Medical History and Prenatal Care

Questionnaire

Name : Chelsea Ledyfia Vernanda

Nim : G2E022062
Documentation

Interviewer & Interviewee

 Personal Information
Full Name: Siti Ulfi
Age: 35 years old
Address: Jl. Anggrek No. 8, Semarang, Indonesia
Religion: Islam
Marital Status: Married
Occupation: Teacher
 Family History
History of heart disease, stroke, high blood pressure, diabetes, or
cancer in family members: Yes, father has a history of high blood
pressure.
History of mental health conditions in family members: No.
 Lifestyle Habits
Smoking or tobacco use: No.
Alcohol consumption: No.
Diet: Healthy diet with plenty of fruits, vegetables, and whole
grains; limited processed foods, sugary drinks, and red meat.
Physical activity: Regular exercise for at least 30 minutes most
days of the week (walking, swimming, yoga).
 Obstetric History
Current pregnancy: Second pregnancy.
Previous pregnancy: Delivered first child three years ago at 39
weeks pregnant at a hospital.
Previous pregnancy complications: None.
Birth weight of previous child: 3,200 grams.
Gender of previous child: Male.
Health of previous child at birth: Healthy.
Current children's health: Both healthy and doing well.
 Menstrual History
Age of first menstrual period: 13 years old.
Typical menstrual cycle length: 5-7 days.
Pain or discomfort during menstrual cycles: Mild cramps and
bloating.
Changes in menstrual cycle: None.
 Prenatal Health
Are you currently pregnant? Yes.
How far along are you in your pregnancy? Approximately 12
weeks.
Have you had any prenatal appointments yet? Yes, two so far.
Are you taking any prenatal vitamins? Yes, as prescribed by my
doctor.
Have you noticed any changes in your health or well-being since
becoming pregnant? Mild fatigue and morning sickness, but
nothing out of the ordinary.
 Contraception
Are you currently using any form of contraception? No.
Why did you stop using contraception? I am now trying to conceive
a child.
Have you discussed your contraceptive options with your healthcare
provider? Yes.
Are there any particular concerns you have about using
contraception? Potential side effects of hormonal contraceptives.
What are your preferred contraceptive methods? Non-hormonal
options like condoms or diaphragms.
Conclusion of Siti Ulfi's
Medical History
Siti Ulfi (35, teacher, Semarang) is in her healthy second pregnancy (12 weeks).
She maintains a healthy lifestyle and has a mostly unremarkable family history.
Her first delivery (3 years ago) was uncomplicated. Currently trying to conceive,
she prefers non-hormonal contraception. Siti Ulfi is engaged in prenatal care and
experiencing typical pregnancy symptoms.
Thankyou 💕