Appendix-B

DATA COLLECTION SHEET

Study title: Fetomaternal outcome of vaginal birth after cesarean section in women with
spontaneous labour.

Case No: Date:

 Name
 Address
 Age(Years)
 Lived in 1= Rural 2=Urban
 Education 1=Illiterate 2=Primary 3=Secondary
4=Higher secondary 5= Graduate
 Occupation 1=house wife 2=Service 3=Student
 Socioeconomic status 1=Ultra poor 2=Poor 3=lower middle class
4=Middle Class
 Para
 Gravida
 Anthropometry: Height and Weight at the time of
admission BMI (Kg/m2)
 Gestational age(weeks)
 Antenatal checkup: 1=Regular 2=Irregular 3=Not done
 Previous obstetric history 1=Present 2= Absent (1=PE, Eclampsia)
 Past history of normal vaginal delivery 1=Present 2=Absent
 Past history of cesarean section : 1/2/more
 Past history of puerperal sepsis 1=Present 2=Absent
 Rupture of membrane 1=Present 2= Absent
 Cervical Dilatation
 Medical history(DM, HTN, Thyroid disorders)
1=Present 2= Absent
 Oedema 1= Nil 2= Mild 3= Moderate 4= Severe
 Blood pressure