OG8.1-10 | Antenatal Care — Glossary

A brief nutritional assessment tool in which the patient describes all food and drink consumed in the previous 24 hours; used in ANC to assess dietary adequacy and identify deficiencies.

Circumference of the maternal abdomen measured at the level of the umbilicus; at term approximately 80–100 cm; an unusually large girth may suggest polyhydramnios or macrosomia.

The number of pregnancy losses before 20 weeks of gestation, whether spontaneous (miscarriage), induced, or missed; distinguishes from Para by the 20-week threshold.

A Doppler finding in which the umbilical artery flow velocity waveform shows no forward flow during diastole; indicates critical placental vascular resistance; associated with 50% risk of fetal compromise within 1 week; delivery indicated at ≥34 weeks.

Ultrasound measurement of amniotic fluid volume by summing the vertical depths of the largest fluid pocket in each of the four uterine quadrants; normal 5–24 cm; oligohydramnios <5 cm; polyhydramnios >24 cm.

Haemoglobin below 11 g/dL in the first and third trimesters or below 10.5 g/dL in the second trimester; most commonly caused by iron deficiency in India.

A female pelvic type (~30% of women) with a heart-shaped inlet, straight sacrum, narrow subpubic arch (<80°), and prominent ischial spines; associated with deep transverse arrest of labour and the least favourable pelvic type for vaginal delivery.

Organised health-care delivered to a pregnant woman from conception to the onset of labour, aimed at promoting maternal-fetal wellbeing and detecting complications early.

Bleeding from or into the genital tract after 20 weeks of gestation and before the onset of labour; principal causes are placenta praevia and placental abruption.

An autoimmune thrombophilia associated with recurrent pregnancy loss and stillbirth due to placental thrombosis; diagnosed by presence of lupus anticoagulant, anticardiolipin, or anti-β2-glycoprotein antibodies on two occasions ≥12 weeks apart.

An obstetric history characterised by adverse previous outcomes including recurrent pregnancy loss, previous perinatal death, severe preterm birth, previous uterine surgery, or previous PPH.

The clinical observation that symphysio-fundal height in centimetres approximately equals gestational age in weeks between 20 and 36 weeks; forms the basis for detecting SFH discordance (≥3 cm from expected = warrants ultrasound evaluation).

A structured set of compassionate clinical actions following a perinatal loss: clear communication of the diagnosis, offering to see and hold the baby, memory-making, psychological support referral, and follow-up counselling.

The transverse diameter of the pelvic outlet measured between the ischial tuberosities; normal ≥8 cm; clinically assessed by placing a closed fist between the tuberosities (a standard fist ≈ 8 cm).

A fetal assessment tool combining NST with ultrasound evaluation of four biophysical activities — fetal breathing movements, gross body movements, fetal tone, and amniotic fluid volume — each scored 0 or 2; maximum score 10; score 8–10 reassuring, 6 equivocal, ≤4 concerning.

A counselling framework ensuring that a pregnant woman and her family have pre-arranged: skilled birth attendant, delivery facility, transport route, blood donor and emergency funds, to minimise delays in seeking and receiving emergency obstetric care.

A 5-parameter scoring system (dilatation, effacement, station, consistency, position of cervix; total 0–13) used to assess cervical favourability for induction of labour; a score of ≥6–8 indicates a favourable cervix.

The transverse diameter of the midpelvis measured between the ischial spines; the most important midplane diameter; normal ≥10 cm; clinically assessed by palpating the prominence of the ischial spines on vaginal examination.

Elemental calcium 1.5–2 g per day (typically 500 mg three times daily) given from 20 weeks of gestation to women with low dietary calcium intake, as recommended by WHO 2016 for the prevention of pre-eclampsia.

1 g elemental calcium per day (two 500 mg tablets) from the second trimester; indicated for fetal skeletal mineralisation and prevention of pre-eclampsia in populations with low dietary calcium.

A classification of female pelvic types (1933) based on the shape of the pelvic inlet: gynaecoid (round, most common and most favourable), android (heart-shaped, least favourable), anthropoid (oval AP-dominant), and platypelloid (flat, wide transverse).

Continuous electronic recording of the fetal heart rate and uterine contractions using Doppler ultrasound (fetal heart) and a tocodynamometer (uterine activity); used for NST (antepartum fetal surveillance) and intrapartum fetal monitoring.

