Antenatal Checklist
NAGERCOIL
OB-SOCIETY
Antenatal Care
Preventive medicine in pregnancy
Antenatal Care
 Clinical examination
 Investigations
 Counselling
Investigations in Pregnancy
Rifle vs Shotgun approach
Rifle – hit bull’s eye
 Specific test based on
 Clinical judgment
 Diagnostic accuracy
 Predictive value
Shotgun – spray shots
 Many tests
 Diagnostic accuracy + / Predictive value + / May not hit the bull’s
eye!!
What is a ‘necessary’ test?
A test should be done only if the
result is likely to make a difference to
the management
What is an ‘unnecessary’ test?
Any test the results of which
are not likely to be make a difference
in the appropriate management of the
patient
Questions to ask before ordering a
test
 Why is the test being ordered?
 What are the consequences of not ordering the
test?
 How good is the test?
 How are the test results interpreted?
 How will the test results influence patient
management and outcome?
Reasons for ordering a test
Diagnosis (eg, Pregnancy / no pregnancy)
Screening (eg, for Down’s syndrome)
Monitoring (eg, serial ultrasound scan)
Research (to understand the pathophysiology of a
particular disease process)
Reasons for unnecessarily ordering
a test
Financial gains
Defensive medicine
Institutional pressures
Patient demands
The flip side….

Generates anxiety

Involves time, cost

Risks & complications exist

Results may be shocking!

Leads to unnecessary/inappropriate
interventions
Pre test Counseling
What test?
Why is it done?
How is it done?
What is the likely expense?
What are the risks & likely outcomes?
What is the plan of management?
What are the fall outs if it is not done?
Investigations in Pregnancy
Which and when???
Developed by
Abbott National Advisory Board
for Duphaston
Members of the Advisory Board
 Dr Ameet Patki, Chairman, Mumbai
 Dr Mala Arora, Delhi
 Dr Ritu Joshi, Jaipur
 Dr Bhasker Pal, Kolkata
 Dr Parul Kotdawala, Ahmedabad
 Dr Susheela Rani, Bangalore
 Dr Suchitra Pandit, Mumbai
 Dr Anita Singh, Patna
Investigations in Antenatal Care
 Mandatory
 Preferable
Mandatory
These tests are mandatory in the provision of
standard antenatal care
Preferable
These tests have been shown to be of clinical
value, but are not into evidence based
recommendations as of now
ANC was released in FOGSI Varanasi, Jan 27th 2012
Acknowledgements
A special thanks to –
Dr Susheela Rani, Bangalore and
Dr Bhasker Pal, Kolkata
for providing material for this presentation.