You are on page 1of 24220

PHILIPPINE OBSTETRICAL AND GYNECOLOGICAL SOCIET

version 0.12
Overview
Hospital Information
Name
Code
Location
Data Period

Instructions
1. The paper Maternal Mortality Form and the paper Gestational Trophoblastic Disease Form STILL HAVE T

LOGICAL SOCIETY

ic Disease Form STILL HAVE TO BE SUBMITTED.

PHILIPPINE OBSTETRICAL AND GYNECOLOGICAL SOCIET


version 0.12
Maternal Fetal Form
PATIENT DATA
CASE NO

LASTNAME

FIRSTNAME

Birthday

Age

Service

608004 Santiago
607957 Borja
608619 Rigon

Cherrylene
Jophel
Joy Marie

6/12/1984
11/10/1982
8/27/1984

30 Private
32 Private
30 Private

609105
608597
608929
608990

Baricuatro
Sumayang
Celestino
Tuballa
Sarausad
609710 Fernandez
609846 Andrey

Josephine
Jeanette
Dinah
Mae Lorraine
Vanessa
Sheila
Mary Ellen

7/23/1975
1/15/1971
10/23/1990
10/19/1981
1/6/1988
3/21/1977

34
39
44
24
33
25
36

610236 Kintanar
610258 Armada

Jessica
Jocelyn

610707
611096
611114
611214

Yokoi
Sotto
Cezar
Retes

Marilou
Renelyn
Genevive
Caryl Claire

7/28/1985
7/1/1986
3/20/1977
8/9/1979

29
28
36
35

Private
Charity
Private
Private

611239
611234
611597
611750
612448
612595
61247
613099
613624
613895
614095
614011
614586
614867
614873
614914
614937
614980
615576
615770

Yuson
Merin
Nelmida
Concha
Go
Sheldon
Luayon
Arado
Amomonpon
Abatayo
Ngujo
Takahashi
Gadin
Rubia
De Los Santos
Fernandez
Cedeno
Torrefranca
Mejica
Angana

Jessica
Leilani
Mary Grace
Charlyn
Ruth Joy
Beatrez
Riza
Melody
Joanne
Sheryl
Jonabeth
Aya
Benilda
Charity Faith
Michelle
Arfeli Marie
Pamela Ann
Carmili
Regina
Dorothee

11/12/1975
4/7/1982
1/17/1979
4/29/1985
3/25/1991
8/30/1981
7/11/1974
10/13/1991
4/23/1984
1/17/1974
3/5/1981
5/11/1970
9/28/1994
2/8/1985
7/4/1978
6/22/1983
5/25/1982
10/31/1986
8/4/1979

39
32
36
29
22
33
26
40
23
30
39
32
44
20
28
36
31
32
28
35

Charity
Private
Private
Private
Private
Private
Private
Private
Charity
Private
Private
Private
Private
Charity
Private
Private
Private
Private
Private
Private

616010
616323
616937
617032

Dejos
Malabanan
Ong
Samson

Meriam
Sibriena
Mabeth
Ermalyn

5/10/1970
5/23/1984
9/27/1975
4/26/1986

44
30
39
28

Private
Private
Private
Charity

1/9/1991
9/6/1975

Private
Private
Private
Private
Private
Charity
Private

24 Private
39 Private

617037
617067
617188
617204
617673
617861
617862
618037
618334
618386
618446
618557
618180
618324
618501
619338

Balaga
Andrews
Du
Crisolo
Tanjay
Realino
Navales
Chavez
Siao
Farol
Baculi
Cerrado
Lucaban
De Guzman
Disuanco
Granados

Era
Jane
Evelyn
Roselyn
Ikie
Angelica
Yuri
Juliean
Majie Allison
Charito
Rubylen
Kathleen Chloe
Mailyn Lucy
Jeane May
Jayzelle
Erlyn

619330 Monto

Joan

619604
619905
619808
620540
620682
620845
621620
621529
621375
501813

Cristita
Jeanne
Johanna
Giselle Anne
Janise
Yang
Analyn
Janet
Giza Mae
Arlene
Elizabeth

Ilustrisimo
Araneta
Turtoga
Ybo
Colina
Zheng
Bukiron
Dacudao
Frejoles
Salahuddin
Arnado

622104 Camotes

Lowella

622551 Serad
622577 Thomas

2/27/1986
3/18/1987
5/20/1976
10/28/1987
10/5/1985
2/7/1986
4/29/1981
5/23/1982
9/19/1987
7/19/1975
3/17/1980
9/11/1982
8/9/1987
5/9/1983
9/3/1989
12/3/1974
6/18/1978
10/27/1980
8/14/1972
1/29/1982
4/8/1997
1/4/1977
5/10/1979
7/19/1981
3/27/1979
2/27/1992
2/25/1985
9/28/1977

27
26
38
27
29
27
33
32
27
39
33
32
27
31
25
40

Private
Private
Private
Private
Private
Charity
Private
Private
Charity
Private
Charity
Private
Private
Private
Private
Private

36 Private
34
42
32
17
38
35
33
34
21
28
37

Private
Private
Charity
Charity
Private
Private
Private
Private
Private
Charity
Private

