DELIVERY AND NEWBORN CASE DETAILS DELIVERY AND NEWBORN CASE DETAILS

Patient name: Age: Civil status: Patient name: Age: Civil status:
Address: LMP: EDC: AOG: Address: LMP: EDC: AOG:
G: T: P: A: L: M: G: T: P: A: L: M:
Attending Physician: Attending Physician:
Staff Nurse on Duty: Staff Nurse on Duty:
Diagnosis: Diagnosis
ASSIST ASSIST ASSIST ASSIST

Method of Delivery: Vital Signs: Method of Delivery: Vital Signs:

□ NSVD □ Cesarian Heart rate: □ NSVD □ Cesarian Heart rate:

Presentation: Temperature: Presentation: Temperature:

□ Cephalic □ Breech Respiratory rate: □ Cephalic □ Breech Respiratory rate:

Time of Delivery: Gender: Anthropometric Measurement Time of Delivery: Gender: Anthropometric Measurement
Anesthesia: □ Yes □ No HC: CC: Anesthesia: □ Yes □ No HC: CC:
Time of Lidocaine Admin: AC: MAC: Time of Lidocaine Admin: AC: MAC:
Blood Pressure: WT.: LENGTH: Blood Pressure: WT.: LENGTH:

Time of Oxytocin Admin: HEP B admin: Time of Oxytocin Admin: HEP B admin:
Type of Episiotomy: VIT K admin: Type of Episiotomy: VIT K admin:
□ Medio-lateral □ Midline Crede’s Prophylaxis: □ Medio-lateral □ Midline Crede’s Prophylaxis:
PLACENTA APGAR SCORE PLACENTA APGAR SCORE
Placenta out: Score 0 1 2 Placenta out: Score 0 1 2
Presentation: Appearance Presentation: Appearance
□ Schultze □ Duncan Pulse □ Schultze □ Duncan Pulse
EPISIORAPHY EPISIORAPHY
Grimace Grimace
Time begins: Time end: Time begins: Time end:
Activity Activity
Color of vaginal secretion: Color of vaginal secretion:
Respiration Respiration