Somanur PHC PHC Clinical Reference

Clinical reference

Consolidated from AN Guidelines (April 2025), Paediatric Dosage Guidelines, Symptoms–Diagnosis–Drugs quick reference, PHC drug stock list, blank Antenatal History-Taking template, NHM Tamil Nadu / NPCDCS NCD protocols (summarised), Somanur PHC posting instructions, and anonymized ANC case notes.

Clinical reference only. Always confirm current local protocol and MO guidance before prescribing. The portal password is not published on this site — it is shared separately by the PHC.

Sections are numbered 1–10 in the order shown below. Posting instructions, the drug stock list and the prescribing quick reference come first, as the things usually reached for during a shift.

1 Daily Posting Instructions Equipment, daily rules, and the HMIS entry sequence. 17 rules 2 PHC Drug Stock List Medicines available under government supply. 21 categories 3 Symptoms to Diagnosis to Treatment Common presentations mapped to diagnosis and treatment. 6 presentations 4 NCD Protocols — Diabetes & Hypertension Stepwise DM and HTN protocols, without complications. 2 protocols 5 Paediatric Dosage Guidelines Weight-based paediatric dosing for 21 drugs. 21 drugs 6 Paediatric Dose Calculator Work out a paediatric dose from the child's weight. 21 drugs 7 Antenatal Care Guidelines Visit schedule, trimester protocols, anaemia and PIH management. 5 stages 8 ANC History-Taking Template The fields to cover when taking an antenatal history. Checklist 9 ANC Case Documentation Format What to capture when documenting an ANC visit. Checklist 10 Anonymized Antenatal Case Notes Two worked antenatal cases, identifiers removed. 2 cases

Daily practice

1Daily Posting Instructions

Equipment to carry, rules for the day, the HMIS entry sequence, and the iPad-based workflow at Somanur PHC.

Required equipment (carry daily)

  1. Stethoscope
  2. BP apparatus
  3. Yellow torch (pupil exam) and white torch
  4. Gloves
  5. Mask
  6. Knee hammer
  7. iPad

Rules

  1. Be on time (8:00 AM) — relieve night duty staff promptly.
  2. Formals only, no scrubs.
  3. Wear mask while attending patients.
  4. One person must go to Karumathampatti daily — report to Somanur PHC first, then head there around 9:30 AM.
  5. Enter all patient details properly in the HMIS online portal.
  6. Workflow: online registration → vitals → prescription → pharmacy.

    HMIS entry sequence

    1. Log in with the Nurse ID and enter vitals — only the starred (required) fields.
    2. Log in with the MO ID and enter diagnoses and drugs.
    3. Before clicking “Yes” on the end of treatment field, confirm both the vitals and the diagnosis/drug entries are complete.
    4. Save the record under both IDs — nurse-entered vitals and MO-entered diagnosis/drugs must each be saved separately, not just once at the end.

    Night duty HMIS sequence

    Different from daytime — includes registration and pharmacy steps.

    1. Register the patient using the Registration ID.
    2. Log in with the Nurse ID and enter vitals.
    3. Log in with the MO ID and enter diagnoses and drugs.
    4. Log in with the Pharmacy ID and close the prescription.
  7. Emergency case: check vitals first, coordinate and assign roles among the team.
  8. Take turns for lunch.
  9. Tuesday and Saturday are ANC days at Somanur.
  10. Refer to the pediatric booklet in the OPD before prescribing for pediatric age group — study it, as questions may be asked from it.
  11. Review the posters in the PHC — know emergency-treatment basics.
  12. Do not take the postings lightly.
  13. Do not prescribe for ANC mothers or pediatric age groups on your own — consult MO first.
  14. Don't order investigations without proper clinical reason.
  15. Wear coat and stethoscope daily.
  16. IP daily progress notes: write for all IP (in-patient) patients three times a day — morning (8:00am), afternoon (2:00pm), and night (8:00pm). In practice, this mostly involves copying forward the previous note and updating the current vitals.

Portal login credentials

The HMIS portal IDs are published on this site — the five home-page buttons copy the MO, Nurse, Pharmacy, Registration or Karumathampatti ID for you. The password is deliberately not published; it is shared separately by the PHC. Ask the MO or the Staff Nurse if you do not have it.