A relative or absolute mismatch between the size of the fetal head and the dimensions of the maternal pelvis, leading to failure of engagement or failure of descent in labour; evaluated clinically (pelvimetry) and radiologically.

A high-resolution chromosomal analysis that detects copy number variants (deletions/duplications) not visible on conventional karyotype; higher diagnostic yield in stillbirth with structural anomaly or unexplained intrauterine death.

A vertical (longitudinal) incision through the upper body of the uterus; reserved for specific indications; exposes the contractile upper segment and carries a TOLAC rupture risk of 4–9% — an absolute contraindication to TOLAC.

A pelvis in which one or more key obstetric diameters falls below the threshold for that level: inlet (OC <10 cm), midplane (bispinous <10 cm), or outlet (bi-ischial <8 cm); increases risk of obstructed labour.

Ultrasound measurement of the longest fetal axis from the top of the head to the bottom of the body; the most accurate method for gestational age determination when measured between 10 and 13+6 weeks of gestation (accurate to ±3–5 days).

A maternal surveillance method in which the pregnant woman counts fetal movements daily; the Cardiff count-to-10 method defines adequate as ≥10 movements within 2 hours; fewer than 10 movements in 12 hours constitutes reduced DFMC and warrants urgent clinical evaluation.

A defined set of symptoms and signs indicating potentially life-threatening obstetric complications requiring immediate medical assessment: severe headache, visual disturbance, vaginal bleeding, decreased/absent fetal movements, convulsions, severe abdominal pain, fever with rigors, and generalised oedema.

The clinically measurable AP diameter of the pelvic inlet, from the sacral promontory to the inferior border of the pubic symphysis; normal ≥12.5 cm; measured by vaginal examination reaching the sacral promontory with the examining middle finger.

A systemic coagulopathy triggered by release of thromboplastin from a retained dead fetus; characterised by consumption of clotting factors and platelets leading to bleeding; requires prompt delivery and replacement of clotting factors.

Diabetes In Pregnancy Study group India protocol: 75 g oral glucose given non-fasting, venous blood glucose ≥140 mg/dL at 2 hours = gestational diabetes mellitus. The non-fasting design improves uptake in primary care settings.

Descent of the biparietal diameter of the fetal head below the plane of the pelvic brim; clinically detected when the presenting part is no longer mobile on Leopold's third grip. Normally occurs at 36–38 weeks in primigravidae, at or after onset of labour in multigravidae.

Elective Repeat Caesarean Section — planned, non-emergency repeat caesarean delivery at a predetermined gestational age, as the primary delivery mode rather than in response to an acute intrapartum complication.

Fetal weight predicted by combining ultrasound biometric measurements (BPD, HC, AC, FL) using validated formulae (most commonly Hadlock); EFW <10th centile for gestational age defines suspected IUGR.

The calculated date of expected parturition, derived by Naegele's rule from LMP or by first-trimester ultrasound (CRL ≤13+6 weeks); the reference point for all gestational-age-dependent assessments.

Rhythmic movements of the fetal chest and diaphragm observable on real-time ultrasound; an episodic activity reflecting central nervous system maturity; absent fetal breathing movements for >30 minutes constitutes an abnormal BPP parameter.

The orientation of the fetal long axis relative to the maternal long axis: longitudinal (normal), transverse, or oblique. A non-longitudinal lie after 36 weeks is a complication.

The orientation of the denominator (reference bony point) of the presenting part relative to the maternal pelvis; for cephalic presentation the denominator is the occiput: ROA, LOA, ROP, LOP, OA.

The fetal part that occupies the lower uterine segment and will enter the pelvis first: vertex (cephalic, most common), breech (frank, complete, or footling), shoulder (in transverse lie), or face/brow.

Leakage of fetal red blood cells into the maternal circulation; a cause of fetal anaemia and stillbirth; relevant for anti-D immunoglobulin dosing in Rh-negative women.

Stillbirth with no maceration — skin intact and coloured normally — indicating death occurred recently (within 12–24 hours) or during labour (intrapartum).

New-onset hypertension (systolic ≥140 or diastolic ≥90 mmHg on two occasions ≥4 hours apart) developing after 20 weeks of gestation, in the absence of proteinuria or end-organ dysfunction.

