Antenatal Care and Midwifery Assessment
What this domain tests
Antenatal Care and Midwifery Assessment examines booking assessment, pregnancy dating, risk stratification, scheduled surveillance and the screening profile that fits Jordan's epidemiology - thalassaemia trait, iron-deficiency anaemia, gestational diabetes and vitamin D deficiency are common, so locally flavoured screening items appear often.
Core rules
- Dating. Naegele's rule: first day of LMP minus 3 months plus 7 days. A first-trimester scan (CRL 7–13+6 weeks) re-dates the pregnancy only if it differs by more than 5–7 days; later scans should not overrule an early one.
- Obstetric history. Gravida counts all pregnancies including the current one; para counts births at ≥24 weeks. TPAL separates term, preterm, abortions and living children.
- Contacts. WHO recommends 8 contacts - before 12 weeks, then 20, 26, 30, 34, 36, 38 and 40 weeks. Jordanian MOH clinics follow a comparable visit-based schedule.
- Surveillance. BP and urine at every visit; fundal height from 24 weeks (centimetres ± 2–3 of gestational weeks); fetal heart 110–160 bpm by Pinard from about 20 weeks; lie and presentation from 32–34 weeks.
- Screening. CBC and ferritin at booking and around 28 weeks, blood group and Rh, 75 g OGTT at 24–28 weeks, HBsAg/HIV/syphilis per protocol, and anti-D 300 µg IM at 28 weeks for unsensitised Rh-negative women, plus within 72 hours of an Rh-positive birth.
- Supplementation. Folic acid 400 µg daily from preconception to 12 weeks (5 mg if previous neural tube defect, diabetes or obesity); iron and folate throughout pregnancy.
Worked example
LMP 10 March gives an EDD of 17 December. A 9-week CRL scan dates 3 days earlier - under the 5–7 day threshold, so LMP dating stands. At 26 weeks the SFH is 24 cm: within 2 cm, so no action beyond a 2-week recheck. Haemoglobin 9.8 g/dL with low ferritin means oral iron, dietary advice and repeat testing in 4 weeks.
Traps that cost marks
Re-dating from a third-trimester scan; counting pregnancies as para; treating one 140/90 reading as pre-eclampsia before repeat measurement and proteinuria assessment; missing the 72-hour anti-D window; ignoring a SFH–gestation gap of 3 cm or more, which needs ultrasound growth assessment.