## Routine Antenatal Care Investigations at First Visit **Key Point:** Amniocentesis is NOT a routine screening investigation for all pregnant women; it is an invasive diagnostic test reserved for high-risk pregnancies with specific indications. ### Routine Investigations at First ANC Visit (Indian Guidelines) | Investigation | Purpose | Timing | |---|---|---| | Blood group & Rh typing | Identify Rh-negative mothers for anti-D prophylaxis | First visit | | Haemoglobin/Haematocrit | Screen for anaemia | First visit | | Blood pressure | Baseline; screen for hypertension | First visit | | Urine routine & microscopy | Detect proteinuria, glycosuria, UTI | First visit | | Fasting blood glucose / OGTT | Screen for gestational diabetes | 24–28 weeks (OGTT) | | Infectious disease serology | HIV, Syphilis, Hepatitis B & C | First visit | | Pap smear / cervical screening | Cervical cancer screening | As indicated | **High-Yield:** Amniocentesis is an **invasive diagnostic procedure** (not screening) indicated only for: - Maternal age ≥35 years with abnormal first-trimester screening - Abnormal ultrasound findings - Previous child with chromosomal abnormality - Positive non-invasive prenatal testing (NIPT) **Warning:** Amniocentesis carries a small risk of miscarriage (~0.1–0.3%) and is NOT offered routinely to all pregnant women. ### Non-Invasive Screening Alternatives - **First trimester:** Nuchal translucency (NT) + maternal serum markers (PAPP-A, β-hCG) - **Second trimester:** Quadruple marker test (AFP, hCG, uE3, inhibin A) - **Cell-free fetal DNA (NIPT):** Non-invasive, high sensitivity; increasingly used in India **Clinical Pearl:** Modern practice favours non-invasive screening (ultrasound + serum markers or NIPT) before considering invasive testing like amniocentesis.
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