Antenatal consultations — MSF Essential obstetric and newborn care — Médecins Sans Frontières 2026

Q: How many antenatal consultations are recommended and when?

Four consultations for uncomplicated pregnancies: first in the first trimester (≤13 weeks LMP), second in the second trimester (14-26 weeks), third in early third trimester (27-35 weeks), and fourth in late third trimester (36-40/41 weeks). If a woman presents after month 6, aim for at least 2 consultations before delivery.

Q: What screening tests are required at the first antenatal visit?

Syphilis (treponema-specific rapid test), HIV (with consent; offer to all who don't know their status), anaemia (haemoglobin measurement with HemoCue; <11 g/dl in first/third trimester or <10.5 g/dl in second trimester defines anaemia), malaria (rapid test in endemic areas even without symptoms), and asymptomatic bacteriuria (urinalysis with reagent test strips).

Q: What is the correct iron and folic acid supplementation for pregnant women without anaemia?

Ferrous sulfate 200 mg (containing 65 mg elemental iron) plus folic acid 400 micrograms, one tablet once daily, starting as early as possible and continuing throughout pregnancy. Alternatively, 30 mg elemental iron daily can be used in settings where anaemia prevalence in pregnant women is <40%. In areas where hookworm is common, add albendazole 400 mg single dose from the second trimester.

Q: How should tetanus vaccination be scheduled during pregnancy?

Women not previously vaccinated should receive at least 2 doses of tetanus vaccine (preferably Td, or TT if unavailable) before giving birth: the first dose at the first consultation, and the second dose at least 4 weeks after the first and ideally at least 2 weeks before the due date. Continue after birth to a total of 5 doses for lifelong protection (80% protection after 2 doses, 95% after 3 doses, 99% after 4-5 doses).

MSFClinical guideline (chapter)Current edition

From Essential obstetric and newborn care › Chapter 1: Diagnosing and monitoring pregnancy · Médecins Sans Frontières, Current online edition, 2026

MSF clinical guideline on scheduling, screening, preventive treatments and birth planning for uncomplicated pregnancies.

In one sentenceMSF recommends four antenatal consultations with screening for syphilis, HIV, anaemia and bacteriuria; tetanus vaccination (≥2 doses); iron 65 mg + folic acid 400 micrograms daily; and birth planning.

Issuer: Médecins Sans Frontières
Edition: Current online edition, 2026
Audience: Midwives, obstetricians, general practitioners, clinical officers
Evidence: Expert consensus based on WHO and evidence-based protocols
Reviewed: 23 Oct 2026 · GMJ

Read the original on MSF Whole guideline (PDF)

Summary by GMJ Guidelines Desk•Reviewed by Prof. Giorgi Pkhakadze, MD, MPH, PhD•Record updated 23 Oct 2026•Next check Apr 2027

What this guideline says

GMJ summary

This MSF guideline section provides a comprehensive framework for antenatal care in resource-limited settings. It recommends four antenatal consultations for uncomplicated pregnancies, scheduled in the first, second, early third and late third trimesters. The first consultation includes detailed history taking, gestational age estimation, clinical examination and laboratory screening for syphilis, malaria (in endemic areas), HIV, anaemia and urinary tract infections. Subsequent consultations focus on monitoring foetal growth, presentation and heart tones, with repeated screening for urinary tract infections and malaria.

The guideline emphasises preventive interventions including tetanus vaccination (at least 2 doses before delivery), iron and folic acid supplementation (65 mg elemental iron + 400 micrograms folic acid daily, or 30 mg elemental iron in low-prevalence anaemia settings), intermittent preventive treatment for malaria with sulfadoxine-pyrimethamine in endemic African regions, antihelminthic treatment in hookworm-endemic areas, and calcium supplementation (1.5 g elemental calcium daily) for adolescents and high-risk women. Treatment protocols are specified for HIV-positive women and those with urinary tract infections.

Birth preparedness is central, with both group and individual counselling sessions to develop personalised birth plans. The guideline distinguishes between Basic Emergency Obstetric and Newborn Care (BEmONC) and Comprehensive Emergency Obstetric and Newborn Care (CEmONC) facilities, guiding appropriate site selection based on pregnancy course and risk factors.

Key points

For clinicians — doses and thresholds as stated in the guideline

Four antenatal consultations recommended: first trimester (≤13 weeks), second trimester (14-26 weeks), early third trimester (27-35 weeks) and late third trimester (36-40/41 weeks); minimum 2 consultations if presenting after month 6
First-visit screening: syphilis (treponema-specific rapid test; re-test at ≥28 weeks if prevalence ≥5%), HIV (offer to all; re-test in third trimester if initially negative), anaemia (Hb <11 g/dl in first/third trimester or <10.5 g/dl in second trimester defines anaemia), malaria (rapid test in endemic areas) and asymptomatic bacteriuria (urine dipstick)
Iron and folic acid supplementation for all pregnant women: ferrous sulfate 200 mg (65 mg elemental iron) + folic acid 400 micrograms PO once daily; alternatively 30 mg elemental iron daily in settings where anaemia prevalence is <40%
Tetanus vaccination: at least 2 doses (Td or TT vaccine) with first dose at first consultation, second dose ≥4 weeks later and ideally ≥2 weeks before delivery; continue to total of 5 doses for lifelong protection
Malaria prevention in moderate-to-high transmission areas: insecticide-treated bed nets, testing at each second/third trimester visit, and intermittent preventive treatment with sulfadoxine-pyrimethamine 3 tablets as single dose (at least 3 doses from second trimester, ≥1 month apart) if test negative
Calcium supplementation for adolescents (<20 years) and women with low calcium intake at high risk of pre-eclampsia: calcium carbonate 1.25 g (500 mg elemental calcium) PO 3 times daily throughout pregnancy, with 2-hour gap from iron
Foetal heart rate should be 110-160 beats/minute, regular and out of sync with maternal pulse; fundal height measurement from second trimester correlates with gestational age (e.g. 20 cm = 18-22 weeks, 34 cm = 33 weeks to term)
Birth plan must specify delivery site (BEmONC or CEmONC facility based on risk) and necessary arrangements; women with height <1.50 m require identification but small pelvis alone does not predict foeto-pelvic disproportion