Shorthand for obstetric history: G (gravida) P (para) + (abortion) L (living children), e.g. G3P2+0L2 means three pregnancies, two deliveries beyond 20 weeks, no abortions, two living children.

A woman who has had five or more previous deliveries beyond 20 weeks of gestation; associated with increased risks of atonic PPH, malpresentation, obstructed labour, placenta praevia and uterine rupture.

The total number of pregnancies a woman has had, including the current one, regardless of duration or outcome (normal, ectopic, molar, aborted, or delivered).

The most common and most favourable female pelvic type (40–50% of women); rounded or slightly oval inlet, curved sacrum, wide subpubic arch, non-prominent ischial spines; best suited for vaginal delivery of a vertex presentation.

A pregnancy in which one or more factors from demographic/social, obstetric history, medical, or current pregnancy categories confer a significantly elevated probability of adverse maternal or fetal outcome compared with the general obstetric population.

Iron and folic acid supplementation: 60 mg elemental iron + 500 µg folic acid per tablet, one tablet daily throughout pregnancy and 100 days postpartum, under India's national programme.

Iron-Folic Acid tablet containing 60 mg elemental iron and 500 µg (0.5 mg) folic acid; the standard antenatal supplement provided free under India's National Health Mission.

Vaccine containing killed or fragmented organisms or purified proteins; incapable of replication; safe in all trimesters (examples: TT/Td, inactivated influenza, IPV, COVID-19 mRNA).

Pregnant women are at high risk of severe influenza complications; inactivated influenza vaccine is recommended in all trimesters; live attenuated influenza vaccine (LAIV) is contraindicated.

The time elapsed from a previous caesarean delivery to the next delivery; a minimum of 18–24 months is recommended to allow adequate uterine scar healing and reduce rupture risk.

Stillbirth occurring during labour; almost always a fresh stillbirth; represents a largely preventable death and a quality indicator for intrapartum care.

Failure of the fetus to achieve its genetically predetermined growth potential, defined as EFW or abdominal circumference (AC) <10th centile for gestational age; may be asymmetric (head-sparing, suggesting placental insufficiency) or symmetric (proportionate, suggesting early-onset insult or fetal anomaly).

A conceptual framework for risk-stratified ANC delivery in which all women enter at the broad primary-care level and only those identified as high-risk are escalated to successively more specialised tiers.

Essential for fetal thyroid hormone synthesis and neurological development; maternal requirement rises to 220 µg/day; iodised salt is the primary strategy; direct supplementation in deficient areas.

A blood test that detects fetal red blood cells in maternal circulation, used to diagnose fetomaternal haemorrhage and quantify the volume of fetal blood that has crossed into the maternal circulation.

The first day of the last normal menstrual period before the current pregnancy; used in Naegele's rule to calculate EDD; requires a regular 28-day cycle for accuracy.

A systematic series of four external abdominal palpation grips used to determine fetal lie, presentation, position and engagement: (1) fundal grip, (2) lateral/umbilical grip, (3) pelvic/lower uterine grip, (4) Pawlik's grip.

Vaccine containing weakened live micro-organisms; capable of replication in the host and contraindicated in pregnancy due to risk of fetal infection (examples: MMR, varicella, OPV).

The full-thickness measurement of the lower uterine segment by ultrasound in the third trimester; a thin LUS (<2–3 mm, thresholds vary) suggests scar weakness and may influence the TOLAC/ERCS decision.

The standard modern caesarean incision: a horizontal cut through the lower uterine segment (the non-contractile, thin lower portion of the uterus); heals well and carries a TOLAC rupture risk of approximately 0.5%.

Stillbirth with maceration features — skin slippage, discolouration, softening — indicating antepartum death ≥12–24 hours before delivery.

Any presentation other than vertex (cephalic) presentation: includes breech (frank, complete, footling), shoulder (transverse lie), face, and brow presentations; associated with increased risk of obstructed labour and perinatal morbidity.

India's national antenatal record card issued to every registered pregnant woman; documents all ANC findings, interventions, immunisations and counselling; travels with the woman across facilities to ensure continuity of care.

