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Assessment
Name
All
Hypertension
Diabetes
Obstructed Labor
HamoRhage
Speticaemia
Septic Inudced Abortion
Thrombo Embolism
Others
Type
All
PIH
Chronic
Pre Eclampsia
Eclampsia
HELLP Syndrome
GDM
Known
Yes
No
Antipartum
Postpartum
Placental Abruption
Placenta Praevia
Puerperal Sepsis
Septic Shock
Yes
No
Pulmonary Embolism
Amniotic Fluid Embolism
Active phase of labour precious pregnancy / bad obstetric history
active phase of labour pregnancy with anaemia
active phase of labour
Dai handled / obstructed labour
Ectopic pregnancy
latent phase of labour
polyhydraminos
post dates / prolonged pregnancy
PPROM
precious pregnancy diabetes
precioys pregnancy / bad obstetric history renal pathology
pregnancy with anaemia
Preterm labour
previous 1 lscs pregnancy with anaemi breech presentation
previous 1 lscs/ CPD
previous 2 LSCS pregnancy with anemia
Previous 2 LSCS for ELLSCS
Prolonged pregnancy precious pregnncy / bad obstetric history
prolonged pregnancy / post dates active phase of labour
prolonged pregnancy / post dates latent phase of labour
prolonged pregnancy / post dates
PROM Bad obstetric history
PROM
renal pathology
unassessed breech in labour
Patient Information
Patient Education
Family Maternal Mortality
Family Prenatal Mortality
All
Matriculate
Not Known
Masters/Post graduation
Graduate
Illiterate
Middle
Intermediate
Primary
All
No
All
Yes
No
Blood Group
Cousin Marriage
All
O-
A+
UnKnown
A-
B-
AB-
O+
AB+
B+
All
Not related
First
Second
Presenting Complaints History
Presenting Complaints History
All
Abdominal Pain
Dai Handling
Diabetes
Fever
Fits
Labor Pain
PV Bleeding
PV Leakage
Raised BP
Red FM
Syncopal Attacks
Urinary Complaints
Vaginal Discharge
Vomitting
Absent Fetal Movement
Vision Bluring
Dysponea
Easy Fatiguability/Generalized Weakness
Epigastric Discomfort
Headache
Nausea
Passage of Vesicles Per Vaginum
Post Dates/Prolonged Pregnancy
Pregnancy
Planned Pregnancy?
Pregnancy Reaction
All
No
Yes
Unknown
All
Unpleased
UnKnown
Pleased
Gravida
ParityBefore24Months
ParityAfter24Months
PatientAge
1
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