2/7/1979

34 Private

Jennierose
Nalla Nezza

4/10/1989
12/13/1981

24 Charity
33 Private

622869 Albano
62340 Borden
623378 Tan

Aida-Claire
Faith
Gertrude

12/9/1980
6/5/1986
9/13/1978

34 Private
28 Private
36 Private

623456
623477
623492
623901
623865
624203
624071
624999
625094
624691
625476

Ryzcal
Regine
Marie Bernadett
Ma.Bernadette
Ruby Kareen
Lynnette
Rosalinda
Iris Nikki
Leonora
Kristina Camille
Charissa

2/15/1986
8/13/1990
11/7/1982
12/8/1988

27
24
32
26

6/7/1983
1/26/1978
9/10/1980
6/18/1975
10/27/1986
11/26/1976

31
35
34
39
28
38

Deiparine
Monteclar
Yap
Lerios
Jayme
Yap
Maglasang
Oguis
Garciano
Flor
Bargamento

Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private

625826
467760
429588
626513
626734
627180
627404
627415
627708
628425
627857
628571
628783
629257
629618
629705

Cutamora
Seniedo
Olmedo
Alpuerto
Albotra
Guadez
Albano
Tan
Sy
Maego
DicDican
Booc
Talisic
Sarabia
Gabaca
Egos

Catherine
Joanne
Rodlloyda
Shiela Lyn
Lizbeth
Melody
Genelyn
Mary Shene
Catherine
Irene
Catherine
Marymel
Rowena
Riza
Jorjie
Haidee

9/6/1983
10/13/1985
6/27/1982
6/15/1992
2/28/1990
11/3/1991
9/7/1987
10/20/1985
9/18/1980
4/23/1979
11/5/1980
3/6/1987
1/8/1984
4/8/1986
10/10/1982
4/26/1976

31
29
32
22
23
23
27
29
34
35
34
26
31
27
32
38

Private
Private
Private
Private
Private
Private
Private
Private
Private
Charity
Private
Charity
Private
Charity
Private
Charity

630438
630555
630573
630529
630325
630642
630743
630910
630965
631901
631568
632069
632148
632234
633073
633353

Alforque
Cutamora
Uymatiao
Sanguenza
Carzano
De Leon
Zhang
Villacarlos
Sio
Velasco
Cabal
Go
Javier
Vecina
Yu
Macabugto
Pearanda
Dingding
Libaton
Verano
Arcaya
Sevilla
Encarnacion
Romero
Lao
Go
Carzano
Jarque
Llanto
Tigloy
Flores
Panugalinog
Zhan
Uy
Limosnero

Jae
Catherine
Julie
Pitchie
Nerriza
Audrey
Yan
Lou
PB Nayix
Rodevita
Rowena
Raeziel
Jayra
Eve
Ardelle
Joy Quennie
Robie Ann
Sofia
Annabelle
Jovelyn
Irish Michelle
Maricel
Arlene
Jiesta
Cherry Lynn
Janika
Nerriza
Isabel
Mary Joy
Josephine
Nelieta
Veronica
Li Yun
Michelle
Marites

9/2/1973
9/6/1983
5/2/1980
3/14/1984
9/27/1988
11/30/1983
10/29/1987
4/20/1988
12/27/1988

41
31
34
29
26
31
27
26
26
35
29
38
26
26
34
31
23
20
28
26
32
30
33
25
32
28
26
38
22
36
25
22
27
31
33

Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Charity
Private
Private
Private
Private
Private
Private
Private
Private
Charity
Private
Private
Private
Private
Private
Private
Private
Private
Charity
Private
Charity
Charity
Private
Private
Private

633940
633988
633274
634288
634235
634959
635303
635329
635347
635420
635949
636125
636211
635873
636303
636317
636322

9/19/1988
9/23/1980
3/17/1982
3/10/1990
12/4/1994
10/1/1986
3/12/1987
4/22/1982
10/15/1984
7/23/1989
6/30/1982
1/22/1986
9/27/1988
9/15/1976
3/28/1991
3/13/1977
4/13/1988
10/14/1992
4/27/1987
1/19/1984
1/5/1982

636368
636545
637112
637123
637171

SUNPONGCO
VALERIO
ROSIL
ABAYON
CHAN
JABONITE
637606 GALLEGOS
638110 CATALAN
638074
638694
638039
638202
638301
638265
637612
639473
639738
639802
639779

LEONERAH
9/17/1995
IRISH
6/5/1992
MARIA JOSEPH
8/13/1995
MARIA CARMEN 4/10/1983
CLEMENTINE
8/25/1983
ANALYN
10/30/1976
LEAH
11/18/1985
ESMERALDA
8/8/1981

LECENA
ROCHELLE
DUMAGUIT
ROWENA
VILLACORTA SIG-RID
GACASAN
MARY
CERVANTES CHERYL
VILLACARLOS JHENELYN
PELIGRO
MARIA
ONGLUICOKATHLEEN
QUILATON
CAIDY HOPE
VILLAMOR
LYNN
ABUTON
LOVELY

639947 GO
640011 CATALAN

AURA LYNN
ESTRELLA

9/14/1994
6/20/1977
9/10/1981
8/10/1990
8/6/1985
4/10/1985
9/22/1979
8/24/1989
3/20/1987
10/12/1975
6/16/1986
1/10/1982
3/19/1972

