Antenatal Checkup (ANC) - Early Pregnancy Checkup

The antenatal check-up (ANC) or pregnancy check-up is a set of pregnancy tests that includes checking for random blood sugar, HIV-I and HIV-II, hepatitis B surface antigen, syphilis screening (VDRL), iron, thyroid-stimulating hormone (TSH), complete urine analysis, haemoglobin A (HbA) profile, haemogram (blood count), blood group and Rh typing, and hepatitis C antibodies.

Infections like HIV and syphilis can be passed from a pregnant woman to her baby and may cause serious health problems. Hepatitis occurs when the liver becomes inflamed, which can lead to problems such as cirrhosis. A urine test is important for detecting urinary tract infections, and kidney disease. Blood grouping is important for preventing anaemia and jaundice in newborn babies. Finally, thyroid tests are important for diagnosing and monitoring thyroid problems, such as hyperthyroidism (an overactive thyroid gland) and hypothyroidism (an underactive thyroid gland).

Therefore, this test is important for assessing the mother’s and baby’s health and ensuring a healthy pregnancy.

A pregnant woman may be advised to get the ANC check-up if:

• She has high glucose levels during regular pregnancy check-ups.
• She has a family history of diabetes.
• She has a history of pregnancy-related complications or high-risk pregnancy.
• She or her partner has been diagnosed with a sexually transmitted infection.
• She or her partner has been diagnosed with hepatitis B or C.
• She has a thyroid disorder, such as hyperthyroidism or hypothyroidism.

The antenatal profile test can be used with other tests to screen for and help detect certain conditions such as:

• Gestational diabetes – High blood sugar that develops during pregnancy.
• Human immunodeficiency virus (HIV) infection – This viral infection weakens your immune system.
• Hepatitis B – A viral infection that affects the liver.
• Syphilis – A sexually transmitted disease that can be passed from mother to baby during pregnancy.
• Hyperthyroidism – This is a condition characterised by an overactive thyroid gland.
• Hypothyroidism – This is a condition characterised by an underactive thyroid gland.
• Hepatitis C – A viral infection that affects the liver.
• Nutritional deficiencies – This refers to the deficiency of nutrients such as iron, folate, or vitamin B12.
• Anaemia – A condition where the body has fewer healthy red blood cells or less haemoglobin than normal.

What to Expect Before the Test

• You need to fast overnight for at least 8 - 10 hours before the test. Do not eat or drink anything except water during the fasting period.
• Provide information about your medical history, pregnancy details, and a list of current medications and supplements.
• Drink a glass of water before sample collection if you are required to provide a urine sample.
• Always consult your healthcare provider for any special instructions beforehand.

What to Expect During the Sample Collection

Two types of samples- blood and urine are required for this test, and the steps for the collection of both samples are explained below:

For the Blood Sample

A blood sample is collected by a trained professional from the vein in inner side of your elbow, following the routine procedure explained below:

• An elastic band is tied around your upper arm for better blood flow to veins.
• The skin is cleaned with an antiseptic, and a small needle is inserted into the vein.
• After the sample is collected, the needle is withdrawn, and a bandage is applied to the site to stop any minor bleeding.

For the Urine Sample

• Open the lid of the sterile container.
• Clean the genital area with gauze pads and wash your hands thoroughly.
• Urinate the first few drops into the toilet, then collect midstream urine directly into the container.
• Close the lid and hand the container to the lab technician.

What to Expect After the Test

• Both test procedures are generally safe, with minimal to no risk.
• Feeling dizzy for a few seconds after giving a blood sample is normal and resolves with a little rest.

Note: If you notice persistent bruising, pain, swelling, redness, or a rash at the puncture site after the test, consult your healthcare provider.

In the ANC test, the parameters included are:

• Iron
• TSH-ultrasensitive
• Complete blood count (CBC)
• Haemoglobin
• Haematocrit
• Total RBC
• Mean corpuscular volume (MCV)
• Mean corpuscular haemoglobin (MCH)
• Mean corpuscular haemoglobin concentration (MCHC)
• Red cell distribution width – SD (RDW -SD)
• Red cell distribution width (RDW - CV)
• Red cell distribution width index (RDWI)
• Mentzer index
• Total leucocyte count (WBC)
• Differential leukocyte count
• Neutrophils percentage
• Lymphocytes percentage
• Monocytes percentage
• Eosinophils percentage
• Basophils percentage
• Immature granulocyte percentage (IG%)
• Nucleated red blood cells %
• Absolute leucocyte count
• Neutrophils - Absolute count
• Lymphocytes - Absolute count
• Monocytes - Absolute count
• Basophils - Absolute count
• Eosinophils - Absolute count
• Immature granulocytes (IG)
• Nucleated red blood cells
• Platelet count
• Mean platelet volume (MPV)
• Platelet distribution width (PDW)
• Platelet to large cell ratio (PLCR)
• Plateletcrit (PCT)
• Glycated haemoglobin (HbA1c)
• Average blood glucose (ABG)
• VDRL (RPR) for syphilis
• Hepatitis B surface antigen (HBSAG)
• HIV I and II
• Anti hepatitis C virus (ANTI HCV) – total
• Complete urinogram (from a urine sample)
• Random blood sugar (glucose)

The ANC count normal range is given in the table below.

The ANC count interpretation is given in the table below.

Like other medical tests, this test also has certain risks and limitations.

Risks:

The test is usually safe and involves little risk. You may feel slight pain when the needle is inserted or mild bruising afterwards, which usually resolves spontaneously.

Limitations:

• The test alone cannot be used to diagnose any condition; additional tests are required to confirm a diagnosis.
• You may have to fast for a few hours or stop taking certain medications. Consult your doctor for best advice on this.

Depending on your symptoms and results, your doctor might recommend the following tests to better understand your condition:

• Double marker, triple marker study
• HPLC/ Haemoglobin electrophoresis
• Oral glucose tolerance test
• Amniocentesis
• Chorionic villus sampling
• Obstetric ultrasound
• Red blood cell antibody screen
• Strep B test