What investigations should be included in the first Antenatal Care (ANC) check-up?

Essential Investigations for First Antenatal Care (ANC) Check-up

The first antenatal care visit should include comprehensive screening with hemoglobin, platelet count, serum creatinine, urinalysis, and quantification of urinary protein as baseline references to ensure optimal maternal and fetal outcomes. 1

Basic Laboratory Investigations

• Complete Blood Count (CBC): Hemoglobin and platelet count are essential baseline measurements to detect anemia and assess clotting function 1, 2
• Renal Function: Serum creatinine to evaluate kidney function, particularly important for detecting early signs of preeclampsia 1
• Urinalysis: Basic urinalysis with protein dipstick testing to screen for proteinuria as a potential indicator of preeclampsia 1
• Quantification of Urinary Protein: Ideally using spot urine protein/creatinine ratio rather than 24-hour collection when available 1
• First Trimester Screening: Between 11-14 weeks, nuchal translucency (NT) measurement, pregnancy-associated plasma protein A (PAPP-A), and human chorionic gonadotrophin (hCG) for Down syndrome risk assessment 1

Clinical Assessments

• Blood Pressure Measurement: Critical baseline measurement for all pregnant women, with community-based BP measurement available at first point of care 1
• Dating Ultrasound: First trimester dating ultrasound to establish accurate gestational age 1
• Fetal Assessment: Initial assessment of fetal viability and number of fetuses 1

Additional Recommended Screenings

• Maternal Serum Screening: For neural tube defects and fetal aneuploidy, with options for first trimester screening if presenting before 14 weeks gestation 1
• Nasal Bone Assessment: Optional component of first trimester screening, limited to clinicians with specific training and ongoing quality assurance 1
• Maternal Fetal Medicine Consultation: For high-risk pregnancies or abnormal findings on initial screening 1

Timing Considerations

• Early Initiation: First ANC visit should ideally occur before 16 weeks gestation, with evidence showing only 37.15% of women in Africa achieve this target 3
• Frequency Planning: Schedule for minimum of four ANC visits throughout pregnancy, with evidence showing improved outcomes with adequate ANC attendance 4, 5
• Follow-up Planning: Women should be advised to attend more frequently if they develop warning symptoms or signs of preeclampsia 1

Special Considerations for Resource-Limited Settings

• Prioritization of Tests: In settings with limited resources, focus on hemoglobin, platelet count, serum creatinine, urinalysis, and protein quantification 1
• Community-Based Care: Implement community-based BP measurement and protein dipstick testing at first point of care for women living far from facilities 1
• Task-Shifting: Consider policies allowing lower-level providers to manage asymptomatic women with chronic hypertension on an outpatient basis 1

Impact of Adequate ANC

• Reduced Adverse Outcomes: Women receiving adequate antenatal care (≥4 visits) are 79% less likely to experience adverse perinatal outcomes 4
• Improved Quality of Care: Group ANC models have shown improved quality of care and higher frequency of ANC attendance compared to individual ANC 5
• Higher Facility-Based Delivery Rates: Adequate ANC is associated with higher rates of facility-based deliveries, particularly in settings where those rates are typically low 5

Common Pitfalls to Avoid

• Late Booking: Delaying first ANC visit beyond 16 weeks limits opportunities for early intervention and screening 3, 6
• Inadequate Content: Focus should be not only on frequency of visits but also on ensuring all core components of ANC are provided at each visit 6
• Missing Psychosocial Factors: Employment status, pregnancy intention (wanted vs. unwanted), and partner involvement significantly impact ANC utilization 7