19
22
19
31
31
38
29
33

Private
Private
Private
Private
Private
Charity
Private
Charity

20
37
33
24
29
29
35
25
27
39
28

Charity
Private
Private
Charity
Private
Charity
Private
Private
Private
Private
Private

33 Private
42 Private

640176
640081
640444
640756
640746

LANGCUYANCECILE
MOJADO
CHERYL
PESTANASMARVIE
MATUGUINAS IMEE
BAUTISTA
ANAMARIEZEL

11/22/1982
7/20/1988
3/26/1979
4/1/1980
8/24/1984

32
26
35
34
30

Private
Private
Charity
Charity
Private

6402
6403
6406
6407
641419
641397
641720
641882
642395
643524
642921
642869
642943
642956
643618
643682
643775
643782
64430
644083
644067
644170

CLARO
JANIE FAITH
TO-ONG
MELDY
BUHIA
ROSE MAE
TURA
CHRISTINE
CANEDO
EMILY JOY
ESPINOSA
TITA
LORECHE
MIA TRINA
SUAN
RIZZI
BORJA
LIGAYA
DIVINAGRACIAIMEE
GENISTON
JOAN PAULA
LLENES
ROXANNE
LABANDERO JOY
TAGUD
LAIDEE
OBERES
LILMA
VILLARTA
FAITH
ABANTO
MERTHPHA
GO
RAZEIL
LAVISTE
ADRIENNE
CABELLON
GRACE GAY
JAPITAN
MA. THERESA
BADAYOS
OXZIE

1/25/1983
9/28/1984
5/3/1980
5/22/1986
9/22/1976
1/26/1975
5/17/1974
11/15/1987
10/7/1976
7/1/1982
5/29/1986
12/7/1981
4/7/1984
12/11/1988
5/19/1990
4/13/1982
11/19/1987
11/15/1975
8/17/1982
11/6/1980
7/2/1978
10/1/1985

31
30
34
28
38
39
40
27
38
32
28
33
30
26
24
32
27
39
32
34
36
29

Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Charity
Charity
Charity
Charity
Private
Private
Charity
Private
Charity
Private
Private
Charity

644460
644960
645000
645102
645317
645704
645543
646280
646360
646367
646798
646966

VILLANUEVA
HANOPOL
SARTE
SATINA
UY
JUDILLA
DIANO
ROSALES
ILUSTRISIMO
LEYSON
MABALA
SEBOLINO

CELEDONIA
JENEL
MARIA CECIL
JOANA MARIE
QUEENA
JIVAH
LIZ MURIEL
HARLEY
MANILYN
JOJIE
MARCHIE
SIMONET

647075
647396
647381
647565
648121
648262
648954
649111
649107
649431
650238
649561
650052
650289
650324
650296
650220
541823
650332
650004
650380
650442
651781
651911
651876
650847
650833
651581
651771
651845
652253
652266
652783
652082
653301
653495
653761
653854
654071

JANDAYAN
DARLENE
ESTELLA
RICHELITA
ARDIMER
MARY ROSE
MAHASOL
MARNEE
REPUNTE
CHERRIE
BELVESTRE LORRAINE FAIT
CHUA
JANA
CABANIG
NIMFA
KILONGKILON RUDILYN
SU
HUI LING
JUDILLA
JOANN
SARTE
MARIA CECIL
SO
JONALYN ROSE
BAGUIO
MARIFE
DELA FUENTE JADE
CODILLA
ROXANE
LOOD
JOHANNAH
AGUIPO
VIENILLYN
REYES
SHERLY
FLORES
MARY ROSE
PACOT
CONCEPCION
BARLISO
ROSELYN
SUMALINOG MARY GOLD
SERAFIN
CARMEL
SERVIDOR
KATHY
VICOY
CIRILA
TAN
GERTRUDE
VILLACARLOS JHENELYN
CANALITA
ARLENE
MORENO
AN-AN
MAMIGO
RAQUEL
SEVILLA
MARICEL
LORECHE
MIA TRINA
VILLAPEZ
CASSYMAE
TABORADA
JACQUILYN
MIRANDA
DANICA
YOSORES
FLORA
DEIPARINE
RYZCIL
ACAIN
MARIA

3/3/1980
2/18/1989
11/12/1986
2/5/1986
8/31/1988
6/17/1985
4/14/1985
9/12/1990
4/30/1993
4/8/1983
3/6/1984
11/22/1973

34
25
28
28
26
29
29
24
21
31
30
41

Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private

3/14/1974
4/30/1976
6/10/1985
6/17/1986
7/22/1985
5/28/1987
10/4/1988
10/18/1979
11/6/1977
5/22/1989
12/25/1985
11/12/1986
12/18/1982
12/19/1983
8/15/1978
7/21/1981
6/12/1988
10/26/1991
11/4/1976
3/28/1993
12/8/1981
1/13/1985
10/2/1981
7/19/1984
10/16/1985
3/18/1984
9/13/1978
4/10/1985
1/19/1974
3/18/1981
1/14/1979
10/15/1984
5/17/1974
1/2/1989
10/5/1982
8/20/1986
10/28/1988
2/15/1986
7/6/1983

40
38
29
28
29
27
26
35
37
25
29
28
32
31
36
33
26
23
38
21
33
30
33
30
29
30
36
29
41
33
36
30
40
26
32
28
26
28
31

