A 24-year-old primigravida from rural Maharashtra presents to the primary health centre at 12 weeks of gestation for her first antenatal check-up. She has no complaints and denies any vaginal bleeding or discharge. On examination, her blood pressure is 110/70 mmHg, weight 58 kg, and height 155 cm. Urine dipstick is normal. The health worker counsels her on the components of the antenatal care package as per NRHM guidelines. Which of the following is NOT a component of the basic antenatal care package that should be provided at the primary health centre level during the first trimester?

Explanation

## Antenatal Care Package — First Trimester Components **Key Point:** The basic antenatal care (ANC) package at the primary health centre (PHC) level during the first trimester focuses on screening, counselling, and preventive interventions—not advanced imaging. ### Components of Basic ANC Package (First Trimester) | Component | Timing | Purpose | | --- | --- | --- | | Blood pressure monitoring | Every visit | Detect hypertension | | Weight & height measurement | Baseline + each visit | Assess nutritional status & BMI | | Urine examination | Each visit | Screen for proteinuria, glycosuria | | Blood tests (Hb, ABO/Rh, VDRL, HIV) | First trimester | Identify anaemia, blood group, infections | | Tetanus toxoid (TT) | 1st dose at first visit, 2nd at 4 weeks | Prevent neonatal tetanus | | Nutritional counselling | First visit onwards | Iron, folic acid, calcium supplementation | | Counselling on danger signs | First visit | Recognition of complications | | Birth preparedness planning | Second/third trimester | Facility delivery, transport, savings | **High-Yield:** Detailed fetal anatomical survey (anomaly scan) is a **second-trimester ultrasound** (18–20 weeks) performed at secondary/tertiary centres, NOT a basic PHC-level first-trimester intervention. ### Why Detailed Ultrasound is Not Basic ANC 1. Requires trained sonographer and equipment (not always available at PHC) 2. Timing is 18–20 weeks (second trimester), not first trimester 3. Classified as a **secondary-level intervention** under NRHM 4. First-trimester ultrasound (if done) is for dating and viability, not detailed anatomy **Clinical Pearl:** A PHC can offer a basic dating scan at 8–12 weeks to confirm dates and rule out multiple pregnancy, but detailed anatomical survey is a **secondary/tertiary care responsibility**. **Warning:** Do not confuse "basic ANC package" with "comprehensive ANC." Comprehensive ANC includes advanced imaging, specialist referral, and interventions—basic ANC is what every PHC must deliver.