Antenatal Care and Normal Pregnancy
This domain tests whether you can deliver focused antenatal care that separates normal pregnancy from early warning signs, using Cambodia's public-sector workflow from health centre to referral hospital.
Core rules
- Book the first visit before 12 weeks: confirm pregnancy, calculate EDD from LMP, take history, measure BP, weight and height, test haemoglobin, urine protein, blood group, HIV and syphilis, and screen for danger signs.
- Give iron-folic acid daily, tetanus-diphtheria toxoid per schedule, deworming after the first trimester, and calcium where dietary intake is low. Advise insecticide-treated nets in malaria-endemic areas.
- Schedule at least four visits (more if risk factors), with fundal height from 20 weeks and fetal heart auscultation from 20 weeks. Symphysis-fundal height in centimetres roughly tracks weeks from 20 to 36.
- Agree a birth-preparedness plan: place of birth, transport, money, blood donor, companion and decision-maker.
Worked example
A 24-year-old G2P1 attends at 10 weeks. BP is 128/84, urine protein negative, haemoglobin 10.8 g/dL. She had pre-eclampsia in her last pregnancy. Reasoning: she needs standard booking tests plus early referral-level review because prior pre-eclampsia raises recurrence risk. Start iron-folate, arrange calcium, document BP and urine at every visit, and teach danger signs: bleeding, severe headache, blurred vision, fever, reduced fetal movement, draining fluid.
Traps
- Treating ankle oedema as pre-eclampsia without BP or proteinuria.
- Missing a multiple pregnancy because the uterus is large for dates.
- Recording 'normal ANC' without risk screening or a written plan.
- Giving tetanus toxoid without checking the card.