Charity
Private
Private
Private
Private
Charity
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Charity
Charity
Charity
Private
Private
Private
Private
Charity
Charity
Charity
Charity
Private

654115
654459
654461
654698
654790
654867
655101

VILLAMOR
KINTANAR
BARRO
OFLANA
RABE
GONZALES
OLANDRIA
ISLAO
655114 BAJAO
655917 TINGA

BEVERLY
JESA
LIVI IVY
EILEEN
CARIZZA
MARIA JESUSA
ALMA
DENNABELLE
ELIZABETH
PAT

4/10/1980
8/28/1978
8/31/1980
3/19/1982
9/10/1970
10/14/1983
7/17/1979
4/30/1988
1/21/1980
6/28/1974

34
36
34
32
44
31
35
26
35
40

Charity
Charity
Private
Private
Private
Private
Private
Private
Private
Private

656186
656287
656799
656948
650954
656974
657030
657161
657229
657574
657784
657813
658071
658273
659826
659952
660097
660527
660315

PATRICIA
MARIA
MA THERESA
EDILYN
GELFA
GENE ROSE
HANNA
MAYROSE
CHARITO
FARRAH
BARBARA
CAIDY HOPE
REZYL A
DONNA JILL
JAHZEEL
MERIAM
ROSABELLA
AIRA
MICKELYN
JENNIFER
CATHLEEN
ROCELYN
HERBE
MARCELA
ARLENE MAY

5/6/1980
8/19/1976
8/13/1984
10/22/1980
9/10/1976
7/4/1983
7/25/1991
5/14/1984
3/8/1983
8/3/1982
4/12/1977
3/20/1987
5/11/1988
7/23/1977
4/15/1983
8/5/1980
9/25/1975
5/9/1989
10/5/1985
2/12/1981
5/22/1982
10/26/1988
10/31/1980
12/29/1982
8/12/1984

34
38
30
34
38
31
23
30
31
32
37
27
26
37
31
34
39
25
29
33
32
26
34
32
30

Private
Private
Charity
Charity
Private
Private
Private
Private
Private
Private
Charity
Private
Charity
Private
Private
Private
Charity
Private
Charity
Private
Private
Private
Private
Charity
Charity

66135
661947
662126
662139
66287

QUILATON
CAREY
PEROCILLO
BALCITA
LOBITANA
SAYCO
ABELLANOSA
CLEMENTES
LAPINIG
VARGAS
QUITOY
QUILATON
EMPERADO
JABON
SUSUSCO
HARASYM
QUIMBO
DY
ALAMEDA
TANILON
GO
PARINASAN
UY
BALILISA
ELLOS

OGICAL SOCIETY
HISTORY
ADMIT DATE

OB Score
Gravidity

Parity

Term

Preterm

Abortion

Alive

1/1/2014
1/1/2014
1/2/2014

3
3
2

0
1
1

0
1
1

0
0
0

2
1
0

0
1
1

1/3/2014
1/2/2014
1/2/2014
1/2/2014
1/3/2014
1/3/2014
1/3/2014

5
1
3
1
1
1
3

4
0
2
0
0
0
2

3
0
2
0
0
0
2

1
0
0
0
0
0
0

0
0
0
0
0
0
0

3
0
2
0
0
0
2

1/3/2014
1/4/2014

1
2

0
1

0
1

0
0

0
0

0
1

1/4/2014
1/4/2014
1/4/2014
1/5/2014

2
1
1
1

1
0
0
0

1
0
0
0

0
0
0
0

0
0
0
0

1
0
0
0

1/5/2014
1/5/2014
1/5/2014
1/6/2014
1/6/2014
1/6/2014
1/7/2014
1/7/2014
1/7/2014
1/8/2014
1/8/2014
1/8/2014
1/8/2014
1/8/2014
1/8/2014
1/8/2014
1/8/2014
1/9/2014
1/9/2014
1/9/2014

3
2
4
1
1
3
1
3
1
4
4
1
3
1
2
1
1
1
1
1

2
1
2
0
0
2
0
2
0
3
1
0
2
0
1
0
0
0
0
0

2
1
2
0
0
2
0
2
0
3
1
0
2
0
1
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
1
0
0
0
0
0
0
0
2
0
0
0
0
0
0
0
0
0

2
1
2
0
0
2
0
2
0
3
1
0
2
0
1
0
0
0
0
0

1/9/2014
1/10/2014
1/10/2014
1/10/2014

3
1
1
2

2
0
0
1

2
0
0
1

0
0
0
0

0
0
0
0

2
0
0
1

1/10/2014
1/10/2014
1/10/2014
1/10/2014
1/11/2014
1/11/2014
1/11/2014
1/11/2014
1/12/2014
1/12/2014
1/12/2014
1/13/2014
1/12/2014
1/12/2014
1/13/2013
1/13/2014

