Antenatal Care (ANC)
Antenatal care refers to the systematic and periodic supervision of a pregnant woman throughout pregnancy to ensure the optimal health and well-being of both the mother and the developing fetus.
• It involves
o Clinical evaluation,
o Preventive care and
o Counseling, and health education
Objective of ANC and Booking the Case
The primary objective of antenatal care is to ensure that every pregnancy results in a healthy mother and a healthy newborn.
Why Antenatal Care and Case Booking Are Essential?
The aims of ANC are to:
• Identify high-risk pregnancies through regular screening and risk assessment.
• Earliest possible; detect and manage complications of pregnancy
• Prevent complications of pregnancy
• Educate the mother about pregnancy and labor and allay anxiety
• Promote exclusive breastfeeding (EBF) and Newborn care
• Counsel on:
1. Nutrition,
2. Rest,
3. Hygiene, and
4. Birth preparedness.
• Offer family planning counseling and discuss suitable postpartum contraceptive options.
• Provide appropriate guidance to couples seeking medical termination of pregnancy (MTP) in accordance with the Medical Termination of Pregnancy Act, 2021 (India).
Case Booking
Booking refers to:
• Registration of a pregnant woman for antenatal care
• Scheduling the follow-up visits throughout pregnancy.
• Preparing the mother and family for childbirth and possible complications
• It ensures systematic documentation and continuity of care.
Recommended Number of Visits:
The ideal schedule includes 13 visits distributed across trimesters as follows:
• First trimester: One visit (preferably before 12 weeks of gestation).
• Second trimester: Every 4 weeks (making a total of 3 visits)
• Third trimester:
o From 28 to 36 weeks – every 2 weeks (total, 4 visits);
o From 36 weeks till term – every week (approximately 4-5 visits)
Minimum Four-Visit Schedule (as per MoHFW and WHO recommendations)
When frequent visits are not feasible—especially for women from lower socioeconomic backgrounds or those residing in remote areas:
• A minimum of four antenatal visits is recommended (As per the Government of India (GoI) guidelines under the Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCH+A) strategy):
1. First Visit (Registration Visit): As soon as pregnancy is suspected, ideally within 12 weeks of gestation. Registration of pregnancy and comprehensive baseline evaluation are done.
2. Second Visit: During the second trimester (between 14–26 weeks).
3. Third Visit: Between 28 and 34 weeks of gestation.
4. Fourth Visit: Between 36 weeks and term.
Definition of a Booked Pregnancy
A woman is considered to have a booked pregnancy if she meets the following criteria:
• She has had a minimum of three antenatal visits after registration, with at least two visits in the third trimester.
• She has received iron and folic acid (IFA) and calcium supplementation as per national guidelines.
• She has been immunized with two doses of tetanus-toxoid as Td vaccine.
Note: These three visits represent the minimum standard of care; additional visits may be scheduled based on individual risk factors or complications.
References
1. Dutta DC. Textbook of Obstetrics. 9th ed. New Delhi: Jaypee Brothers Medical Publishers; 2023.
2. Padubidri VG, Daftary SN. Shaw’s Textbook of Gynaecology. 18th ed. New Delhi: Elsevier; 2022.
3. Park K. Park’s Textbook of Preventive and Social Medicine. 28th ed. Jabalpur: Bhanot Publishers; 2025.
4. Babu SA. Clinical Obstetrics and Gynecology. 2nd ed. New Delhi: Wolters Kluwer India Pvt Ltd; 2025.