A 28-year-old primigravida at 20 weeks of gestation attends her second ANC visit. Regarding the components of focused antenatal care (FANC) as per WHO and Indian guidelines, all of the following should be offered at this visit EXCEPT:

Explanation

## Focused Antenatal Care (FANC) at Second Trimester **Key Point:** The 75-gram OGTT for GDM screening is performed at 24–28 weeks, NOT at the 20-week visit. At 20 weeks, the focus is on detailed anatomical assessment and fetal viability. ### Components of FANC at 20 Weeks (Second Trimester Visit) **High-Yield:** FANC emphasizes quality over quantity—four focused visits with specific objectives at each stage. #### Clinical Assessment at 20 Weeks 1. **Fetal Viability & Well-being** - Auscultation of fetal heart rate (Doppler or fetoscope) - Assessment of fetal movements (quickening) - Palpation of abdomen for presentation and lie 2. **Maternal Health Monitoring** - Blood pressure (detect hypertension) - Weight gain assessment - Urine dipstick (proteinuria, glycosuria) - Symphysis-fundal height (SFH) measurement 3. **Counseling & Education** - Danger signs: vaginal bleeding, severe headache, epigastric pain, reduced fetal movements, leakage of amniotic fluid - When to seek emergency care - Nutrition, rest, hygiene - Birth preparedness and complication readiness 4. **Investigations** - Detailed anatomy ultrasound scan (18–22 weeks) - Repeat serology if indicated (high-risk cases) ### OGTT Timing and Rationale **Clinical Pearl:** OGTT (75 g, 2-hour) is universally recommended at 24–28 weeks because: - Insulin resistance peaks in the second and third trimester - Earlier screening (at 20 weeks) has lower sensitivity - Allows time for dietary intervention and repeat testing if abnormal ### FANC Visit Schedule | Visit | Gestation | Key Focus | Investigations | | --- | --- | --- | --- | | 1st | < 12 weeks | Confirm pregnancy, baseline assessment | Blood group, CBC, VDRL, HIV, HBsAg, Ultrasound | | 2nd | 20 weeks | Fetal anatomy, viability, maternal health | Detailed anatomy scan, BP, SFH | | 3rd | 24–28 weeks | GDM screening, anemia, Rh antibodies | OGTT, repeat CBC, NST | | 4th | 36+ weeks | Fetal presentation, pelvic assessment | NST, CTG if indicated | **Mnemonic:** FANC at 20 weeks = **FETAL + MATERNAL + COUNSELING** (not GDM screening yet) [cite:Park 26e Ch 6]