1
1
4
1
5
3
1
2
1
1
3
2
3
3
1
1

0
0
3
0
3
2
0
1
0
0
2
1
2
2
0
0

0
0
2
0
3
2
0
1
0
0
0
1
2
2
0
0

0
0
0
0
0
0
0
0
0
0
2
0
0
0
0
0

0
0
1
0
1
0
0
0
0
0
0
0
1
1
0
0

0
0
2
0
3
2
0
1
0
0
1
1
2
2
0
0

1/13/2014

1/14/2014
1/14/2014
1/14/2014
1/14/2014
1/15/2014
1/15/2014
1/15/2014
1/15/2014
1/15/2014
1/15/2014
1/16/2014

1
2
1
1
6
3
2
1
1
3
2

0
1
0
0
5
2
1
0
0
2
1

0
1
0
0
5
2
1
0
0
2
1

0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0

0
1
0
0
5
2
1
0
0
2
1

1/16/2014

1/16/2014
1/17/2014

1
3

0
2

0
2

0
0

0
0

0
2

1/17/2014
1/17/2014
1/17/2014

2
1
1

1
0
0

1
0
0

0
0
0

0
0
0

1
0
0

1/18/2014
1/18/2014
1/18/2014
1/18/2014
1/18/2014
1/20/2014
1/19/2014
1/20/2014
1/20/2014
1/20/2014
1/21/2014

4
4
1
2
2
1
1
4
3
1
3

1
2
0
1
1
0
0
2
1
0
2

1
2
0
1
1
0
0
2
1
0
2

0
0
0
0
0
0
0
0
0
0
0

2
1
0
0
0
0
1
1
1
0
0

1
2
0
1
1
0
0
2
1
0
2

1/21/2014
1/21/2014
1/21/2014
1/22/2014
1/22/2014
1/22/2014
1/23/2014
1/23/2014
1/23/2014
1/23/2014
1/23/2014
1/23/2014
1/24/2014
1/24/2014
1/24/2014
1/25/2014

2
2
2
1
3
3
4
2
4
2
4
1
4
2
1
3

0
1
0
0
0
1
3
0
1
1
3
0
2
1
0
1

0
1
0
0
0
1
3
0
1
1
3
0
2
1
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2

1
0
1
0
2
1
0
1
2
0
0
0
1
0
0
1

0
1
0
0
0
1
3
0
1
1
3
0
2
1
0
2

1/25/2014
1/25/2014
1/25/2014
1/25/2014
1/25/2014
1/26/2014
1/26/2014
1/26/2014
1/27/2014
1/27/2014
1/27/2014
1/27/2014
1/27/2014
1/28/2014
1/28/2014
1/28/2014
1/28/2014
1/29/2014
1/29/2014
1/29/2014
1/29/2014
1/29/2014
1/30/2014
1/30/2014
1/30/2014
1/30/2014
1/30/2014
1/31/2014
1/31/2014
1/31/2014
1/31/2014
1/31/2014
2/1/2014
2/1/2014
2/1/2014

4
2
1
1
3
1
3
3
2
2
4
4
2
2
3
3
1
1
2
1
1
1
1
1
2
1
3
1
1
3
2
2
2
1
2

2
0
0
0
2
0
1
1
1
1
2
2
1
1
2
1
0
0
1
0
0
0
0
0
1
0
2
0
0
2
1
0
0
0
1

2
0
0
0
2
0
1
1
1
1
2
2
1
1
2
1
0
0
1
0
0
0
0
0
0
0
2
0
0
2
1
0
0
0
1

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0

1
1
0
0
0
0
1
1
0
0
1
1
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
1
0
0

2
0
0
0
2
0
1
1
1
1
2
2
1
1
1
1
0
0
1
0
0
0
0
0
1
0
2
0
0
2
1
0
0
0
1

2/1/2014
2/1/2014
2/2/2014
2/2/2014
2/2/2014
2/2/2014
2/3/2014
2/3/2014

1
1
1
3
2
3
1
1

0
0
0
1
1
2
0
0

0
0
0
1
1
2
0
0

0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0

0
0
0
1
1
2
0
0

2/3/2014
2/3/2014
2/3/2014
2/3/2014
2/3/2014
2/3/2014
2/3/2014
2/4/2014
2/4/2014
2/5/2014
2/5/2014

1
3
2
1
1
3
5
1
2
1
1

0
1
1
0
0
2
2
0
0
0
0

0
1
1
0
0
2
2
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
2
0
1
0
0

0
1
1
0
0
2
2
0
0
0
0

2/5/2014
2/5/2014

1
3

0
0

0
0

0
0

0
2

0
0

2/5/2014
2/5/2014
2/5/2014
2/5/2014
2/5/2014

2
1
3
5
1

0
0
2
3
0

0
0
2
3
0

0
0
0
0
0

1
0
0
1
0

0
0
2
3
0

2/6/2014
2/5/2014
2/5/2014
2/5/2014
2/6/2014
2/6/2014
2/6/2014
2/6/2014
2/7/2014
2/7/2014
2/7/2014
2/7/2014
2/7/2014
2/7/2014
2/8/2014
2/8/2014
2/8/2014
2/9/2014
2/9/2014
2/9/2014
2/9/2014
2/10/2014

1
4
2
2
3
4
2
1
3
2
2
1
2
1
1
1
1
4
3
1
1
1

0
2
1
1
1
3
1
0
2
1
1
0
1
0
0
0
0
2
1
0
0
0

0
2
1
1
1
3
1
0
2
1
1
0
1
0
0
0
0
2
1
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

