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Antenatal Assessment

The document contains an antenatal assessment form which collects medical history, family history, personal history, socioeconomic background, menstrual history, marital history, past obstetrical history, general examination, systemic examination, obstetric examination, investigations, treatment given and health education provided to the patient.

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hir
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132 views3 pages

Antenatal Assessment

The document contains an antenatal assessment form which collects medical history, family history, personal history, socioeconomic background, menstrual history, marital history, past obstetrical history, general examination, systemic examination, obstetric examination, investigations, treatment given and health education provided to the patient.

Uploaded by

hir
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

ANTENATAL ASSESSMENT

Name:- Age:-
Registration No:- Date:-
L.M.P.:- E.D.D:-

 MEDICAL HISTORY:
Anaemia: Heart Disease:-
Pulmonary Disease:- Allergy:-
Other:- *H/o: RTI/STI/HIV:-

 FAMILY HISTORY:
Type of Family: Single......................... No. of
Persons:...........................
Joint........................... No. of
Persons:...........................

 PERSONAL HISTORY:
Diet: Addiction:
Likes: Dislikes:
Bowel: Bladder:
Tetanus Immunization:

 SOCIOECONOMIC BACKGROUND:
Religion: Family Income:
Education: Husband Wife:
Occupation: Husband Wife:
 MENSTRUAL HISTORY:
Menarchy: Duration:
Interval: Flow:

 MARITAL HISTORY:
Age of marriage: Years Married:
Consanguineous: Yes/no

 PAST OBSTETRICAL HISTORY:

Sr. Year Full Pre Abortion Type Baby Re


No. term term of Sex Alive Stillborn Weight mark
Delive
ry

 GENERAL EXAMINATION:
General Condition: Temperature:
Pulse: Respiration:
Blood Pressure: Other Features:
Pallor: Oedema:
Icterus: Lymphadenopathy:
Breasts: Right: Left:
Nipples: Right: Left:

 SYSTEMIC EXAMINATION:
1. Nervous System:
2. Cardiovascular System:
3. Respiratory System:
4. GastrointestinalSystem:
5. Reproductive System:
6. Musculo-skeletal System:
7. Integumentary System:

 OBSTETRIC EXAMINATION:
Date Weight B.P. Urine Fundal Abdom Uterine Present FHR Posit Re
mmHg Protein Gluc height inal Size ation (bpm) ion mar
ose (cm) Size (wks) k
(cm)

 INVESTIGATIONS:
Blood group: Rh:
Hemoglobin: VDRL:
HIV: Others:

 TREATMENT GIVEN:

 HEALTH EDUCATION:

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