Open HMIS login portal

The portal requires a captcha, so the password must be entered manually each time. A button copies its role’s ID to the clipboard and opens the portal; the password is always typed by hand.

Prescribing

2PHC Drug Stock List

Medicines available under government supply at the PHC.

21 categories

Government supply

Anti-inflammatory / analgesic
Aceclofenac 100mg, Diclofenac Na 50mg, Dicyclomine 10mg, Ibuprofen 200mg, Paracetamol 500mg.
Antiviral
Acyclovir 200mg.
Antibiotics (broad spectrum)
Amoxycillin 250mg, Co-trimoxazole (adult & paed), Doxycycline 100mg, Metronidazole 200mg.
Antiparasitic
Albendazole 400mg.
Macrolides
Azithromycin 250mg, Erythromycin 250mg.
Antifungal
Fluconazole 150mg.
Fluoroquinolones
Norfloxacin 400mg, Ciprofloxacin 500mg.
Antacids / GI
Aluminium hydroxide + MTS, Ascorbic acid 100mg, Omeprazole 20mg, Bisacodyl 5mg, Ranitidine 150mg.
Supplements
Calcium + Vit D3, Calcium lactate 300mg, Multivitamin, Ferrous sulphate + Folic acid, Folic acid 5mg, Vit-B complex, Zinc sulphate, ORS.
Antihistamines
Cetirizine 10mg, Chlorpheniramine maleate 4mg.
Steroids
Dexamethasone 0.5mg, Prednisolone 5mg.
Antiemetic
Domperidone 10mg.
Bronchodilators
Salbutamol 4mg, Theophylline + Etophylline.
Antithyroid
Thyroxine 100mcg.
Cardiac (NCD)
Amlodipine 5mg, Aspirin 150mg, Atenolol 50mg, Atorvastatin 10mg, Chlorthalidone 12.5mg, Clopidogrel 75mg, Digoxin 0.25mg, Enalapril 2.5mg, Labetolol 100mg, Isosorbide dinitrate 5mg, Metoprolol 25mg, Nifedipine 10mg, Telmisartan 40mg.
Diuretics
Frusemide 40mg, Spironolactone 25mg.
Diabetic
Vildagliptin 50mg, Glibenclamide 5mg, Glimepiride 1mg, Metformin 500mg.
Syrups
Paracetamol 125mg/5ml, Co-trimoxazole, Erythromycin 100mg/5ml, Pheniramine maleate 15mg/5ml, Liquid antacid.
Ointments
Betamethasone, Cetrimide, Clotrimazole, Compound benzoic acid, Povidone iodine, Silver sulphadiazine, Diclofenac gel, GBHC lotion, Liquid paraffin 500ml, Zinc oxide cream.
Eye drops
Gentamicin, Ciprofloxacin.
Other
Paracetamol suppository (80mg, 125mg), Refresh Tears eye drops.

Prescribing

3Symptoms to Diagnosis to Treatment

Quick reference for common presentations at the PHC.

6 presentations

Standing instructions. Do not prescribe for the pediatric age group independently — confirm with MO first. Check PHC drug stock (Section 3) before prescribing. MLC and ANC cases go directly to MO. For patients insistent on an injection for pain: Inj. Vit B12 0.5 ml IM. Write separate medicine tokens for injections vs tablets.

Fever / URI / Sinusitis

Presentation: fever, chills, rigor, headache, nasal block, rhinitis, cough

→ PUO / URI / LRI / Sinusitis

  • Paracetamol 500mg 1-1-1, CPM 1-0-1, ORS.
  • If antibiotics needed: Adult — Amoxy 250mg 2-2-2; Peds — Amoxy 25mg/kg/day or Erythromycin 30mg/kg/day; Cefalexin (adult) 250mg 2-2-2; Doxy 100mg if eschar+. <30kg BW: halve the dose.

Pain

Presentation: knee/ROM issues, myalgia, dental/lymph node swelling, cellulitis

→ Myalgia, OA, gingivitis, cellulitis, abscess, swelling

  • Severe: T. Diclofenac 50mg 1-0-1.
  • Moderate: T. Ibuprofen 200mg 1-0-1.
  • Mild / peds / >60yrs: T. Paracetamol 500mg 1-0-1.
  • Add T. Ranitidine 150mg 1-0-1 with any of the above.