0
1
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
1
1
0
0
0

0
2
1
1
1
3
1
0
2
1
1
0
1
0
0
0
0
2
1
0
0
0

2/10/2014
2/10/2014
2/10/2014
2/10/2014
2/10/2014
2/11/2014
2/11/2014
2/11/2014
2/11/2014
2/11/2014
2/12/2014
2/12/2014

3
1
2
1
1
1
1
1
1
2
1
1

0
0
0
0
0
0
0
0
0
1
0
0

0
0
0
0
0
0
0
0
0
1
0
0

0
0
0
0
0
0
0
0
0
0
0
0

2
0
1
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
1
0
0

2/12/2014
2/12/2014
2/12/2014
2/13/2014
2/13/2014
2/13/2014
2/14/2014
2/14/2014
2/14/2014
2/14/2014
2/15/2014
2/15/2014
2/15/2014
2/16/2014
2/16/2014
2/16/2014
2/15/2014
2/15/2014
2/15/2016
2/15/2014
2/16/2014
2/16/2014
2/17/2014
2/17/2014
2/18/2014
2/17/2014
2/17/2014
2/17/2014
2/17/2014
2/17/2014
2/18/2014
2/18/2014
2/18/2014
2/19/2014
2/19/2014
2/19/2014
2/19/2014
2/19/2014
2/19/2014

5
4
2
3
1
1
2
3
2
1
2
2
1
2
2
2
1
1
3
1
3
1
1
2
1
1
1
3
3
2
1
1
2
1
3
1
3
2
2

4
2
0
1
0
0
0
1
1
0
1
0
0
0
1
1
0
0
2
0
2
0
0
1
0
0
0
2
1
1
0
0
1
0
2
0
1
1
1

3
2
0
1
0
0
0
1
1
0
1
0
0
0
1
1
0

1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

0
1
1
1
0
0
1
1
0
0
0
1
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
1
0
0

4
2
0
1
0
0
0
1
1
0
1
0
0
0
1
1
0
0
2
0
2
0
0
1
0
0
0
2
1
1
0
0
1
0
2
0
1
1
1

2
0
2
0
0
1
0
0
0
2
1
1
0
0
1
0
2
0
1
1
1

2/20/2014
2/20/2014
2/20/2014
2/20/2014
2/20/2014
2/20/2014
2/20/2014
2/20/2014
2/20/2014
2/21/2014

4
2
1
2
2
1
2
2
3
1

1
1
0
1
1
0
1

2/21/2014
2/22/2014
2/22/2014
2/22/2014
2/22/2014
2/22/2014
2/23/2014
2/23/2014
2/2/2014
2/24/2014
2/24/2014
2/24/2014
2/24/2014
2/25/2014
2/26/2014
2/26/2014
2/26/2014
2/27/2014
2/27/2014
2/27/2014
2/28/2014
2/28/2014
2/28/2014
2/28/2014
2/28/2014

4
2
3
2
3
3
1
1
2
2
2
1
1
6
3
3
7
2
2
1
4
5
3
2
2

3
1
1
1
2
2
0
0
1
1
0
0
0
4
2
2
5
0
1
0
2
4
2
1
1

2
0

1
1
0
0
1
0
1
1
2
0

0
0
0
1
0
0
0
0
0
0

2
0
0
0
0
0
0
0
0
0

1
1
0
1
1
0
1
1
2
0

3
1
1
1
2
2
0
0
1
1
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0

0
0
1
0
0
0
0
0
0
0
1
0
0
1
0
0
1
1
0
0
1
0
0
0
0

3
1
1
1
2
2
0
0
0
1
0
0
0
4
2
2
4
0
1
0
2
4
2
1
1

0
4
2
1
5
0
1
0
2
4
2
1
1

ADMISSION AOG

MEDICAL/SURGICAL HISTORY

Weeks

Days

40 1/7
38
36

Last Year of Pregnancy

28
39
40
38
41
39
36

1
6
4
6
2

38

39
39
39

39
39
40
40
25
39
39
37
38
37
39

Category

2012 Respiratory
2013
2006

37-38
40-41

Respiratory
Surgical
2008

39-40

Gastrointestinal
Endocrine, Nutritional, Metabolic
Hypertension
2009 Rheumatologic/Immunologic
2011 Hypertension
2012

1
1
1
6
1

Endocrine, Nutritional, Metabolic


2007
2012 Hypertension

38-39

2001
34
38
39

6
4

39
39
38

5
6

40
38

1
2

2011

40-41
Endocrine, Nutritional, Metabolic
Endocrine, Nutritional, Metabolic
Gynecologic

38-39
36-37

Endocrine, Nutritional, Metabolic


2012

38
37

38
37
37
38

38

24
41

39-40
2
3

2012
2011 Infection

37-38
38-39
7 to 8
10 to 12
7 to 8

2012
2011
2013
2011

39

Hypertension
Endocrine, Nutritional, Metabolic
Endocrine, Nutritional, Metabolic
Surgical
Gynecologic

