- IDENTIFICATION DATA
- Name -
- Age -
- Residency -
- Education -
- Profession -
- Blood group ?
- LMP ?
- G P [TPAL]
- Husband's Name -
- Husband profession -
- Time since marriage ?
- Husband Blood group ?
- [Booked/Unbooked]
- [Registered/Referred]
- EDD ?
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- Chief COMPLAINTS (great detail)
- H/O PRESENT PREGNANCY
1st trimester - Nausea-Vomiting
- Folic Acid tablet (Yellow)
- Ultrasound (& date?)
- Tetanus toxoid
- Fever
- Pain - abd./pelvic/back
- Burning micturition
- Discharge
- Bleeding p/v
- ANC visit?
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Period of amenorrhea ? Conceivement ? spontaneous/planned/treatment Realization of pregnancy ? symptoms / test kit / other Confirmation of pregnancy ? 2nd trimester - Iron + Folic Acid tablets
- Quickening - date?
- Ultrasound
- Tetanus toxoid?
- Fever
- Pain - Abd/pelvic/back
- Bleeding - p/v
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3rd Trimester - Ultrasound
- ANC visits?
- Bleeding p/v
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- PAST OBSTETRICS HISTORY ? * for each pregnancy *
- Pregnancy
- # Outcome of pregnancy
- # gestational age at delivery
- Delivery
- # Normal/C-section (Why?)
- # LABOR - induced/spontaneous normal/prolonged
- * if Abortion (method of abort.) # place of delivery ?
- # complications ?
- Perperium
- complications
- Baby
- # Gender
- # Age (current)
- # Birth Wt.
- # breastfeeding
- # Immunization
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- MENSTRUAL HISTORY
- # Menarche - Age
- # Cycle - No. of days
- # Rhythm - Regular / Irregular
- # Post-coital bleeding
- # Contraceptive use
- * Note LNMP here if not noted before
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- Family History
- Personal History
- diet
- Smoking
- alcoholism
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- PAST HISTORY
- H/o blood transfusion
- any surgery
- Chronic disease-
- DM
- HTN
- TB
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- Pelvic inflammatory Disease
- other (medicine History)
- Allergy
- (drug allergy)
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This download link is referred from the post: MBBS Lecture Notes for all subjects (updated for 2021 syllabus) - All universities