Antenatal Care: What Each Visit, Scan and Test Is Actually For
Antenatal care looks like a long list of appointments and tests with little explanation attached. Each one exists to catch something specific, and knowing what makes the schedule far easier to keep.
Why early booking matters
The first visit should ideally be before 12 weeks. Early booking establishes dating accurately, identifies risks that can be acted on, and allows folic acid and anaemia to be addressed while it still makes a difference.
Dating is more accurate by an early scan than by last menstrual period, and accurate dating affects every later decision about growth and delivery.
The visit schedule
A commonly used pattern for an uncomplicated pregnancy:
- First visit before 12 weeks
- Then roughly every 4 weeks until 28 weeks
- Every 2 weeks from 28 to 36 weeks
- Weekly from 36 weeks until delivery
More visits are needed with high blood pressure, diabetes, twins, previous complications or any problem found along the way.
At every visit, expect weight, blood pressure, urine testing for protein and sugar, abdominal examination for growth and position, and from around 24 weeks, fetal heart sounds.
Blood tests at booking
- Haemoglobin and complete blood count, repeated later. Anaemia is very common in Indian pregnancies and strongly affects outcomes
- Blood group and Rh typing. If you are Rh negative and the father is Rh positive, anti-D injection at around 28 weeks and after delivery prevents problems in later pregnancies. This single injection prevents serious disease in future babies
- Blood sugar, with an oral glucose tolerance test around 24 to 28 weeks for gestational diabetes, earlier if risk factors are present
- Thyroid function, since untreated hypothyroidism affects fetal brain development
- HIV, hepatitis B, syphilis, all of which have effective interventions to prevent transmission to the baby
- Urine culture, because symptomless urinary infection in pregnancy causes kidney infection and preterm birth and is treated even without symptoms
- Haemoglobin electrophoresis where thalassaemia or sickle cell trait is possible, which matters a great deal in several Indian states
The scans
Dating scan, 6 to 12 weeks. Confirms pregnancy location, viability, number of babies and dates.
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NT scan, 11 to 14 weeks. Measures nuchal translucency, combined with blood markers to estimate the chance of chromosomal conditions. It is a screening test giving a probability, not a diagnosis.
Anomaly scan, 18 to 22 weeks. A detailed structural survey of the baby’s brain, spine, heart, abdomen, limbs and face, plus placental position and amniotic fluid. This is the single most important scan.
Growth scans, from around 28 to 32 weeks onwards. Assess growth, fluid and blood flow, used selectively or routinely depending on risk.
Sex determination is illegal in India under the PCPNDT Act, and clinics are required to display this. It exists to prevent sex-selective abortion.
Supplements
- Folic acid, ideally started one to three months before conception and continued through the first trimester, which prevents neural tube defects. Higher doses are used with previous affected pregnancy, diabetes or certain medications
- Iron and folic acid from the second trimester, or earlier if anaemic
- Calcium, which reduces the risk of pre-eclampsia in populations with low intake
- Vitamin D where deficient
- Iodised salt
- Low-dose aspirin from around 12 weeks for women at raised risk of pre-eclampsia, which is a genuinely effective preventive measure that is still under-used
Vaccination
Tetanus-containing vaccine protects against neonatal tetanus. Influenza vaccination is recommended in pregnancy, and Tdap is offered in some programmes to protect the newborn from whooping cough. Live vaccines are avoided.
Danger signs needing immediate care
Go to hospital straight away for:
- Vaginal bleeding
- Leaking fluid
- Severe or persistent headache
- Blurred vision, flashing lights or spots
- Swelling of the face and hands, especially sudden
- Upper abdominal pain, particularly under the right ribs
- Persistent vomiting
- Fever
- Painful urination with back pain
- Reduced fetal movements, which should never be waited out overnight
- Regular painful contractions before 37 weeks
- Severe breathlessness, chest pain or fainting
- Convulsions, which is an emergency
Headache with visual changes and swelling together suggests pre-eclampsia, which can progress quickly and is a leading cause of maternal death.
Counting movements
From around 28 weeks, get to know your baby’s pattern. A commonly used guide is 10 movements within 2 hours while lying on your side after a meal. Reduced or changed movement is a reason to be seen the same day. The old advice to drink something cold and wait is not adequate.
Things worth planning in advance
Where you will deliver and how you will get there at night, who will accompany you, blood availability and your blood group, a birth plan discussed with your doctor, and arrangements for the first weeks after delivery. Keep all reports together in one file and bring them to every visit.
This is general information. Your schedule of visits and tests should follow the plan set by your own obstetrician, which accounts for your specific risks.