40
38
37
40
38
40
37
37
32
38
38
37

6
6
3
3

37
18

38
38
33

6
4
4

39
40
37
37
40
7
38
37
16
39

3
2
3
5
1

2009 Endocrine, Nutritional, Metabolic


2007

4
1
4
3
5
6

21-22

Endocrine, Nutritional, Metabolic


2011 Gynecologic
Respiratory
2006
2008 Endocrine, Nutritional, Metabolic
Respiratory
2001
2008

34-35

2009
Hypertension
Endocrine, Nutritional, Metabolic
2011 Hypertension
2012
2010

2011
2012
4
2

2007

37
39
39
38
40
36
36
39
39
37
28
39

33
32
35

2
6
5

40
38
38
30
40
33

6
1
4
2
3
3

6
3
1
3
5
6
6
5
4

38-39

39-40
38
39
38
38
33
38
39
38
36

5
4
2
2
1
5
5
3

2011
2010 Surgical
2004

Endocrine, Nutritional, Metabolic


2013 Endocrine, Nutritional, Metabolic
2009
2011
2011
2012
2012
2012 Surgical
2011
2010
2010
2011
2012
1998
2012
1999
2009
2012
2012
2012

Respiratory
Hypertension
Surgical
Infection
Surgical

13-14
43
38
38
39
34
38
38
38

4
6
5

40
38
38

2008 Endocrine, Nutritional, Metabolic

6
1
3
6

Hypertension

40-41

38-39
38
38
38
38
39

6
3
2
1
5

2010
2010
2005
2012
2012
2010

40
39
39
37
39
36
39
36

1
1
3
6
2
3

37

39
38
40
39
40
39

3
1

2012
2012
2006
Gynecologic

36-37

4
6

2011

36-37
39
38

39
38

2
2

40
40
38
38
37

3
1

39

12
17
39
38
37

38
38
39

4
2
6

38
37
37

2
5
3

39
35
39
38
38
37

4
5
2
6
2
3

Hypertension
Endocrine, Nutritional, Metabolic
2007 Hypertension
Cardiovascular
2013
2009
2009 Surgical
Hypertension
Respiratory
2013
Respiratory

39-40
2010
2011

38-39
2012

41-42

Neurologic/Psychiatric

36
39
40
38
38
39
37
38
40
39
38
40

Endocrine, Nutritional, Metabolic


6
6
1
5
3
4
4
3
4
1

37
39
40
39
38
39
39
41
38
37
40
41

38
31
38
39

6
4
6
4

3
6
2

2012

2010
Hypertension
Endocrine, Nutritional, Metabolic
Surgical
2012
2012
Respiratory

2
5
2
4
4

2012
2012
2010
2012

34-35
2012
2003 Respiratory
2005

38-39
36
38
36-37

2009
38
38
38
38
38

4
5
5

38
38
38
36
37
38
40
39

2008

38-39

38
39
36

1
5
4
5

2011 Endocrine, Nutritional, Metabolic


2012 Hypertension
2010
2007
2007

1
1

2006

37
38
39
38

2011

36-37

2012
38

37-38
39

37

40
38
39
38
39

3
1
3
6
1

37
29
38
39
40
39
38
39

2
6
2
1
5
6
6

2007

38
38
38
39
38
38
38
38
38
37

2012
2008
2009
2004

39-40

2011
2006

2011
2010

38-39
3
1
6
6
2
4

2009
2012
2011
2008
2006

OBSTETRIC HISTORY
Condition

Category

Bronchial asthma in acute asthmatic attack

Abortion

Pulmonary tuberculosis
Other surgical conditions
Other digestive diseases
Gestational diabetes mellitus
Gestational hypertension
Systemic lupus erythematosus
Pre-existing (chronic hypertension with BP 140/90)

Gestational diabetes mellitus

Pre-existing (chronic hypertension with BP 140/90)

Diffuse nontoxic goiter


Gestational diabetes mellitus
Other gynecological conditions
Gestational diabetes mellitus

Bacterial vaginosis
Hemorrhagic
Problems in Fetal Aging, Stru

Gestational hypertension
Gestational diabetes mellitus
Hypothyroidism
Acute appendicitis
Other gynecological conditions
Gestational diabetes mellitus

Gestational diabetes mellitus


Other gynecological conditions
Bronchial asthma in remission
Gestational diabetes mellitus
Bronchial asthma in acute asthmatic attack

Gestational hypertension
Gestational diabetes mellitus
Mild preeclampsia (BP 140/90, protein 0.3 gms/24 hr)

Abortion
Ectopic Pregnancy

Other surgical conditions

Hypothyroidism
Gestational diabetes mellitus

Abortion

Poor Obstetric History


Problems in Fetal Aging, Stru
Abortion
Other surgical conditions

Bronchial asthma in remission


Gestational hypertension

Abortion

Acute appendicitis
Other infection
Other surgical conditions
Gestational diabetes mellitus

Gestational hypertension

Abortion

Uterine myoma

Gestational hypertension
Gestational diabetes mellitus
Pre-existing (chronic hypertension with BP 140/90) Abortion
Rheumatic heart disease (RHD), mitral stenosis

Acute appendicitis
Severe preeclampsia (BP > 160/110, protein > 0.3gms/24 hr)
Bronchial asthma in remission
Abortion
Pneumonia

Obstetric Conditions

Obstetric Conditions
Other neurologic or mental disorder

Hypothyroidism

Gestational hypertension
Diabetes mellitus non-insulin dependent
Acute appendicitis