Table 1.2 – Schedule of antenatal consultations

Table extracted from the guideline

Trimester	Month	Weeks LMP	Consultation schedule
First	1-3	2-13	≤ Consultation 1
Second	4-6	14-26	≤ Consultation 2
Third	7-8	27-35	≤ Consultation 3
Third	9	36-40/41	≤ Consultation 4

Source: Médecins Sans Frontières, Antenatal consultations — MSF Essential obstetric and newborn care. Reproduced in summary form.

From the guideline

Verbatim

“Four antenatal consultations are recommended for uncomplicated pregnancies.”

— Médecins Sans Frontières, Antenatal consultations — MSF Essential obstetric and newborn care, Section 1.2.2 (2026)

Editor’s perspective

Why this matters for Georgia and the region

Prof. Giorgi Pkhakadze, MD, MPH, PhD

Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration

As a WHO consultant and chair of Georgia's Public Health Institute, I recognise this MSF guideline addresses the reality of antenatal care in resource-constrained settings with practical, evidence-based protocols. For Georgian clinicians, I would emphasise the four-visit model as a minimum standard—our national protocols may specify additional visits, but these four capture essential screening and preventive interventions. The tetanus vaccination schedule deserves particular attention: while Georgia's EPI programme has achieved high childhood coverage, we must verify each pregnant woman's vaccination history and provide at least two doses if previously unvaccinated, ensuring the second dose is given at least two weeks before delivery for optimal passive antibody transfer. The calcium supplementation recommendation—1.5 grammes of elemental calcium daily for adolescent pregnancies and high-risk women—is often overlooked in our protocols but is crucial for pre-eclampsia prevention. Implementation challenges in Georgia include ensuring consistent availability of treponema-specific rapid tests for syphilis screening in primary care settings, and clearly delineating which facilities in our regions qualify as BEmONC versus CEmONC level under our universal health coverage system.

ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 23 Oct 2026

Applicability

Georgia and the South Caucasus

This guideline is directly applicable to Georgia and the South Caucasus where primary health care and maternal health programmes require standardised antenatal protocols. Georgian national programmes should verify local prevalence thresholds: syphilis prevalence to determine re-testing schedules, anaemia prevalence (if ≥40%, the 65 mg elemental iron dose is preferred over 30 mg), and malaria transmission intensity (Georgia is malaria-free since 2010, so malaria screening and intermittent preventive treatment are not relevant, though screening may be considered for returning travellers or migrants). Calcium supplementation recommendations are particularly relevant given dietary patterns and the WHO European Region’s lower but still significant anaemia prevalence (25%). National protocols should clarify tetanus vaccination status given Georgia’s expanded programme on immunisation, ensure availability of treponema-specific rapid tests for syphilis, and define the distribution of BEmONC versus CEmONC facilities within the universal health coverage framework introduced in 2013.

Questions this guideline answers

Quick answers

How many antenatal consultations are recommended and when?

Four consultations for uncomplicated pregnancies: first in the first trimester (≤13 weeks LMP), second in the second trimester (14-26 weeks), third in early third trimester (27-35 weeks), and fourth in late third trimester (36-40/41 weeks). If a woman presents after month 6, aim for at least 2 consultations before delivery.

What screening tests are required at the first antenatal visit?

Syphilis (treponema-specific rapid test), HIV (with consent; offer to all who don't know their status), anaemia (haemoglobin measurement with HemoCue; <11 g/dl in first/third trimester or <10.5 g/dl in second trimester defines anaemia), malaria (rapid test in endemic areas even without symptoms), and asymptomatic bacteriuria (urinalysis with reagent test strips).

What is the correct iron and folic acid supplementation for pregnant women without anaemia?

Ferrous sulfate 200 mg (containing 65 mg elemental iron) plus folic acid 400 micrograms, one tablet once daily, starting as early as possible and continuing throughout pregnancy. Alternatively, 30 mg elemental iron daily can be used in settings where anaemia prevalence in pregnant women is <40%. In areas where hookworm is common, add albendazole 400 mg single dose from the second trimester.

How should tetanus vaccination be scheduled during pregnancy?

Women not previously vaccinated should receive at least 2 doses of tetanus vaccine (preferably Td, or TT if unavailable) before giving birth: the first dose at the first consultation, and the second dose at least 4 weeks after the first and ideally at least 2 weeks before the due date. Continue after birth to a total of 5 doses for lifelong protection (80% protection after 2 doses, 95% after 3 doses, 99% after 4-5 doses).

Related on GMJ

Interconnected resources

Dictionary of Public Health

Conditions A–Z

Urinary Tract Infection

GMJ News coverage

Quality & accreditation

Same guideline

Diagnosing pregnancy — MSF Essential obstetric and newborn careChapter 1: Diagnosing and monitoring pregnancy

Antenatal consultations — MSF Essential obstetric and newborn care

What this guideline says

Key points

Table 1.2 – Schedule of antenatal consultations

From the guideline