# Maternal Health Programmes for NEET PG PSM: ANC Schedule, Partograph, AMTSL, JSY, JSSK, PMSMA, Calcium, MDSR Source: https://tracknation.in/story/maternal-health-programmes-for-neet-pg-psm-anc-schedule-partograph-amtsl-jsy-jssk-pmsma-calcium-mdsr (TrackNation — free UPSC notes with PYQs) > NEET PG Community Medicine: the four-visit ANC schedule and where each test is done, anaemia cut-offs, partograph alert and action lines, AMTSL with oxytocin or misoprostol, calcium from 14 weeks, Janani Suraksha Yojana cash amounts, JSSK free entitlements, PMSMA on the 9th of every month, post-natal care and maternal death surveillance — from MoHFW guidelines, with verified MCQs and cards. ## Start Here 🎯 **Exam priority: High-yield (Tier 1).** *Maternal health questions test the ANC visit windows, partograph lines, AMTSL, JSY amounts and eligibility, JSSK entitlements, the PMSMA date and the definition of a maternal death. Everything here is from MoHFW guideline documents.* CBME mapping: **CM 10**. ## Antenatal Care At least **four** antenatal visits (more if needed): | **Visit** | **When** | | 1st | Within 12 weeks — as soon as pregnancy is suspected (registration + first check-up) | | 2nd | 14–26 weeks | | 3rd | 28–34 weeks (ideally with the PHC medical officer) | | 4th | 36 weeks to term | - At the **sub-centre**: pregnancy test, haemoglobin, urine sugar and protein, rapid malaria test. At the **PHC/CHC/FRU**: blood group with Rh, VDRL/RPR, HIV, blood sugar and more. - **Anaemia** in pregnancy: Hb below **11 g/dl**; severe below **7 g/dl**. (IFA and deworming schedules are in the nutrition article — Anaemia Mukt Bharat.) - **Calcium**: 1 g a day as two tablets (with two different meals — never both at once), from **14 weeks** of pregnancy to **6 months after delivery**. - **PMSMA**: fixed-day, assured ANC for women in the **2nd/3rd trimester** on the **9th of every month** by obstetricians/medical officers, with private doctors volunteering. High-risk women get a **red sticker** on the MCP card; others a green one. ## Labour: Partograph and AMTSL - Active labour starts at **4 cm** cervical dilatation; the first plot goes on the **alert line**. - The **action line** is **4 hours** to the right of the alert line. Crossing the alert line means refer to an FRU; crossing the action line means intervention is needed. - The second stage takes about 2 hours in a primigravida and about half an hour in a multigravida. - **AMTSL** (to prevent PPH): (1) a uterotonic — **oxytocin 10 IU IM** in a facility, or **misoprostol 600 µg orally** for a home delivery; (2) **controlled cord traction**; (3) **uterine massage**. - Oxytocin is stored at **4–8 °C** and must not be frozen. - Newborn: normal respiratory rate is 30–60 a minute; outside this range, refer. ## Janani Suraksha Yojana and JSSK **JSY** pays cash for institutional delivery. Low Performing States (LPS): UP, Uttarakhand, Bihar, Jharkhand, MP, Chhattisgarh, Assam, Rajasthan, Odisha and J&K; the rest are High Performing States (HPS). | **Area** | **LPS: mother / ASHA** | **HPS: mother / ASHA** | | Rural | ₹1400 / ₹600 (total ₹2000) | ₹700 / ₹200 (total ₹900) | | Urban | ₹1000 / ₹200 (total ₹1200) | ₹600 / ₹200 (total ₹800) | - In LPS, all pregnant women delivering in government or accredited private institutions are eligible; in HPS, BPL women aged 19+ and all SC/ST women. - Home delivery (BPL, 19+): ₹500 per delivery, up to **2 live births**. Each beneficiary has a JSY card with the MCH card. - *Amounts as in the national JSY guidelines (ASHA package for HPS from April 2009).