Overlapping of the fetal skull bones at the sutures and fontanelles during labour, allowing the presenting diameter to reduce by up to 1 cm; a physiological compensatory mechanism that facilitates descent through a borderline pelvis.

The standard method for calculating the expected date of delivery: add 9 calendar months and 7 days to the first day of the last menstrual period (or equivalently, add 1 year, subtract 3 months, add 7 days). Valid only for regular 28-day cycles.

Tetanus infection in the newborn caused by Clostridium tetani spores entering through the umbilicus; prevented by adequate maternal immunisation which transfers protective IgG to the neonate.

Congenital malformation resulting from failure of neural tube closure in the first 28 days of gestation; prevented by periconceptional folic acid supplementation.

A reason for previous caesarean that is unlikely to occur again in the current pregnancy — e.g., fetal distress, cord prolapse, or malpresentation that has corrected; contrasted with recurrent indications such as cephalopelvic disproportion.

Cardiotocographic recording of fetal heart rate patterns in the absence of uterine contractions; reactive NST = ≥2 accelerations of ≥15 bpm above baseline lasting ≥15 seconds within 20 minutes — indicates low risk of acute fetal compromise.

Ultrasound measurement of the fluid-filled space at the back of the fetal neck between 11 and 13+6 weeks; NT ≥3.5 mm is associated with increased risk of chromosomal anomalies (trisomy 21, 18, 13) and structural cardiac defects; interpreted with maternal serum biochemistry for first-trimester combined screening.

Motivational interviewing technique: Open questions, Affirming, Reflecting, Summarising; used in patient counselling to promote health behaviour change in ANC settings.

The true conjugate — the shortest AP diameter of the pelvic inlet, from the sacral promontory to the inner surface of the pubic symphysis; the critical limiting dimension for the fetal head at the inlet; normal ≥10 cm; calculated as DC minus 1.5–2 cm.

Labour in which the presenting part cannot descend through the pelvis despite strong, regular uterine contractions; caused by CPD, malpresentation, or soft tissue obstruction; leads to uterine rupture and vesicovaginal fistula if not managed with caesarean section.

Reduced amniotic fluid volume defined as AFI <5 cm or single deepest pocket <2 cm; reflects decreased fetal urinary output due to placental insufficiency or fetal renal dysfunction; associated with cord compression in labour and adverse perinatal outcome.

The use of intravenous oxytocin to strengthen or initiate contractions during TOLAC; permissible with careful dose titration but approximately doubles the uterine rupture risk compared to spontaneous labour; high doses are particularly hazardous.

The number of deliveries beyond 20 weeks of gestation, regardless of whether the infant was born alive or as a stillbirth.

The period encompassing approximately 3 months before conception through the end of the first trimester; the critical window for folic acid supplementation to prevent NTDs.

A relative reduction in haemoglobin concentration during pregnancy due to disproportionate plasma volume expansion (40–50%) exceeding the rise in red cell mass (20–30%); the nadir occurs at 28–34 weeks. Distinct from true iron-deficiency anaemia (Hb <11 g/dL by WHO).

A monaural wooden stethoscope used to auscultate the fetal heart through the maternal abdomen; placed over the fetal back (identified by second Leopold's grip); normal fetal heart rate 110–160 bpm.

A range of conditions in which placental trophoblast abnormally invades the myometrium: accreta (superficial), increta (deep), percreta (through serosa into adjacent organs); risk increases dramatically with each successive caesarean scar.

Microscopic examination of placental tissue; the most informative single investigation in stillbirth evaluation, identifying villous infarction, chorioamnionitis, and vascular lesions.

Excessive amniotic fluid volume defined as AFI >24 cm or single deepest pocket >8 cm; associated with fetal anomalies (oesophageal/duodenal atresia, anencephaly), diabetes mellitus, fetal hydrops, and multiple pregnancy.

New-onset hypertension (≥140/90 mmHg) after 20 weeks of gestation combined with proteinuria (≥300 mg/24 h or protein:creatinine ratio ≥0.3) or end-organ dysfunction (thrombocytopenia, renal insufficiency, liver dysfunction, pulmonary oedema, new headache unresponsive to medication, visual disturbance).

Prostaglandin agents (misoprostol, PGE₂/dinoprostone) used for cervical ripening or induction; generally contraindicated in TOLAC due to risk of uterine hyperstimulation, which significantly increases uterine rupture risk in the scarred uterus.

