Regarding routine antenatal investigations in a low-risk singleton pregnancy, all of the following are recommended at the first antenatal visit EXCEPT:

Question

Accepted Answer

D. Fasting blood glucose and 2-hour post-load glucose tolerance test. ## Routine First Antenatal Visit Investigations

### Standard Investigations at Booking Visit

**Key Point:** The first antenatal visit (booking visit, typically before 12 weeks) includes baseline investigations to establish maternal health status and screen for infections and anemia.

### Correct Investigations at First Visit

| Investigation | Purpose | Timing |
| --- | --- | --- |
| Blood group & antibody screen | Identify blood type, detect alloimmunization | First visit |
| Serological tests (syphilis, HIV, HBsAg) | Screen for transmissible infections | First visit |
| Full blood count | Assess hemoglobin, detect anemia | First visit |
| Urine microscopy & culture | Screen for asymptomatic bacteriuria | First visit |
| Blood pressure & weight | Baseline measurements | First visit |

### Glucose Tolerance Testing — Timing

**High-Yield:** Glucose tolerance testing (GTT) or fasting blood glucose is performed at **24–28 weeks gestation**, not at the first antenatal visit. This is the standard window for screening gestational diabetes mellitus (GDM) in most guidelines, including ICMR and WHO recommendations.

**Clinical Pearl:** A fasting blood glucose at the first visit may be done to rule out pre-existing diabetes, but the formal 2-hour post-load GTT for GDM screening is deferred to the second trimester.

**Warning:** Confusing the timing of GDM screening is a common trap. First visit = baseline investigations; 24–28 weeks = GDM screening.

### Summary

Options 0, 1, and 3 (blood group/antibody, serology, FBC) are all performed at the first visit. Option 2 (formal GTT with 2-hour post-load) is NOT a first-visit investigation in routine low-risk pregnancies — it belongs at 24–28 weeks.

[cite:Williams Obstetrics 26e Ch 8; ICMR Guidelines on Antenatal Care]

Answer

A. Blood group and antibody screening

Answer

B. Serological testing for syphilis, HIV, and hepatitis B

Answer

C. Full blood count to assess hemoglobin and hematocrit

Regarding routine antenatal investigations in a low-risk singleton pregnancy, all of the following are recommended at the first antenatal visit EXCEPT:

Explanation

Routine First Antenatal Visit Investigations

Standard Investigations at Booking Visit

Correct Investigations at First Visit

Glucose Tolerance Testing — Timing

Summary

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Investigation	Purpose	Timing
Blood group & antibody screen	Identify blood type, detect alloimmunization	First visit
Serological tests (syphilis, HIV, HBsAg)	Screen for transmissible infections	First visit
Full blood count	Assess hemoglobin, detect anemia	First visit
Urine microscopy & culture	Screen for asymptomatic bacteriuria	First visit
Blood pressure & weight	Baseline measurements	First visit