GI

Presentation: vomiting, diarrhoea, pain, loss of appetite

→ Acute diarrhoeal disease, enteritis, colitis, acute abdomen (appendicitis, pancreatitis, cholecystitis)

  • ORS.
  • Bacterial: T. Metronidazole 200mg 1-1-1.
  • Pain: T. Dicyclomine 10mg 1-1-1.
  • Zinc: <6mo — 10mg (half tab) OD; >6mo — 20mg (1 tab) OD.
  • Vomiting: Domperidone 10mg / Ondansetron.
  • Mucus diarrhoea: Ofloxacin.
  • Acid peptic disease: Omeprazole 20mg / Ranitidine 150mg.

Genitourinary

Presentation: pain, fever; in females — white discharge, AUB

→ UTI, calculi, BPH, testicular torsion, epididymitis, PID

  • Pain: Dicyclomine 10mg.
  • Fever: Paracetamol 500mg.
  • Antibiotic: Ciprofloxacin 500mg / Cotrimoxazole; fungal — Fluconazole 150mg; Metronidazole 200mg.

Injury

  • Td injection; Povidone iodine / Cetrimide cream; Paracetamol 500mg or Diclofenac 50mg with Ranitidine 150mg for pain.

Wheezing

→ Asthma

  • Pediatrics: nebulizer only (no tablets).
  • Adult: T. Salbutamol 4mg (first line); T. Deriphylline (second line).

Prescribing

4NCD Protocols — Diabetes & Hypertension

NHM Tamil Nadu / NPCDCS stepwise protocols for diabetes mellitus and hypertension without complications. Summarised, not verbatim — confirm against the current protocol/circular and MO guidance.

Summarised, not verbatim. This is a summary of the NHM Tamil Nadu / NPCDCS revised NCD protocol, not the departmental wording. Confirm every dose against the current NHM Tamil Nadu NCD protocol/circular and MO guidance before prescribing.

Diabetes Mellitus without Complications

Applies to uncomplicated type 2 diabetes mellitus in adults. If any complication is present — retinopathy, nephropathy, neuropathy, foot ulcer, coronary artery disease, stroke, peripheral vascular disease — this protocol does not apply: treat as diabetes with complications and refer.

Diagnosis

  • Fasting plasma glucose ≥126 mg/dl, or
  • 2-hour post-prandial glucose ≥200 mg/dl, or
  • Random blood sugar ≥200 mg/dl with classic symptoms, or
  • HbA1c ≥6.5% (if available).
  • Confirm with a repeat test unless the patient is symptomatic.

Baseline assessment (rule out complications)

  • History: symptoms, duration, diet, exercise, smoking/alcohol, drug history.
  • Examination: BP, weight, BMI, waist circumference, foot examination and pulses, eye/fundus, neuropathy screening.
  • Investigations: FPG/PPG, HbA1c, lipid profile, serum creatinine, urine albumin, ECG.

Lifestyle modification — every patient, every step

  • Medical nutrition therapy: reduce refined carbohydrates, sugar and saturated fat; increase fibre and vegetables; portion control.
  • Exercise: 30–45 minutes brisk walking, at least 5 days/week; resistance exercise 2–3 days/week if possible.
  • Weight reduction of 5–10% if overweight or obese.
  • Stop tobacco and alcohol.
  • Foot care, eye care, and vaccination as advised.

Drug treatment — stepwise

  1. Step 1 — Metformin. Start Tab. Metformin 500 mg once daily after food. Increase to 500 mg twice daily after 1–2 weeks if tolerated. Maximum 1000 mg twice daily (2000 mg/day). Contraindicated if eGFR <30, severe liver disease, hypoxia, sepsis.
  2. Step 2 — add Glimepiride. If not controlled after 3 months on maximally tolerated Metformin, add Tab. Glimepiride 1 mg once daily before breakfast. Increase to 2 mg once daily after 2 weeks if needed; maximum usually 4 mg/day. Warn about hypoglycaemia.
  3. Step 3 — add Pioglitazone. If still not controlled after 3 months on dual therapy, add Tab. Pioglitazone 15 mg once daily if no contraindication (heart failure, liver disease, bladder cancer, fracture risk), or refer to a higher centre for insulin or other therapy.
  4. Start insulin and refer if: symptomatic hyperglycaemia, FPG >250 mg/dl, HbA1c >9%, ketosis, weight loss; suspected type 1 diabetes, pregnancy, children/adolescents; acute illness, infection, or a surgical condition.

