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    Obstetrical History Previous Pregnancies Complicated With YES NO Family History

    Uploaded by

    Desiree Cecilio Manlangit
    This document contains a patient's obstetric history and information on their present pregnancy. It collects information such as the patient's name, occupation, blood type, age, height, weight, last menstrual period, and estimated date of confinement. It also notes their obstetric history including previous pregnancies, deliveries, complications, and family history of disease. For their present pregnancy, it tracks information by trimester including dates of visits, gestational age, weight, symptoms, vital signs, fetal presentation, and results of lab tests and exams.

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    Obstetrical History Previous Pregnancies Complicated With YES NO Family History

    Uploaded by

    Desiree Cecilio Manlangit
    59 views2 pages
    This document contains a patient's obstetric history and information on their present pregnancy. It collects information such as the patient's name, occupation, blood type, age, height, weight, last menstrual period, and estimated date of confinement. It also notes their obstetric history including previous pregnancies, deliveries, complications, and family history of disease. For their present pregnancy, it tracks information by trimester including dates of visits, gestational age, weight, symptoms, vital signs, fetal presentation, and results of lab tests and exams.

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    Original Title

    Maternity Health Record

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    This document contains a patient's obstetric history and information on their present pregnancy. It collects information such as the patient's name, occupation, blood type, age, height, weight, last menstrual period, and estimated date of confinement. It also notes their obstetric history including previous pregnancies, deliveries, complications, and family history of disease. For their present pregnancy, it tracks information by trimester including dates of visits, gestational age, weight, symptoms, vital signs, fetal presentation, and results of lab tests and exams.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    59 views2 pages

    Obstetrical History Previous Pregnancies Complicated With YES NO Family History

    Uploaded by

    Desiree Cecilio Manlangit
    This document contains a patient's obstetric history and information on their present pregnancy. It collects information such as the patient's name, occupation, blood type, age, height, weight, last menstrual period, and estimated date of confinement. It also notes their obstetric history including previous pregnancies, deliveries, complications, and family history of disease. For their present pregnancy, it tracks information by trimester including dates of visits, gestational age, weight, symptoms, vital signs, fetal presentation, and results of lab tests and exams.

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    © All Rights Reserved
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    FAMILY NUMBER: _____________________________________________________________________________

    NAME : _____________________________________________________________________________

    OCCUPATION : _____________________________________________________________________________

    BLOOD TYPE : _____________________________________________________________________________

    < 18 YEARS OLD 145 cm GRAVIDA: __________ Date of Last


    AGE 18-34 HEIGHT 145 cm PARA: ______________ Delivery:
    More than 35 yrs WEIGHT ABORTION: __________ Type of Delivery:
    old LMP: _______________
    EDC: _______________

    OBSTETRICAL HISTORY PREVIOUS


    PREGNANCIES YES NO FAMILY HISTORY
    COMPLICATED
    WITH
    No. of children born alive Hemorrhage Any special disease:
    No. of living children Toxemia ( ) Yes: Specify
    No. of Abortion Placenta Previa _____________________________
    No. of stillbirths/fetal Sepsis Special Case:
    No. of deaths Non-Obstetrical ( ) Yes: Specify
    Illness (specify) _____________________________
    No. of deliveries thru cesarean Others (specify) ( ) No

    PRESENT PREGNANCY
    TRIMESTER 1ST 2ND 3RD
    2-3 4 5 6 7 8 9
    mons.

    Date of visit
    Age of gestation (in weeks)
    Weight (in kg)
    Bleeding/Spotting (Y?N)
    Urinary Tract Infection (Y/N)
    B/P
    B/P > 140/90
    Fever > 38 c (Y/N)
    Pallor (Hgb.<110mg/dl)
    Fundic Height (cm)
    Presentation 20 cm 21-24 25-28 28-30 30-34
    Presence of FHT (Y/N)
    Edema (Y/N)
    Abnormal Vaginal Discharge (Y/N)
    Laboratory Result:

    Blood
    Urine (Albumin)
    VDRL
    Others
    Date Hemoglobin
    Taken/Result (P/F)
    Date Given
    Iron tablets Prescribed
    Date Given
    Vitamin A Prescribed
    Seen by Dentist
    Seen by Doctor

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