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
clear
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
clear
Obstetrics Remarks
Sl# Date Blood Group Haemoglobin Urine RBS GCT GTT HBSAG HIV VRDL TSH Platelet HCV HBA1C FBS PPBS
clear
DM/NIPT
Investigation Remarks
TD1
TD2
TDAP
ANTINATAL ANTI D
INFLUVAC
USG
1st
2st
3st
4st
5st
6st
Therapeutic Diet
Counseling
Review/Follow up
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