NST showing ≥2 heart rate accelerations (each ≥15 bpm above baseline, lasting ≥15 seconds) within a 20-minute window; a reassuring finding indicating an intact fetal autonomic nervous system response to movement.

Relevant Condition at Death — a classification system for stillbirth causes using eight groups: Placenta (P), Umbilical cord (U), Fetus (F), Amniotic fluid (A), Maternal (M), Intrapartum (I), Neonatal (N), and Unexplained (U).

A Doppler finding in which umbilical artery blood flow is reversed during diastole; indicates near-critical placental failure; associated with very high perinatal mortality; immediate delivery is warranted regardless of gestational age.

Overlapping of skull bones on X-ray due to liquefaction of brain tissue in a macerated fetus; a radiological sign of antepartum fetal death.

Delivery of a dead baby at ≥28 weeks of gestation or ≥1000 g birth weight with no signs of life (no breathing, no heartbeat, no definitive movement).

Number of stillbirths per 1,000 total births (live births + stillbirths); India's rate is approximately 13.9 per 1,000 (SRS 2020); the global target is ≤12 per 1,000 by 2030.

The angle formed by the two pubic rami at the inferior border of the pubic symphysis; normally >90° (accommodates two thumbs comfortably); <85° suggests android pelvis with reduced effective outlet diameter.

Distance in centimetres from the upper border of the pubic symphysis to the uppermost point of the uterine fundus, measured in a straight line; approximates gestational age in weeks between 20 and 36 weeks (Bartholomew's rule: 1 cm ≈ 1 week).

Combined tetanus toxoid and diphtheria toxoid vaccine used in the ANC immunisation schedule; Td1 is given at first ANC contact and Td2 at least 4 weeks later; a single booster suffices if the woman was immunised within the previous 3 years.

Tetanus-diphtheria toxoid given as Td1 at first ANC contact and Td2 ≥4 weeks later; provides protection against tetanus for mother and neonatal tetanus for the newborn.

Inactivated bacterial toxoid vaccine that protects against tetanus and (for Td) diphtheria; safe in all trimesters of pregnancy and essential for preventing neonatal tetanus.

Trial of Labour After Caesarean — the attempt at vaginal delivery in a woman with a previous caesarean scar; TOLAC is the process, VBAC is the successful outcome.

A group of congenital infections — Toxoplasma, Rubella, Cytomegalovirus, Herpes simplex, and Others (syphilis, parvovirus B19, HIV) — that can cross the placenta and cause stillbirth or severe neonatal disease.

Allowing labour to proceed spontaneously or with augmentation in a woman with borderline CPD (obstetric conjugate 8–10 cm), under close monitoring, to determine whether vaginal delivery is achievable; abandoned and emergency caesarean performed if progress is inadequate.

Ultrasound assessment of blood flow velocity waveforms in the umbilical artery; pulsatility index (PI) above the 95th centile indicates increased placental vascular resistance; absent end-diastolic flow and reversed end-diastolic flow indicate progressive placental compromise and impending fetal demise.

Incomplete separation of a uterine scar confined to the myometrium, with the visceral peritoneum (serosa) remaining intact; the fetus stays within the uterine cavity; clinically distinct from complete rupture and often discovered incidentally at repeat CS.

Complete disruption of all uterine wall layers including the serosa, allowing fetal parts to extrude into the peritoneal cavity; a life-threatening obstetric emergency requiring immediate laparotomy.

Vaginal Birth After Caesarean — successful vaginal delivery in a woman who has had a previous caesarean section; the outcome when TOLAC succeeds.

Required for calcium absorption and fetal bone development; daily requirement 600 IU; deficiency is common in India due to pigmentation, clothing, and indoor work; supplements may be needed.

Normal gestational weight gain indexed to pre-pregnancy BMI; underweight women should gain 12.5–18 kg, normal-weight 11.5–16 kg, overweight 7–11.5 kg, and obese women 5–9 kg (IOM guidelines).

The WHO 2016 recommendation that every pregnant woman have at least 8 structured clinical contacts during her pregnancy, replacing the earlier 4-visit focused ANC model, based on evidence that more frequent contacts reduce perinatal mortality.