Comprehensive Pregnancy Proforma and Medical History Forms
"Capture detailed information about pregnant and lactating women with these comprehensive proforma templates covering medical history, obstetric history, antenatal care, general examination, systemic examination, and more. Ensure thorough documentation for quality healthcare management."
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Presentation Transcript
PROFORMA FOR PREGNANT AND LACTATING WOMEN Name of the woman:- Husband s Name: .. Age Age at time of marriage . Age at 1stpregnancy Education .. Last child birth . Parity .. Complaints if any at present ..
History of past illness . Personal history . History of addiction Y/N, if Yes Type and duration of use Diet vegetarian/non-vegetarian /ovo-vegetarian Family history
OBSTETIC HISTORY s.No Place of delivery Conducted by whom Full term/ premature Normal delivery/ surgical intervention Child alive/death (cause of death) Reason for eventful delivery 1 2
Any H/O abortion Y/N, if yes specify Whether spontaneous or induced H/O use of contraception Y/N If yes type and period of use Any problem due to contraception use If no reason for not use of contraception
ANTENATAL CARE LMP . EDD . PERIOD OF GESTATION .. Contracted by health person Y/N If contracted 1stcontact at month of pregnancy Was seen by Number of ANC visits Tetanus toxoid vaccination IFA tablet Plan for delivery If home delivery conducted by whom
GENERAL EXAMINATION G.C. Pulse B.P. Anaemia Oedema Weight Nurishment Height Clubbing Cynosis Jaundice lymphaedenopathy
SYSTEMIC EXAMINATION Respiratory system Central nervous system Cardiovascular examination Abdomen Other relevant system
P /A EXAMINATION Height of uterus Presentation FHS
Progress of pregnancy, fetal growth, fetal wellbeing, lie position, presentation of fetus and fetal heart sounds. After 12weeks-palpable just above pubis 24 weeks-at level of umbilicus 36 weeks at xiphisternum After this height of uterus comes down. Fetal heart sounds heard after 24 weeks, normal fetal heart rate-120-160/minute best heard at midline upto 28 weeks
Fetal movement begins 18-22 weeks, decreased fetal movement-fetal distress. Fetal parts by 22 weeks and felt best 28 weeks Fetal lie after 32 weeks.
INVESTIGATION Hb. Blood grouping Rh factoring Husband/wife Urine R & M VDRL HbsAg HIV Blood sugar Others USG
BREAST EXAMINATION To see position of nipple, soreness and presence of lump If nipple flat- held between index and thumb, pulled several times a day for few minutes, become normal. If nipple inverted syringe method applied. If soreness- application of emollients. If lump- referred
ANTENATAL ADVICE NUTRITION: No restriction unless medically restricted Balanced diet 2250 kcal/day (inclusive 350 kcal/day as allowance. No food/ fruit-abortifacient More green leafy vegetables. Avoid spicy food Gain weight 9-11 kg
ON PERSONAL HYEIGENE 1. High standard of personal hygiene. 2. Oral hygiene. 3. Clean, light and loose clothes
REST AND SLEEP 1. 8 hours night and loose clothes. 2. Avoid stress and stain 3. Lie down left side and avoid supine position affects both maternal fetal circulation by pressure effect of gravid uterus on pelvic vein reducing blood flow to right heart
ON DRUGS 1. Avoid self medication. 2. X-rays avoided 3. Avoid drugs-Thalidomide, LSD, Streptomycin, Steroids, Tetramycine, Pethidine
ON HABITS 1. Alcohol consumption 2. smoking
ON EXERCISE 1. Light household work can be done. 2. Walking in morning and evening. 3. Exercise physical labor avoided. 4. Dance therapy- simple, graceful dance movements inspires emotion, reduces stress keeps body supple, lower serum cholestrol, cheerful, avoid depression, strenthen body muscles, relax mind-in 2ndtrimester
ON SENSITIZATION OF BREASTFEEDING 1. Early initiation within 1sthour. 2. Feeding of colostrum. 3. Strict prohibition of prelacteal feeds. 4. Exclusive breast feeding for 6 months. 5. Rooming in and demand feeding.
ON SEXUAL RELATION 1. Safe to have sex if pregnancy uncomplicated. 2. Prohibited during last trimester. 3. If position comfortable and pressu6 weeks re free. 4. If H/O abortion or premature delivery 5. Desire for sex decreased, consent sought. 6. PID 7. 1stweeks of postpartum
ON FAMILY PLANNING 1. On birth spacing/ limiting
ON WARNING SIGNS 1. Bleeding/ vagina 2. Blurring of vision 3. Convulsions 4. Loss of fetal movements 5. Severe headach or giddiness 6. Any other unusual symptoms
DIETARY ADVICE TO LACTATING MOTHERS 1. No restriction on diet except 1st2-3 days. 2. Balanced diet-2500kcal/day (1/1/2 times of regular diet 3. Rest and exercise-absolute rest on 1stday on 2ndday up and about. 4. Postnatal yoga after few days. 5. Personal hygiene-high standard. 6. On sexual relation-after 6 weeks