* **JSSK** (launched **1 June 2011**): free and cashless delivery including caesarean section, drugs, diagnostics, diet, blood, no user charges, and free transport home → facility, between facilities and back home after a **48-hour** stay. Sick newborns were covered up to 30 days, since expanded to sick infants. ## Post-natal Care and Maternal Death Surveillance - The post-natal period lasts **6 weeks (42 days)**; up to 30% of maternal deaths happen in it. High-risk mothers are picked up during HBNC home visits and sent to a facility or PMSMA session. - **Maternal death**: death while pregnant or within **42 days** of the end of pregnancy, from any cause related to or aggravated by the pregnancy or its management — *not* accidental or incidental causes. - **MMR** = maternal deaths per **1,00,000 live births**. - **MDSR**: the **ASHA** is the primary informant and reports the death of any woman aged 15–49 within **24 hours**; a facility sends the notification within 24 hours and the investigation form within 48 hours, and files a **NIL report** in months without deaths. ## Traps the Examiner Sets - First ANC visit is within **12 weeks**; the 3rd visit (28–34 weeks) is the one with the MO. - Action line = alert line + **4 hours**. - Home-delivery uterotonic = **misoprostol 600 µg**, not oxytocin. - Calcium starts at **14 weeks**, not the first trimester. - PMSMA = **9th** of every month, 2nd/3rd trimester only. - JSY LPS rural mother gets ₹1400; JSSK is entitlements (no cash). - Maternal death window is **42 days** and excludes accidental causes; MMR denominator is live births. ## Rapid-Revision Cards - ≤ 12 wk · 14–26 wk · 28–34 wk (with MO) · 36 wk–term. - Pregnancy test, Hb, urine sugar + protein, malaria RDT. - Blood group + Rh, VDRL/RPR, HIV, blood sugar. - Hb < 11 g/dl; severe < 7 g/dl. - 1 g/day as 2 tablets, 14 weeks → 6 months postpartum. - Active labour ≥ 4 cm; alert line → refer; action line (+4 h) → intervene. - Oxytocin 10 IU IM (facility) or misoprostol 600 µg oral (home) + CCT + uterine massage. - 4–8 °C, never frozen. - LPS ₹1400 + ASHA ₹600; HPS ₹700 + ASHA ₹200. - LPS ₹1000 + ₹200; HPS ₹600 + ₹200. - LPS: all institutional deliveries; HPS: BPL 19+ and all SC/ST. - ₹500, BPL 19+, up to 2 live births. - 1 June 2011; free delivery/CS, drugs, diagnostics, diet, blood, transport (drop back after 48 h). - 9th of every month; 2nd/3rd trimester; red sticker = high risk. - During pregnancy or ≤ 42 days after; not accidental/incidental. - ASHA primary informant; 24 h notification; facility form 4 within 48 h; NIL reports. ## Sources ## Sources *Facts in this article were checked against these documents.* - Guidelines for Antenatal Care and Skilled Attendance at Birth by ANMs/LHVs/SNs — Maternal Health Division, MoHFW, 2010 (link) - Janani Suraksha Yojana: Features & Frequently Asked Questions and Answers (guidelines) — MoHFW, 2006 (link) - Janani Shishu Suraksha Karyakaram (JSSK) — National Health Mission, n.d. (link) - Pradhan Mantri Surakshit Matritva Abhiyan: Operational Framework — MoHFW, 2016 (link) - National Guidelines for Calcium Supplementation During Pregnancy and Lactation — MoHFW, 2014 (link) - Guidance Note on Optimizing Post-Natal Care — MoHFW, n.d. (link) - Guidelines for Maternal Death Surveillance & Response — MoHFW, n.d. (link) ## Test Yourself: Practice Questions Eighteen questions in NEET PG style. ## Practice Questions (NEET PG pattern) *Original questions written in the style of the exam: +4 for a correct answer, −1 for a wrong one. Every answer was checked against the sources listed above. NEET PG papers are not published by NBEMS, so these are not past-paper questions.* **Q1.** Under MoHFW guidelines, the first antenatal visit should be - (a) after quickening - (b) at 16 weeks - (c) between 14 and 26 weeks - (d) within 12 weeks **Answer: (d)** — 1st visit within 12 weeks (registration); 2nd 14–26; 3rd 28–34; 4th 36 weeks to term. **Q2.** The antenatal visit recommended with the PHC medical officer is between - (a) 36 weeks and term - (b) 14 and 26 weeks - (c) 8 and 12 weeks - (d) 28 and 34 weeks **Answer: (d)** — The third visit (28–34 weeks) should ideally be with the MO at the PHC. **Q3.** Which antenatal test is done at the sub-centre? - (a) VDRL/RPR - (b) Blood grouping with Rh - (c) Haemoglobin estimation - (d) HIV testing **Answer: (c)** — SC: pregnancy test, Hb, urine sugar/protein, malaria RDT; PHC/CHC/FRU: blood group, VDRL/RPR, HIV, sugar. **Q4.** On a partograph, the action line lies to the right of the alert line by - (a) 6 hours - (b) 4 hours - (c) 2 hours - (d) 1 hour **Answer: (b)** — There is a 4-hour difference between the alert and action lines. **Q5.