Treatment targets

  • FPG 80–130 mg/dl; PPG <180 mg/dl; HbA1c <7% (individualise to <8% for the elderly or those with comorbidities).

Follow-up

  • Monthly: FPG/PPG, BP, weight, adherence, hypoglycaemia symptoms.
  • Every 3 months: HbA1c if available, review treatment.
  • Annually: lipid profile, creatinine, urine albumin, ECG, fundus and foot examination.

Referral criteria

  • Not controlled on dual/triple oral therapy.
  • Diabetes with complications (retinopathy, nephropathy, neuropathy, foot ulcer, CVD, stroke).
  • Pregnancy, type 1 diabetes, children/adolescents.
  • CKD, liver disease, recurrent hypoglycaemia, insulin requirement.
  • Suspected secondary diabetes or endocrine disorder.

Hypertension without Complications

Applies to uncomplicated hypertension in adults. Rule out diabetes, CKD, CAD, stroke, heart failure and retinopathy first — with any of these, this protocol does not apply.

Diagnosis

  • BP ≥140/90 mmHg on two separate occasions.
  • If BP ≥180/110 mmHg, or the patient is symptomatic → refer immediately.

Lifestyle modification — every patient, every step

  • Salt <5 g/day; DASH diet; weight reduction.
  • Exercise 150 minutes/week.
  • Stop tobacco and alcohol; stress management.

Drug treatment — stepwise (reassess every 4 weeks)

StepRegimen
1Tab. Amlodipine 5 mg OD
2Tab. Amlodipine 10 mg OD
3Tab. Amlodipine 10 mg + Tab. Telmisartan 40 mg OD (or Losartan 50 mg OD)
4Tab. Amlodipine 10 mg + Tab. Telmisartan 40 mg + Tab. Chlorthalidone 12.5 mg OD (or Hydrochlorothiazide 12.5 mg OD)
5Tab. Amlodipine 10 mg + Tab. Telmisartan 40 mg + Tab. Chlorthalidone 12.5 mg + Tab. Metoprolol 25 mg OD
6Refer to higher centre / physician if still uncontrolled

Notes

  • Target BP: <140/90 mmHg without complications.
  • If initial BP ≥160/100 mmHg, many protocols start directly at Step 3 (two drugs).
  • Review monthly until controlled, then every 3–6 months.
  • Monitor renal function and electrolytes while on ARB/ACEi/diuretic.
  • Avoid ACEi/ARB in pregnancy.
  • In diabetes or CKD, use ACEi/ARB and target <130/80 mmHg.
  • Drug choice may vary with district supply: Losartan vs Telmisartan; Hydrochlorothiazide vs Chlorthalidone.

Prescribing

5Paediatric Dosage Guidelines

Weight-based paediatric dosing. Confirm with MO before prescribing for this age group.

Confirm with MO first. Do not prescribe for the pediatric age group independently. Check PHC drug stock before prescribing.

