Health Centre

/Clinic/Hospital
Delivery Register

Region Zone/Subcity/Woreda Health Facility Name Begin Date End Date

 INSTRUCTION FOR DELIVERY CARE
REGISTER

The register is kept in delivery room (HC/Clinic/Hospital) completed by delivery care provider.
Location information to be completed at front of the register:

NB** If twin or triple deliver occurs u

 1
(1)
S.N

Write ART
(2)

007
006
005
004
MRN

001

002

003

regimine code on
xxx
xxx
xxx

col.(43)
(3)

xxx
xxx
Identification

Personal information

1c = AZT-3TC-NVP
Name of the mother

(4)

23
Age

23 06
23 06
(5)

23 06
06

23 06
Kebele

EFV
(6)
00:00)

23/2/16

23/2/16
23/2/16

23/2/16
and time

23/2/16
Delivery date

1d = AZT-3TC-
(DD/MM/YY -

Y
y
Partograph Used (Y/N)

Y Y
SVD (√)

Y Y

1e =
Y Y

TDF-
y Caesarean section (C/S) (√)

y
y
y
y
Forceps / Vacuum Assisted (√)

y
y
y
y
y

Episiotomy (√)

3TC-EFV
Mode of Delivery

(7) (8) (9) (10) (11) (12)

Other procedures (√)

1f = TDF-FTC-NVP
1J = TDF-3TC-DTG
Uterotonic Drugs Given within one minute

1
2
2
(13)

after delivery (Write code)

1
Labor and Maternal Outcome

Controlled cord traction (CCT)

of 3rd stage labour
Active management

Stable (√)
Unstable / deteriorated and referred
to the next facility (√)
Y
Y

ic Drugs
Died (√)
Y
Y

Uteroton
(22)

5
5

Cause of Death (Write

Maternal Condition

Code) Pre-eclampsia (√)

Delivery Services

Y
Y

Eclampsia (√)

1 = Oxytocin
APH (√)
(14) (15) (16) (17) (18) (19) (20) (21)

Given code Col(13)

PPH(√)

Other Obstetric Complications (√)

Obstetric Complications

Referred (√)

2=
Miso
Alive (√)

APGAR Score 1’ / 5’
y 7.6/10

0/10 F
M

0/10 F
0/10 F
(23) (24) (25) (26) (27)

Sex (M/F)

prostol
Delivery Register

(28)

Weight in grams
300GM

300GM

1
1
1

4=
(29)

Still birth (1= Fresh, 2= Maccerated)

3 = Ergometrine Othe
Newborn birth Outcome**

r
Live birth, died after arrival or delivery in
(30)

facility (√)
(31)
born’s)
MRN (New

Vitamin K (√)

TTC eye oientment (√)

Newborn

Chlorhexidine cord care (√)

Cont Delivery

Vaccinated at birth for (Write code)

Y

Y Y
Y

HIV Testing accepted (√)

HIV re-testing accepted (√)

N

HIV Test results

(P,N)
Known HIV positives
(linked from ART)(√)
Preventive Services

I
I

Target population Category write code

(32) (33) (34) (35) (36) (37) (38) (39) (40)

HIV positive delivery link to PMTCT (

(41)

code:1 = same facility ,2= other facility)

Y
Y
(42)

Counseled on feeding options(√)

Maternal HIV+ care and followup

(43)

Mother’s ART Regimin (write the code)

(44)

New born AZT + NVP (for 6 wks/12 wks)

Count C/S Aneamia <=2000 hs Targeted Sex workers
Cause of maternal 3 Obstructed Count Total coun B. Long distance drivers
death Col(18) population
Labore 6 Mate CountPPH b/n 2000 Still t count C. Mobile workers/daily laborers
1 Hemorhage, 4 category (40)
Others rnal Total birth New Chlorhexi A. Female D. Prisoners
Sepsis death Weighed born dine E. OVC/Children of PLHIV
Vaccinated at birth col(35) Fresh Commercial
2 PE/Eclampsia 5 s deat F. Other MARPS
count Live births

cerated
1g = Others, specify 1 .BCG 2 .OPV 0 3 . HBV & 2500 G.General Population

Mac-
NB** If twin or triple deliver occurs use consecutive rows for each newborn
NB: You can use morethan one code
 Delivery Register
Partner testing IPPFP* Newborn

Problem identified Treatment and outcome

If alive,Birth notification given for mother (√)

IPPFP methods received ( 0-48hrs) use abbrevation

Breast feeding initiated time write code

HIV positives Partner linked to ART(√)
Partner HIV Testing accepted (√)

Partner HIV Test results (P/N)

Age at death (postnatal age)

Target population Category

Respiratory distresse/asphyxia (√)

Resuscitated and survived(√)

Congenital Malformation (√)
Cause of

Repeat acceptor(√)
New acceptor (√)

Oxygen/ Resuscitation(√)
death

Low birth Weight (√)

Other (Write Code)

1.Prematurity Managed by Remark

Prematurity (√)

Sepsis/ VSD(√)
2.Infection

Died(√)
3.Asphexiya
5.Other

(45) (46) (47) (48) (49) (50) (51) (52) (53) (54) (55) (56) (57) (58) (59) (60) (61) (62) (63) (64) (65) (66)

Y P Y I Y IUCD

N Y I
Y Y IMP

N Y I IMP
Y Y

Use Abbrevation For col. 51 count # of within

POP=Progestin only pill Breast feeding initiated deaths within
Imp=Implant time code col (58)
IUCD=Intrautrine device Count sepsis cases 0-24hrs
1. <1hr 4.Not at all Count # Count # Resusci-
TL=Tubaligation 2. 1-2hr 5.Other milk resuscitated tated & survive
Oth=Other 3.>3hrs count # of
deaths
 * To avoide duplication only if provided in the
IPPFP should be registered service is unit
Use FP tally Sheet to capture Age and Method disaggregation 1-7 days
MOH V1 2021