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Antenatal Course
Gravida
Para
Total live births
Total abortions
Total ectopic
Total stillbirths
Patient's Occupation
Husband's Occupation
Husband's Blood Group
Diagnosis
All Previous Pregnancies(Including abortions,ectopic,molar preg.)
Sl#
Year
Gender
Gest.age(Weeks)
Birth wt.(Kg)
Type of delivery
Place of birth
Duration
Current status
Comments:perinatal death,abortion,abnormalities
Date
Weight
(Kg)
BP
Complaints
G.A
(D)
G.A
(U)
Fundal
Ht(cm)
FH
Odema
ft.
Presentation
Urine Sug/Pro
Hb (gm%)
Liquor status
Return Visit
Signature
High Risk
Comments
5 WEEK
12 WEEK
13 WEEK
14 WEEK
15 WEEK
16 WEEK
17 WEEK
18 WEEK
19 WEEK
20 WEEK
21 WEEK
22 WEEK
23 WEEK
24 WEEK
25 WEEK
26 WEEK
27 WEEK
28 WEEK
29 WEEK
30 WEEK
31 WEEK
32 WEEK
33 WEEK
34 WEEK
35 WEEK
36 WEEK
37 WEEK
39 WEEK
40 WEEK
CEPHALIC
VERTEX
BREECH
OBLIQUE
TRANSVERSE
NIL
+
++
+++
++++
Obstetrics Remarks
Sl#
Date
Blood Group
Haemoglobin
Urine
RBS
GCT
GTT
HBSAG
HIV
VRDL
TSH
Platelet
HCV
HBA
1
C
FBS
PPBS
DM/NIPT
Investigation Remarks
TD
1
TD
2
TDAP
ANTINATAL ANTI D
INFLUVAC
USG
1
st
2
st
3
st
4
st
5
st
6
st
Therapeutic Diet
Normal Diet
Antenatal Diet
Post Natal Diet
Diabetic Diet
PCOS Diet
Iron Rich Diet
Low Sodium
Low Cholestrol
High Protein Diet
Counseling
Review/Follow up
Previous Course Details
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