births Percent
Total live births 4,025,933 100
Gestational hypertension 150,329 3.7
Diabetes 124,242 3.1
Anemia 99,558 2.5

23. Maternal Risk Factors Detected
During ANC ( USA 2001)
20,698 0.5
Cardiac Disease
Renal Disease 12,251 0,3
Incompetent Os 11.251 0,3
Hydramnios/oligohydramnios 54,694 1.4
Lung disease 48,246 1.2
Genital herpes 33,560 0.8
Chronic hypertension 32,232 0.8
D (Rh) sensitization 26,933 0.7

24. Thank You