Antenatal Care and Normal Pregnancy
Core concepts
Antenatal care rests on risk assessment, dating, and surveillance. Know the recommended schedule (WHO's 2016 model: eight contacts; many national programmes still use monthly visits to 28 weeks, then fortnightly to 36, then weekly), the purpose of each visit, and the parameters tracked: weight, blood pressure, fundal height, fetal heart rate, urine protein, and fetal movement. Understand Naegele's rule (first day of last menstrual period minus 3 months plus 7 days, adjusted for cycle length) and why ultrasound in the first trimester is more reliable for dating. Be able to describe physiological changes of pregnancy - plasma volume expansion causing dilutional anemia, lowered diastolic pressure in mid-pregnancy, increased glomerular filtration, progesterone-driven smooth-muscle relaxation causing constipation and reflux - and distinguish them from pathology.
Screening and supplementation
Know routine screening: blood group and Rh, hemoglobin, HIV, syphilis, hepatitis B, glucose tolerance testing, and anomaly scanning. Iron and folic acid supplementation, tetanus toxoid, and counseling on danger signs are core midwifery tasks. Danger signs (bleeding, severe headache, blurred vision, reduced fetal movement, fever, leaking fluid, convulsions) must be taught to every woman.
Traps
Questions often confuse gravida (total pregnancies including current) with para (births after 20–24 weeks). Fundal height in centimeters roughly equals gestational weeks between 20 and 36 weeks - a discrepancy of 3 cm or more warrants assessment. Do not attribute edema or mild dyspnea in late pregnancy to pathology without checking blood pressure and urine.
Rule of thumb
If a woman's last menstrual period is reliable and she has had no first-trimester ultrasound, date by Naegele; once a dating scan exists, the scan wins.
Worked example
LMP 10 March. Expected date of delivery = 10 December (10 March minus 3 months = 10 December, plus 7 days = 17 December).