DrugDosage
Paracetamol>10kg: 10–15 mg/kg/dose Q6H, max 60 mg/kg/day. Rectal: 50 mg/kg/dose. IM: 7.5 mg/kg/dose. IV <10kg: 10 mg/kg Q6H over 15 min, max 30 mg/kg/day. IV 10–50kg: 15 mg/kg Q4–6H over 15 min, max 60 mg/kg/day. IV >50kg: 1g Q4–6H, max 3g/day.
Aciclovir20 mg/kg Q6H
Amoxicillin80–100 mg/kg/day Q6H (enteric fever, otitis media, severe infections); 25–50 mg/kg/day Q8–12H (milder infections)
Cotrimoxazole5–8 mg/kg TMP + 25–50 mg/kg SMZ per day, Q12H, oral or IV
Doxycycline2–5 mg/kg/day Q12H oral; avoid <8 years
Metronidazole15–20 mg/kg Q8H × 5–7 days
Albendazole<2yr: 200mg single dose; >2yr: 400mg single dose
Azithromycin10 mg/kg/day single dose day 1, then 5 mg/kg/day ×4 days; or single 30 mg/kg dose. Avoid <6 months. Enteric fever: 20 mg/kg/day ×7–14 days
Erythromycin30–50 mg/kg/day Q6H oral; IV 5 mg/kg/dose Q8H (NS/RL) or intermittent bolus over 20–60 min Q5–8H
Fluconazole6 mg/kg day 1, then 3–6 mg/kg OD ≥2 weeks; IV over 1–2 hrs
Norfloxacin10–15 mg/kg/day Q12H oral
Ciprofloxacin20–40 mg/kg/day Q12H oral; IV 10–20 mg/kg/day Q12H, max 800 mg/day; meningitis contact prophylaxis: 20 mg/kg single dose
Omeprazole2–2.5 mg/kg/day, single or divided
Ranitidine1–5 months: 1 mg/kg Q8H; ≥6 months: 2–4 mg/kg Q12H
Cetirizine6mo–2yr: 2.5mg OD; 2–6yr: 2.5mg BD or 5mg OD; >6yr: 5–10mg OD/BD
Chlorpheniramine maleate0.35 mg/kg/day Q4–6H
Dexamethasone0.05–0.5 mg/kg/day oral; anti-inflammatory: 0.08–0.3 mg/kg/day Q6H
Prednisolone0.5–1.7 mg/kg/day IM/IV/oral
Domperidone0.2–0.5 mg/kg/dose Q4–8H
Salbutamol0.1–0.4 mg/kg/dose Q8H oral
Theophylline / Etophylline10–16 mg/kg/day Q8H oral

Prescribing

6Paediatric Dose Calculator

Enter a weight (and age where the drug needs it) to get the per-dose, per-day, frequency and duration range straight from the paediatric dosage sheet.

Confirm with MO first. Do not prescribe for the pediatric age group independently. This calculator only does the arithmetic from the PHC paediatric dosage sheet — it does not choose the drug, the indication, or the route. Always check PHC drug stock before prescribing.

21 drugs from the paediatric dosage sheet.

Choose a drug, enter the child's weight, and select Calculate. Some drugs also need an age — the form will say so.

Maternal care

7Antenatal Care Guidelines

PHC antenatal protocol: visit schedule, trimester-by-trimester investigations and treatment, anaemia and PIH management.

Reading this page. The tabs below cover the stages of antenatal care. Selecting one narrows the page to that stage; with none selected, every stage is shown in order as a single document.

General Instructions

  • Minimum 5 antenatal visits at PHC + 5 AN home visits by VHN (more if high-risk).
  • AN OP conducted every Tuesday; additional OP on Fridays if needed.
  • MO, Staff Nurse, Lab Technician, Sector Health Nurse must be present during AN OP.
  • Ultrasound growth scan: trained/certified MO or obstetrician to visit Block PHC monthly.
  • Hb/OGCT compulsory immediately on entry for every AN visit; MO prescribes only after result.
  • Moderate anaemia at 21–28 weeks → Inj. Iron Sucrose IV same day before leaving PHC.
    • Iron sucrose infusion: 5 ml (100 mg elemental iron) in 100 ml NS, over 20–30 min — 16 drops/min for first 5 min, then full flow (5 ml/min) to complete in 20 min.
    • Iron sucrose & Labetalol: store at room temperature (not fridge).
    • Oxytocin: store in fridge.
    • Mixtard insulin (for GDM): store in fridge.
  • OGCT: screen 3× — 8–12 wks, 24–26 wks, 32–34 wks. If >140 mg/dl → GDM: start Meal Plan + Inj. Mixtard immediately at PHC.
  • Mid-trimester BP fall: ~10% drop expected at 16–24 wks. No fall → risk of PIH/pre-eclampsia later.
  • Roll-over test (for PIH): baseline BP in lateral/sitting position, then repeat supine. Rise >20 mmHg supine = positive.
  • High-risk mothers: refer and follow up at CEmONC; delivery must be planned there.

