Antenatal Care and Midwifery Assessment
Core concepts
Antenatal care rests on risk identification, dating, and education. Know the schedule of focused ANC contacts (WHO's 8-contact model), the components of each visit (history, blood pressure, weight, fundal height, fetal heart, urine protein, danger-sign review), and the screening tests: haemoglobin, blood group and Rh, syphilis, HIV, hepatitis B, and glucose testing. Understand gestational age calculation from last menstrual period (Naegele's rule: LMP + 7 days − 3 months, then +1 year) and its limits in irregular cycles. Learn the gravida/para notation and the meaning of TPAL. Fetal assessment includes fundal height from ~20 weeks (symphysis-fundus measurement in cm roughly equals weeks between 20 and 36), quickening, and fetal movement counting. Nutritional counselling (folic acid, iron, calcium), tetanus toxoid, and birth preparedness are examinable.
Traps
Questions often blur screening versus diagnostic tests, or ask for the next action when a finding is abnormal. A fundal height smaller than dates is not automatically IUGR - first confirm dates and bladder emptiness, then arrange assessment. Another trap: confusing gravida (all pregnancies including current) with para (births after viability). Also watch questions on Rh prophylaxis timing (around 28 weeks and within 72 hours postpartum for Rh-negative unsensitized women).
Worked rule of thumb
If a woman's LMP was 10 March, add 7 days (17 March), subtract 3 months (17 December), add 1 year: estimated due date 17 December of the following year. Always sanity-check with early ultrasound dating, which overrides LMP when the discrepancy is large.
Exam strategy
Anchor every answer in safety first: identify danger signs (bleeding, severe headache, reduced fetal movement, fever) and escalate rather than reassure.