Regarding the components of the antenatal care (ANC) package as per Indian guidelines, all of the following are recommended at the first ANC visit EXCEPT:

Explanation

## Timing of OGTT in Antenatal Care **Key Point:** The oral glucose tolerance test (OGTT) is NOT performed at the first ANC visit; it is a second or third trimester investigation. ### First ANC Visit Components The first ANC visit (ideally before 12 weeks) focuses on: 1. **Clinical Assessment** - Blood pressure measurement (baseline) - Weight and height recording (BMI calculation) - General physical examination - Abdominal examination (uterine size, tenderness) 2. **Obstetric History** - Menstrual history and expected date of delivery - Parity and obstetric complications - Medical and surgical history 3. **Investigations at First Visit** - Blood group and Rh typing - Complete blood count (anemia screening) - Blood glucose (fasting or random) - Urine routine and culture - VDRL/RPR (syphilis screening) - HIV testing (with counseling) - Hepatitis B and C serology - Obstetric ultrasound (dating scan, anomaly screening) ### OGTT Timing **High-Yield:** OGTT is performed at **24–28 weeks of gestation** for universal screening of gestational diabetes mellitus (GDM), as per ICMR and WHO guidelines. This is NOT a first-trimester investigation. **Clinical Pearl:** Random blood glucose or fasting glucose at the first visit may identify overt diabetes, but formal OGTT is deferred to the second trimester. ### Summary Table: ANC Visit Schedule | Visit Timing | Key Investigations | Key Clinical Tasks | | --- | --- | --- | | First (< 12 weeks) | Blood group, CBC, VDRL, HIV, HBsAg, Urine, Ultrasound | BP, weight, obstetric history, general exam | | Second (16–20 weeks) | Detailed anatomy scan, AFP/quad screen if indicated | Fetal movement counseling | | Third (24–28 weeks) | OGTT, repeat CBC, Rh antibody screen (if Rh−) | Anemia management, GDM counseling | | Fourth (28–36 weeks) | NST, repeat VDRL (if high risk) | Pelvic examination, fetal presentation | | Fifth (36+ weeks) | NST, CTG if indicated | Pelvic assessment, engagement | [cite:Park 26e Ch 6]