I Trimester (before 12 weeks)

  • Confirm pregnancy: urine pregnancy card (+ from 35 days LMP); EDD from LMP; USG dating scan.
  • Early registration within 12 weeks (PICME 3.0 portal); AN clinic register entries; MRMBS/JSY application.
  • History: past obstetric/medical history, last child's birth weight, spacing.
  • Exam: height, weight, BMI, pulse, BP (serial); check obesity, underweight (<40 kg), pallor, pedal edema, jaundice, fever, breathlessness.
  • <40 kg → evaluate for TB, heart disease, HIV/AIDS, malnutrition, cancer, peripheral smear.
  • Investigations: Hb%, CBC, blood group & Rh, thyroid, urine albumin, peripheral smear (malaria/filariasis), HBsAg, VDRL/HIV, hemoglobinopathy screening (HPLC), GCT #1.
    • GCT >140 → meal plan, repeat PP glucose in 15 days; if >120 → Inj. Mixtard 4–8 IU, titrate per GDM protocol.
  • USG dating scan at Block/Additional PHC by scan-trained MO.
  • Birth planning discussion with family.
  • Treatment: Inj. Td 0.5 ml IM (1st dose); Tab. Folic acid 400 mcg daily till 12 weeks.
  • Known GDM/DM/prev. PIH/hyperthyroid → start treatment immediately.
  • All AN check-up data entered in PICME within 14 days (Staff Nurse via institutional login; VHN via VHN login for home/HSC/ICDS visits).

II Trimester — 1st visit (14–20 weeks / ~100th day from LMP)

  • Serial Hb%, weight, pulse, BP, urine albumin; check pallor/edema/jaundice/fever/breathlessness.
  • Note mid-trimester BP fall.
  • USG anomaly scan at 16–22 weeks.
  • ECHO for mother ideally at Medical College Hospital.
  • Treatment:
    • Prev. PIH → Tab. Labetalol + Tab. Aspirin.
    • Known cardiac problem → continue cardiac drugs.
    • Prev. hypothyroidism → Tab. Eltroxin.
    • Inj. Td 2nd dose (0.5 ml IM, 4 wks after 1st; no booster if prior pregnancy within 3 yrs).
    • Tab. Multivitamin OD; Tab. Vitamin C 100 mg OD.
    • Tab. Albendazole 400 mg single dose.
    • PIH prevention: Tab. Calcium Carbonate + Vit D3 BD.
    • Anaemia prophylaxis (Hb >11): 1 IFA tab/day.
    • Anaemia treatment (Hb 7–11): 2 IFA tabs/day (1 hr gap between iron/folic acid and calcium).
    • Severe anaemia (Hb <7): refer to CEmONC (Medicine/OG/Surgery) — rule out other causes/cancer, for blood transfusion.
  • Counsel on quickening, breast changes, iron/protein-rich local foods.

II Trimester — 2nd visit (21–28 weeks)

  • Serial Hb%, weight, pulse, BP, urine albumin; pallor/edema/jaundice/fever check.
  • P/A exam: fundal height, FHR (120–160 bpm).
  • Roll-over test as above.
  • USG growth scan — fetal growth, liquor adequacy, FHR.
  • GCT #2 at 24–28 weeks.
  • Treatment: continue known high-risk treatment; Multivitamin/Vit C OD; Calcium+D3 BD.
    • Anaemia prophylaxis (Hb >11): 1 IFA/day.
    • Mild (Hb 10.1–10.9): 2 IFA/day.
    • Moderate (Hb 7.1–10): 4 doses Inj. Iron Sucrose IV (100 mg elemental iron) at PHC same day, repeat q2–4 days ×4 doses. Recheck Hb after 4 wks; if still 7.1–8.9, give 2 top-up doses of iron sucrose or Inj. FCM.
    • Severe (Hb <7): refer BEmONC/CEmONC for fresh blood/packed cell transfusion.
    • Weekly/fortnightly follow-up for anaemia correction.
  • Birth planning + cross-notification (mail/phone) to planned delivery facility.
  • Counsel on family planning (temporary/permanent).

