1. NAGERCOIL OB-SOCIETY Antenatal Checklist

2. Antenatal Care Preventive medicine in pregnancy

3.  Clinical examination  Investigations  Counselling Antenatal Care

4. Investigations in Pregnancy

5. Rifle vs Shotgun approach Rifle – hit bull’s eye Specific test based on Clinical judgment Diagnostic accuracy Predictive value Shotgun – spray shots Many tests Diagnostic accuracy + /- Predictive value + /- May not hit the bull’s eye!!

6. A test should be done only if the result is likely to make a difference to the management What is a ‘necessary’ test?

7. Any test the results of which are not likely to be make a difference in the appropriate management of the patient What is an ‘unnecessary’ test?

8. Questions to ask before ordering a test  Why is the test being ordered?  What are the consequences of not ordering the test?  How good is the test?  How are the test results interpreted?  How will the test results influence patient management and outcome?

9. Reasons for ordering a test  Diagnosis (eg, Pregnancy / no pregnancy)  Screening (eg, for Down’s syndrome)  Monitoring (eg, serial ultrasound scan)  Research (to understand the pathophysiology of a particular disease process)

10. Reasons for unnecessarily ordering a test  Financial gains  Defensive medicine  Institutional pressures  Patient demands

11. The flip side….  Generates anxiety  Involves time, cost  Risks & complications exist  Results may be shocking!  Leads to unnecessary/inappropriate interventions

12. Pre test Counseling  What test?  Why is it done?  How is it done?  What is the likely expense?  What are the risks & likely outcomes?  What is the plan of management?  What are the fall outs if it is not done?

13. Investigations in Pregnancy Which and when??? Developed by Abbott National Advisory Board for Duphaston

14. Members of the Advisory Board Dr Ameet Patki, Chairman, Mumbai Dr Mala Arora, Delhi Dr Ritu Joshi, Jaipur Dr Bhasker Pal, Kolkata Dr Parul Kotdawala, Ahmedabad Dr Susheela Rani, Bangalore Dr Suchitra Pandit, Mumbai Dr Anita Singh, Patna

15. Investigations in Antenatal Care Mandatory Preferable

16. Mandatory These tests are mandatory in the provision of standard antenatal care

17. Preferable These tests have been shown to be of clinical value, but are not into evidence based recommendations as of now

18. ANC was released in FOGSI Varanasi, Jan 27 th 2012

20. Acknowledgements A special thanks to – Dr Susheela Rani, Bangalore and Dr Bhasker Pal, Kolkata for providing material for this presentation.