Antenatal Care and Midwifery Assessment
Antenatal Care and Midwifery Assessment
This domain tests whether you can take a focused history, date a pregnancy, identify risk, perform a systematic antenatal examination, order only indicated screening, and teach danger signs. The exam favours the WHO eight-contact model, local Nigerian guidelines, and practical interpretation of fundal height, blood pressure, urine, and fetal heart.
Core rules
- First contact before 12 weeks: confirm pregnancy, calculate EDD from LMP or early ultrasound, record BP, weight, height, BMI, and baseline bloods (Hb, blood group and rhesus, HIV, HBsAg, VDRL, urinalysis).
- From 24 weeks, measure symphysis-fundal height in cm; a lag or excess of 3 cm or more needs review and ultrasound.
- Check BP and urine at every contact; use a validated cuff, correct cuff size, and repeat abnormal readings.
- Give iron 60 mg plus folic acid 400 µg daily, Td vaccine per schedule, IPTp-SP from 13 weeks in endemic areas, and an insecticide-treated net.
- Teach danger signs: bleeding, severe headache, blurred vision, fever, reduced fetal movement, draining liquor, convulsions.
Worked example
At 28 weeks, a woman's SFH is 24 cm. Her LMP is uncertain. Reasoning: the 4 cm lag is clinically significant; do not simply reassure. Arrange ultrasound for dating and growth, check BP and urine, review fetal movement, and schedule earlier follow-up. If ultrasound confirms growth restriction, refer.
Traps
Relying on an uncertain LMP; recording BP without correct cuff size; treating every lag as IUGR without ultrasound; missing proteinuria because urine was not tested; giving IPTp before 13 weeks; and documenting "ANC started" without a plan.