The slide's routine investigation list includes Hb, HBsAg, rubella status, Rh blood group, VDRL/syphilis testing, HIV testing and ultrasound ^[1]. Add a full blood count/MCV, antibody screen, urine assessment and any locally indicated tests. Exact booking panels differ by service.

At each visit, reassess rather than merely repeat a checklist:

• maternal symptoms and wellbeing;
• blood pressure and pre-eclampsia symptoms;
• urine testing according to protocol;
• uterine/fetal growth and fetal movement at the appropriate gestation;
• adherence, medicines, safeguarding and psychosocial needs.

The deck checks Hb at booking and again at 26 weeks ^[1]. The repeat looks for anaemia emerging as iron requirement and plasma volume rise later in pregnancy.

Do not assume microcytosis is iron deficiency and prescribe indefinitely without checking ferritin and carrier status.

The deck lists routine HBsAg, syphilis, HIV and GBS screening, plus targeted STI/urine/vaginal testing when indicated ^[1]. Read it as a timing map:

Do not equate protein on a contaminated urine dipstick with renal proteinuria; assess sample quality and send a midstream urine specimen when UTI is possible.

The deck combines risk-factor assessment with a universal 75 g oral glucose tolerance test (OGTT) pathway ^[1]:

• Early OGTT between booking and 16 weeks if risk factors are present: obesity, age ≥35, PCOS, family history of diabetes, previous infant > 4 kg, unexplained stillbirth, previous unexplained abnormal baby or multiple pregnancy.
• Routine OGTT at 26–32 weeks if no listed risk factor.

This is the local lecture algorithm. Many international protocols use 24–28 weeks for routine diagnosis, with earlier testing aimed at detecting overt pre-existing diabetes or early dysglycaemia ^[17]. Follow the local laboratory thresholds and maternity protocol.

Why it matters: hyperglycaemia increases risks of fetal overgrowth, shoulder dystocia, neonatal hypoglycaemia, pre-eclampsia and later type 2 diabetes in the mother.

The slide defines gestational hypertension as BP ≥140 systolic or ≥90 diastolic on two readings more than four hours apart after 20 weeks in a previously normotensive woman ^[1]. Severe hypertension may need confirmation and treatment sooner rather than waiting four hours.

1. LMP assumes a known date and ovulation about 14 days later; it becomes unreliable with uncertain dates, irregular/long cycles or recent hormonal contraception.
2. Clinical uterine size offers a reasonableness check but is altered by fetal number, liquor volume, fibroids, abdominal wall thickness, lie and engagement.
3. Early ultrasound is the best dating method when dates are uncertain. Accuracy progressively decreases with gestation because biological size variation and pathological growth become larger.

The slide's dating accuracy table ^[1]:

Once a reliable early due date has been assigned, later biometry is primarily interpreted as growth, not an invitation to keep redating the pregnancy.

The figure is a schematic for a singleton pregnancy ^[1]:

• 12 weeks: fundus just above the symphysis pubis.
• 20 weeks: fundus at the umbilicus.
• 36 weeks: fundus approaches the xiphisternum.
• Below the umbilicus, the drawing shows growth of roughly two finger-breadths every two weeks.
• Above the umbilicus, it shows roughly one finger-breadth every two weeks.

For serial screening later in pregnancy, measure symphysis–fundal height from the upper border of the symphysis to the uterine fundus. The deck's rule is SFH in cm ≈ gestational weeks ±2; the trajectory is more informative than one isolated value.

Clues include ovulation induction/assisted reproduction, maternal family history of dizygotic twinning, exaggerated pregnancy symptoms, a uterus large for dates, multiple fetal poles or separate heart rates. Ultrasound is the earliest reliable confirmation ^[1]. Determine chorionicity and amnionicity early, because surveillance and complication risk depend on placental sharing.

The deck states that an 18–20-week scan detects about 70% of major anomalies, with lower performance when BMI is high or fetal position is unfavourable ^[1]. Detection varies by anomaly, gestation, equipment and operator; the following are deck figures, not universal counselling guarantees:

The cardiac row groups TGA, AVSD, tetralogy of Fallot and hypoplastic left heart syndrome. A four-chamber view alone can miss outflow-tract abnormalities, so a systematic cardiac survey includes outflow and other standard views.

Serial SFH is a screen, not a diagnosis. A static/falling trajectory or discrepancy from dates prompts ultrasound biometry, liquor assessment and—when indicated—Doppler surveillance. The deck notes that routine ultrasound in an otherwise low-risk pregnancy had not shown clear effectiveness for detecting all growth problems ^[1]; high-risk pregnancies follow condition-specific scan schedules.

The two picture slides answer different questions ^[1]:

• Lie: relation of the fetal long axis to the uterine long axis—longitudinal, transverse or oblique.
• Presentation: fetal part at the pelvic inlet—cephalic, breech or shoulder. A transverse lie generally presents a shoulder.

Before 32–34 weeks, a non-cephalic lie in a patient not in labour often has little significance because there is room to turn. Most fetuses become longitudinal/cephalic by 35–36 weeks. For persistent breech after 36 weeks, assess suitability for ECV.

The ECV image shows a forward-roll sequence: the clinician elevates the breech out of the pelvis, guides the fetal poles through a forward or backward roll, and finishes with the vertex over the pelvis. It is an ultrasound/monitoring-supported hospital procedure performed by trained clinicians where urgent delivery is available—not a bedside manoeuvre to attempt casually.

• Exclusive specialist hospital care, public or private.
• Primary-care or midwife-led care with referral when indicated.
• Shared care between hospital and primary care/Maternal and Child Health Centre ^[1].

Risk is dynamic. A patient may begin in a low-risk pathway and need escalation when hypertension, abnormal growth, multiple pregnancy or another complication appears.

The deck reviews the plan at about 36 weeks in an uncomplicated pregnancy ^[1]:

• allow spontaneous labour at term when mother and fetus remain well;
• consider earlier delivery when maternal or fetal compromise changes the balance;
• discuss induction around 41 weeks if pregnancy otherwise continues;
• aim for vaginal birth unless an obstetric or maternal indication favours caesarean delivery.

The slide includes antenatal classes/exercise, contraception, family involvement, social support, special needs and patient groups ^[1]. Practical counselling should also cover warning symptoms, fetal movements, medicines/substances, nutrition, folic acid before conception/early pregnancy, vaccination, feeding intentions, birth planning and postpartum contraception. Tailor advice rather than handing over an undifferentiated list.

If cervical screening is up to date, the lecture does not add a routine test solely because of pregnancy. If overdue, assess whether screening during pregnancy or planned postpartum screening is most appropriate under the local programme ^[1].

The lecture lists higher risks of miscarriage, FGR, preterm birth, pre-eclampsia, neonatal lupus and variable maternal flares ^[1]. Anti-Ro/SSA and anti-La/SSB antibodies are relevant to neonatal lupus and congenital heart block. Conception is safest when disease is quiescent and medications/renal status have been reviewed by rheumatology and maternal medicine.

The durable principle is do not stop an essential medicine abruptly and do not conceive until the disease and medicine plan are ready.

Late in pregnancy, the gravid uterus can compress the inferior vena cava when supine, reducing venous return and cardiac output. Dizziness that improves in the left lateral position supports the diagnosis; reposition and assess for other causes if symptoms persist or red flags are present ^[8][11].