III Trimester — 1st visit (29–36 weeks)

  • No IV infusion during 30–34 weeks (avoid volume overload).
  • Weight (excess gain), pulse, BP, pallor/edema/jaundice/fever, Hb, urine albumin.
  • P/A exam: fundal height, FHR (120–160 bpm).
  • GCT #3 at 32–34 weeks.
  • USG: presentation, placental position, liquor adequacy, FHR, weight, IUGR check.
  • Treatment: Multivitamin/Vit C OD; Calcium+D3 BD.
    • Anaemia prophylaxis (Hb >11): 1 IFA/day.
    • Mild (10.1–10.9): 2 IFA/day (1 hr gap iron/folic vs calcium).
    • Moderate/severe (<7–10): refer CEmONC — transfusion after 34 weeks if necessary.
    • Pre-eclampsia/eclampsia: Inj. Labetalol 2 ml IV (20 mg) over 2 min + loading dose Inj. MgSO4 at PHC, refer immediately to CEmONC.
  • Quickening: count time for 10 fetal movements (should average <2 hrs).
  • Birth planning + cross-notification; family planning counsel.
  • Ensure high-risk mothers attend MCH and follow treatment (GDM → physician/diabetologist; heart disease → cardiologist).

MgSO4 loading dose (pre-eclampsia / eclampsia)

  • IM: 10 ml in each buttock + 1 ml 2% lignocaine.
  • IV: 8 ml MgSO4 diluted in 12 ml distilled water, over 20 minutes.

III Trimester — 2nd visit (37–40 weeks)

  • Weekly visits for high-risk women to MCH/CEmONC.
  • High-risk delivery only at CEmONC.
  • Weight, pulse, BP, pallor/edema/jaundice/fever, Hb, urine albumin.
  • P/A exam: fundal height; FHR 120–160 bpm.
  • Treatment: continue known high-risk treatment; Multivitamin/Vit C OD; Calcium+D3 BD.
    • Anaemia prophylaxis (Hb >11): 1 IFA/day.
    • Mild (Hb 9–11): 2 IFA/day (1 hr gap rule).
    • Moderate/severe (<9): refer CEmONC — transfusion after 34 weeks if necessary.
    • Pre-eclampsia/eclampsia: same Labetalol + MgSO4 protocol as above, refer immediately.
  • Quickening monitoring continues.
  • Final birth planning + cross-notification.
  • Educate mother/companion on delivery signs, danger signs, 108 transport, VHN/SHN contacts.
  • Ensure continued CEmONC attendance for high-risk cases.

Maternal care

8ANC History-Taking Template

Fields to cover when taking an antenatal history at the PHC.

Fields to cover

  • Name, husband's name, age, PH (personal history), DOB, Aadhaar, HSC, VHN, GPLA.
  • High risk factors: bad OB history, higher order birth, marriage/census details, blood transfusion history, outlet obstruction, meconium-stained liquor, consanguinity.
  • Menstrual history; personal history (TB/seizure/psychiatric); family history (sugar/pressure/TB/seizure).
  • Ht, Wt, BMI, BP, Hb, urine albumin/sugar, nitrate, BT/CT, serology, spouse HIV, TSH, blood group, ICT, RBS, GCT/OHA/MNT status.
  • Complaints by trimester: fetal movement onset (primi ~20 wks, multi ~18 wks); any decrease in movements after 25 wks.
  • O/E: pallor, edema, systemic exam, P/A.
  • Scan sequence: after GPLA, before O/E — NT scan (low-lying placenta check), anomaly scan, cervical length (<3–3.5 cm → consider cerclage), uterine artery Doppler (resistant flow / absent-reversal flow).
  • Note: presentation, liquor, placental position.
  • Hb + urine albumin/sugar every ≥3 weeks; fever → CBC; note pain/discharge.
  • GCT schedule: first ANC visit (ideally 12–16 wks), 24–28 wks, 32–34 wks.
Correction note on the GCT schedule

Matches the Antenatal Care Guidelines and the DIPSI/GOI single-test protocol. The 9–11 / 18–22 / 28–32 wk schedule previously listed here does not match any published Tamil Nadu/GOI GDM screening protocol.

Maternal care

9ANC Case Documentation Format

What to capture when documenting an antenatal visit, including the investigation list.

