Antenatal Care and Normal Pregnancy
The antenatal domain tests whether you can run a risk-based schedule, interpret routine screening correctly, and recognise the moment a pregnancy stops being normal. Mongolia's national protocol follows the WHO eight-contact model, with the first contact booked before 12 weeks so that dating, risk classification and preventive care happen early.
What the first visit must achieve
- Confirm gestational age: a certain LMP plus ultrasound crown–rump length before 14 weeks (accurate to about ±5 days).
- Structured history: parity, previous caesarean, pre-eclampsia, stillbirth, postpartum haemorrhage, chronic hypertension, diabetes, TB, cardiac or renal disease.
- Blood pressure with the correct cuff, weight, height, BMI.
- Haemoglobin, blood group and Rhesus, urinalysis, HIV, syphilis, HBsAg, and TB symptom screening at every contact - Mongolia remains a high-TB-burden country.
- Classify risk and book the place of birth: soum health centre for low risk, aimag hospital or the National Center for Maternal and Child Health for high risk.
Prevention routinely due
Folic acid 400 µg daily (5 mg after a previous neural tube defect), iron 60 mg elemental daily, iodine where the diet is deficient, calcium 1.5–2 g where intake is low, tetanus–diphtheria immunisation, anti-D immunoglobulin 300 µg at 28 weeks for unsensitised Rh-negative women, and gestational diabetes screening at 24–28 weeks.
Worked example
A herder's wife gives an uncertain LMP of 3 March 2024 and attends on 14 June. Naegele gives 10 December 2024. Ultrasound the same day measures a CRL consistent with 13+2 weeks, giving an EDD of 20 December 2024. Reasoning: when the LMP is uncertain, early ultrasound is the more reliable dating method, so that date is adopted and recorded as final.
Traps
Changing the EDD after 24 weeks; missing Rhesus status; transfusing instead of giving iron for haemoglobin 105 g/L; and discharging a woman with headache and 2+ proteinuria as 'normal pregnancy'.