** Active phase of labour begins at a cervical dilatation of - (a) 2 cm - (b) 8 cm - (c) 6 cm - (d) 4 cm **Answer: (d)** — Latent stage < 4 cm; active stage beyond 4 cm — the first recording goes on the alert line. **Q6.** For a home delivery, the uterotonic recommended for AMTSL by the MoHFW guidelines is - (a) misoprostol 600 µg orally - (b) ergometrine 0.2 mg IV - (c) oxytocin 10 IU IV push - (d) carboprost 250 µg IM **Answer: (a)** — Oxytocin 10 IU IM at a facility; misoprostol 600 µg orally at home. **Q7.** Which is NOT a component of AMTSL? - (a) Controlled cord traction - (b) Early fundal pressure - (c) Uterotonic drug - (d) Uterine massage **Answer: (b)** — AMTSL = uterotonic + controlled cord traction + uterine massage. **Q8.** National guidelines recommend calcium supplementation of - (a) 500 mg/day from conception - (b) 1 g/day in two divided doses from 14 weeks of pregnancy to 6 months postpartum - (c) 2 g/day as a single dose - (d) 1.5 g/day only in the third trimester **Answer: (b)** — Two tablets a day (total 1 g), with two different meals, from 14 weeks to 6 months after delivery. **Q9.** Under Janani Suraksha Yojana, a mother in a rural area of a Low Performing State receives - (a) ₹600 - (b) ₹1400 - (c) ₹700 - (d) ₹1000 **Answer: (b)** — LPS rural: mother ₹1400 + ASHA ₹600; HPS rural: ₹700 + ₹200. **Q10.** In High Performing States, JSY cash for institutional delivery is available to - (a) BPL women aged 19 and above and all SC/ST women - (b) only women delivering at home - (c) only primigravidas - (d) all pregnant women **Answer: (a)** — LPS: all women in government/accredited institutions; HPS: BPL women 19+ and all SC/ST women. **Q11.** JSY assistance for home delivery to BPL women is - (a) ₹500 for every birth - (b) not available - (c) ₹1400 per delivery - (d) ₹500 per delivery, up to 2 live births **Answer: (d)** — ₹500 per delivery for BPL women aged 19+, only up to 2 live births. **Q12.** Janani Shishu Suraksha Karyakram (JSSK) was launched on - (a) 12 April 2005 - (b) 9 June 2016 - (c) 1 June 2011 - (d) 15 August 2018 **Answer: (c)** — JSSK was launched on 1 June 2011. **Q13.** Which is a JSSK entitlement for pregnant women? - (a) Free sterilisation incentive - (b) Cash of ₹1400 - (c) Free drop back home after a 48-hour stay - (d) Free formula milk **Answer: (c)** — JSSK gives free delivery, C-section, drugs, diagnostics, diet, blood and transport including drop back after 48 hours — no cash. **Q14.** Pradhan Mantri Surakshit Matritva Abhiyan provides fixed-day antenatal care on - (a) the 1st of every month - (b) the 15th of every month - (c) every Wednesday - (d) the 9th of every month **Answer: (d)** — PMSMA: assured ANC for women in the 2nd/3rd trimester on the 9th of every month. **Q15.** Under PMSMA, a high-risk pregnant woman's MCP card is marked with a - (a) red sticker - (b) blue stamp - (c) green sticker - (d) yellow sticker **Answer: (a)** — Red sticker/stamp for high risk; green otherwise. **Q16.** A maternal death includes death within how many days of the end of pregnancy? - (a) 42 days - (b) 7 days - (c) 28 days - (d) 1 year **Answer: (a)** — Death while pregnant or within 42 days of termination of pregnancy, excluding accidental or incidental causes. **Q17.** Under MDSR, the primary informant for deaths of women aged 15–49 in a village is the - (a) Gram pradhan - (b) ASHA - (c) Medical officer - (d) ANM **Answer: (b)** — The ASHA reports the death of any woman aged 15–49 to the ANM and block medical officer within 24 hours. **Q18.** The denominator of the maternal mortality ratio is - (a) 1,00,000 women aged 15–49 - (b) 1,00,000 population - (c) 1,00,000 live births - (d) 1000 live births **Answer: (c)** — MMR = maternal deaths per 1,00,000 live births in the same period. ### Active Recall From memory: give the four ANC visit windows and where each test is done; explain the partograph lines and the three steps of AMTSL; state the calcium schedule; give JSY amounts and eligibility, JSSK entitlements and the PMSMA arrangement; and define a maternal death, MMR and the MDSR reporting chain.