SU5MR CR- 1/2020

STILLBIRTH & UNDER 5 MORTALITY CONSOLIDATION REPORT

STATE: DISTRICT:

Antenatal History (

Perinatal History (place of delivery, perinatal events, gestation, mode of delivery, BW, resuscitation, Apgar score,
NICU/SCN admission)

Patient delivered at HRPZ II via SVD after 2nd cycle of prostin at 29weeks 3days POG. Delivered baby girl, bw 970g,
grossly normal baby.

Neonatal History (comorbidity, postnatal visits, hospital admission, feeding issue, social concern)

Childhood History (main carer, immunization, comorbidity, hospital admission, growth, development, social
concern)

Events leading to death (timeline terminal events, investigation (laboratory/radiological, post mortem)

Cause of death

1. Macerated Still Birth grade 3

-Unknown cause

Death category: Please tick ( / ) one column either A/B/C and choose (a) or (b) or both as appropriate:

A. Preventable B. Not preventable √ C. Undetermined

a) Medically treatable a) Palliative case a) Post-mortem done
b) Public health issue b) Non palliative case b) Pending special Ix
√
Shortfalls: (as determined during district U5M meeting)