When documenting an ANC visit, capture

  • Obstetric score (GPLA)
  • History
  • Weight — compare with previous visit weight, note weight gain in kg
  • BP

Investigations

  • Hb, Platelets
  • Urine sugar, urine albumin
  • Blood group
  • Serology: HIV, HBsAg, HCV
  • HIV for both husband and wife
  • VDRL
  • Bleeding time, clotting time
  • ECG
  • ECHO
  • TSH
  • GCT at first ANC visit, 24–28 weeks, and 32–34 weeks
Correction note on the GCT schedule

The “12/24/36 weeks” schedule previously listed does not match the DIPSI/GOI protocol used elsewhere in this document (Section 1) or any Tamil Nadu guideline found; 36 weeks in particular is too late to act on a GDM diagnosis.

Maternal care

10Anonymized Antenatal Case Notes

Transcribed from handwritten PHC/DOMS case sheets. Patient identifiers removed — labelled Case A and Case B.

Transcribed from handwritten PHC/DOMS case sheets. Patient identifiers removed — labelled Case A and Case B.

Case A — FGR / Oligohydramnios workup

  • Primi, pre-pregnancy weight 37 kg, current weight 36.9 kg, height 147 cm, BMI 17.02 — underweight.
  • BP 90/60 mmHg.
  • LMP 21/12/25, EDD 27/9/26, scan EDD 27/9/26; GA at review 31 weeks 6 days.
  • No complaints; able to perceive fetal movements. Urine albumin/sugar — negative.
  • Referred to CMC GH on 31/7/26 for underweight/SGA workup.
  • OP labs (20/7): Hb 11.5 g/dl, PLT 2,40,000.
  • Scan 22/7/26 (28w+4d): AC at 5–7th percentile — possible SGA. Mild early diastolic notch in left uterine artery.
  • Scan 24/7/26: GA by scan 29w±2d with good growth; FGR Stage 1.
  • 26/7/26: Admitted for Stage 1 FGR, EFW <5th percentile, BPD <5th percentile. Admitted 24th, treated as inpatient 25/7–31/7/26 (1 week), then discharged.
    • LP report (25/7): AFB sputum MTB not detected; CBC Hb 10.5, WBC 18,200, PLT 1,95,000; urine albumin/sugar negative; CBNAAT — MTB not detected.
    • 26/7/26: Inj. Dexamethasone 6mg/kg 1-0-1 × 4 doses given; Inj. MgSO4 (neuroprotection) given.
    • USG 28/7/26: cephalic presentation, posterior placenta, FL corresponds to 29w+6d by Doppler, AFI 9 cm.
    • On discharge: T. Aspirin, Arginine sachet, T. BCT, T. Vit C, T. Calcium.
  • On exam: no pallor, no edema. Vitals BP 90/60. CVS S1S2+, RS NVBS, CNS NFND.

Case B — Routine ANC, previous NVD, mild anaemia workup

  • G2P1L1A0, age 29 years. Married 9 years, non-consanguineous.
  • Menarche age 12; cycles 28/3, no history of heavy bleeding.
  • Previous obstetric history: NVD, no complications, delivered at 39 weeks, no NICU admission.
  • Current pregnancy: spontaneous conception, detected UPT positive, folic acid started from 5 weeks, no vomiting, 1 dose Td given.
  • LMP 2/5/26, EDD 16/2/27, scan EDD 14/2/27; GA at booking 11 weeks 6 days.
  • Pre-pregnancy weight 52.6 kg, current weight 52.7 kg, height 153 cm, BMI 22.52, BP 116/70.
  • Previous labs (10/7/26): Hb 12.4, WBC 9900, PLT 1,08,000, blood group O negative. Urine complete: albumin negative, sugar negative, nitrate negative, pus cells 2–3/HPF, RBC 0–1, epithelial 1–3.
  • O/E: no pallor, no edema. CVS S1S2+, RS NVBS, CNS NFND.
  • Labs/investigations checklist (ticked as done): Hb, urine albumin/sugar/nitrate, bleeding time, clotting time, blood group, FSH, HIV, VDRL, HBsAg, spouse HIV, ECG, ECHO.

Identifying details (name, husband's name, address/HSC/VHN codes, Aadhaar/RCH numbers) intentionally omitted.