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    Prenatal Booklet Inside

    Uploaded by

    Jeremiah Mascariñas
    This document contains a prenatal form with fields to record information about a patient's pregnancy such as last menstrual period and estimated due date, trimester, vitals, fetal heart rate, and fundal height at prenatal visits. It also includes fields to check for symptoms, test results, advice provided, and plans for delivery and newborn screening. The form concludes with fields to document information about labor, delivery, and postpartum care such as birth weight, delivery details, and newborn health status.

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    Prenatal Booklet Inside

    Uploaded by

    Jeremiah Mascariñas
    27 views1 page
    This document contains a prenatal form with fields to record information about a patient's pregnancy such as last menstrual period and estimated due date, trimester, vitals, fetal heart rate, and fundal height at prenatal visits. It also includes fields to check for symptoms, test results, advice provided, and plans for delivery and newborn screening. The form concludes with fields to document information about labor, delivery, and postpartum care such as birth weight, delivery details, and newborn health status.

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    This document contains a prenatal form with fields to record information about a patient's pregnancy such as last menstrual period and estimated due date, trimester, vitals, fetal heart rate, and fundal height at prenatal visits. It also includes fields to check for symptoms, test results, advice provided, and plans for delivery and newborn screening. The form concludes with fields to document information about labor, delivery, and postpartum care such as birth weight, delivery details, and newborn health status.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    27 views1 page

    Prenatal Booklet Inside

    Uploaded by

    Jeremiah Mascariñas
    This document contains a prenatal form with fields to record information about a patient's pregnancy such as last menstrual period and estimated due date, trimester, vitals, fetal heart rate, and fundal height at prenatal visits. It also includes fields to check for symptoms, test results, advice provided, and plans for delivery and newborn screening. The form concludes with fields to document information about labor, delivery, and postpartum care such as birth weight, delivery details, and newborn health status.

    Copyright:

    © All Rights Reserved
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    of 1

    PRESENT PREGNANCY

    LMP MONTH DAY YEAR

    EDC MONTH DAY YEAR

    TRIMESTER 1st 2nd 3rd


    AOG in Months 1 2 3 4 5 6 7 8 9
    Date of Visit
    Weight in kg
    Height in cm
    Blood Pressure
    Position of Fetal Heart Beat
    Fundal Height in cm
    Vaginal Bleeding (Y/N)
    Urinary Tract Infection (Y/N)
    Vaginal Infection (Y/N)
    Edema (Y/N)
    > BP 140/90 mmHg (Y/N)
    Fever 39 °C & above (Y/N)
    Pallor (Y/N)
    Abnormal Fundal Height in cm 20 21-24 25-28 30-34
    (Y/N)
    Abnormal Presentation (Y/N)
    Lab test Result

    ACTION

    Iron/Folate #RX
    Iodine Supplementation in High Risk Areas
    Malaria Prophylaxis (Y/N)
    Mother intends to Breastfeed (Y/N)
    Advice on 4 danger signs (Y/N)
    Dental Check Up (Y/N)
    Emergency plans & place of Delivery (Y/N)
    Newborn Screening

    LABOR & DELIVERY

    Immediate breastfeeding (Y/N) Birth Weight in grams


    Type of Delivery Post-Partum Haemorrhage500 cc (Y/N)
    Date of Delivery Baby Alive
    Place of Delivery Baby Health (Y/N)

    Para sa LIGTAS na PANGANGANAK, manganak sa HEALTH CENTER, OSPITAL o


    LYING-IN CLINIC.

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