## Routine Antenatal Care Investigations — First Visit **Key Point:** Routine fetal echocardiography is NOT part of the standard antenatal care package. It is a specialized investigation reserved for specific indications (maternal diabetes, family history of congenital heart disease, abnormal obstetric ultrasound findings). ### Standard First ANC Visit Investigations (NHM/NRHM) | Investigation | Purpose | Timing | | --- | --- | --- | | Blood group and Rh typing | Identify Rh-negative women; transfusion preparedness | First visit | | Hemoglobin estimation | Screen for anemia; baseline assessment | First visit | | Syphilis serology (RPR/VDRL) | Screen for maternal syphilis; prevent congenital syphilis | First visit | | Blood glucose (fasting/random) | Screen for gestational diabetes | First visit | | Urine routine | Detect proteinuria, glycosuria, infection | First visit | | HIV testing | Identify HIV-positive women; PMTCT | First visit | | Hepatitis B and C serology | Screen for hepatitis; prevent vertical transmission | First visit | ### Fetal Echocardiography — When Indicated **High-Yield:** Fetal echocardiography is a specialized investigation performed only when: - Maternal diabetes (pre-gestational or gestational) - Family history of congenital heart disease - Abnormal findings on obstetric ultrasound (cardiac axis deviation, cardiomegaly) - Maternal exposure to teratogenic drugs - Fetal arrhythmias detected on routine scan **Clinical Pearl:** Routine fetal echocardiography is NOT cost-effective for universal screening in normal pregnancies and is not recommended by NHM guidelines. **Mnemonic:** RUSH-HBV for first ANC visit investigations: - **R**PR/VDRL (syphilis) - **U**rine routine - **S**ugar (blood glucose) - **H**emoglobin - **H**IV - **B**lood group - **V**accination status (tetanus) [cite:Park 26e Ch 10, NRHM Guidelines]
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