According to Indian RMNCH+A guidelines, which of the following investigations is NOT part of the routine antenatal care screening package at the first ANC visit?

Explanation

## Routine ANC Investigations at First Visit **Key Point:** The first ANC visit (booking visit) includes a standardized set of investigations to identify maternal risk factors and infections. **Fetal echocardiography is NOT part of routine ANC screening** — it is indicated only when there is a specific risk factor (maternal diabetes, family history of CHD, or abnormal anatomy scan findings). ### Investigations at First ANC Visit (Routine Package) | Investigation | Purpose | Timing | |---|---|---| | Blood group & Rh typing | Identify Rh-negative women for anti-D prophylaxis | First visit | | Hemoglobin & CBC | Screen for anemia, baseline hematocrit | First visit | | VDRL/RPR | Screen for syphilis (vertical transmission risk) | First visit | | HIV test | Screen for HIV (PMTCT programme) | First visit | | Urine routine & microscopy | Screen for UTI, proteinuria, glycosuria | First visit | | Blood glucose (fasting/random) | Screen for gestational diabetes | First visit | | Thyroid function (TSH) | Screen for hypothyroidism | First visit (select settings) | **High-Yield:** **Fetal echocardiography** is a **targeted investigation**, not routine. It is indicated only when: - Maternal diabetes (pre-gestational or GDM) - Maternal congenital heart disease - Family history of CHD in first-degree relative - Abnormal anatomy scan findings (cardiac axis deviation, septal defect) - Maternal infections (rubella, CMV) **Clinical Pearl:** The **routine ANC package aims to be cost-effective and feasible in primary health centers**. Fetal echocardiography requires specialized training and equipment, making it unsuitable for universal screening; it is reserved for high-risk pregnancies. **Mnemonic:** **BHVUT** for first-visit investigations — **B**lood group, **H**emoglobin, **V**enereal disease (VDRL), **U**rine, **T**hyroid (in select settings).