Bronchial asthma in remission

Bronchial asthma in remission

Gestational diabetes mellitus


Gestational hypertension

Amniotic Fluid

Condition

PRENATAL

DELIVERY

Antenatal Procedures

Delivery Date

1/2/2014
1/2/2014
1/2/2014
1/3/2014
1/2/2014
1/3/2014
1/3/2014
1/4/2014
1/3/2014
1/3/2014
1/5/2014
1/4/2014
1/4/2014
1/5/2014
1/5/2014
1/5/2014
1/5/2014
1/6/2014
1/6/2014
1/6/2014
1/6/2014
1/6/2014
1/7/2014
1/7/2014
1/9/2014
1/8/2014
1/9/2014
1/9/2014
1/8/2014
1/8/2014
1/8/2014
1/9/2014
1/9/2014
1/9/2014
1/10/2014
1/10/2014
1/10/2014
1/10/2014
1/10/2014
1/11/2014

1/11/2014
1/11/2014
1/11/2014
1/11/2014
1/11/2014
1/11/2014
1/11/2014
1/11/2014
1/12/2014
1/13/2014
1/12/2014
1/13/2014

Other antepartum hemorrhage


Preterm delivery (upto 38 weeks)

1/14/2014
1/14/2014
1/14/2014
1/14/2014
1/15/2014
1/15/2014
1/15/2014
1/15/2014
1/15/2014
1/19/2014
1/16/2014
1/15/2014
1/18/2014
1/17/2014
1/17/2014
1/17/2014
1/18/2014
1/17/2014
none
none
1/18/2014
1/18/2014
1/18/2014
1/19/2014
1/20/2014
none
1/21/2014
1/20/2014
none
1/21/2014

1/22/2014
1/22/2014
1/22/2014
1/22/2014
1/22/2014
1/23/2014
1/23/2014
1/23/2014
Fetal death in utero
Twin

1/24/2014
1/24/2014
1/24/2014
1/25/2014
1/25/2014
1/25/2014
1/26/2014
1/26/2014
1/25/2014
1/26/2014
1/26/2014
1/27/2014
1/27/2014
1/28/2014
1/27/2014
1/28/2014
1/28/2014
1/29/2014
1/29/2014
1/30/2014
1/29/2014
1/29/2014
1/31/2014
1/30/2014
1/31/2014
1/30/2014
1/31/2014
1/31/2014
1/31/2014
1/31/2014
1/31/2014
1/31/2014
2/1/2014
2/1/2014
2/1/2014
2/1/2014

2/1/2014
2/1/2014
2/2/2014
2/4/2014
2/2/2014
2/2/2014
2/3/2014
2/3/2014
2/3/2014
2/6/2014
2/3/2014
2/3/2014
2/3/2014
2/3/2014
2/5/2014
2/5/2014
2/5/2014
Incomplete abortion

2/6/2014
2/5/2014
2/5/2014
2/5/2014
2/6/2014
2/6/2014
2/6/2014
2/6/2014

Incomplete abortion
2/6/2014
2/6/2014

Previous caesarian section

Previous caesarian section

2/7/2014
2/8/2014
2/7/2014
2/8/2014
2/8/2014
2/8/2014
2/8/2014
2/8/2014
2/9/2014
2/9/2014
2/9/2014
2/10/2014
2/10/2014
2/10/2014
2/10/2014

Oligohydramnios

2/11/2014
2/10/2014
2/11/2014
2/11/2014
2/11/2014
2/11/2014
2/12/2014
2/12/2014
2/12/2014
2/12/2014
2/14/2014
2/12/2014
2/12/2014
2/12/2014
2/13/2014
2/13/2014
2/15/2014
2/15/2014
2/15/2014
2/14/2014
2/15/2014
2/15/2014
2/15/2014
2/15/2014
2/16/2014
2/20/2014
2/16/2014
2/16/2014
2/16/2014
2/16/2014
2/15/2014
2/16/2014
2/16/2014
2/17/2014
2/18/2014
2/18/2014
2/17/2014
2/17/2014
2/17/2014
2/18/2014
2/18/2014
2/18/2014
2/18/2014
2/19/2014
2/19/2014
2/19/2014
2/19/2014
2/20/2014
2/19/2014
2/19/2014

2/21/2014
2/20/2014
2/20/2014
2/20/2014
2/21/2014
2/21/2014
2/22/2014
2/23/2014
2/21/2014
2/21/2014
2/21/2014
2/22/2014
2/22/2014
2/22/2014
2/23/2014
2/22/2014
2/23/2014
2/23/2014
2/24/2014
2/26/2014
2/24/2014
2/24/2014
2/25/2014
2/26/2014
2/27/2014
2/26/2014
2/27/2014
2/27/2014
2/28/2014
3/1/2014
2/28/2014
3/1/2014
2/18/2014
3/1/2014

DELIVERY AOG
Weeks

Days

Route

40 1-Jan Vaginal
38
Vaginal
36
1 Abdominal
28
39
40
39
41
39
36

2 Vaginal
6 Vaginal
5 Vaginal
Vaginal
3 Abdominal
Abdominal
1 Abdominal

38

Vaginal
5 Vaginal

39
39
39

Vaginal
4 Vaginal
1 Abdominal
Vaginal

37-38
40-41

39-40
39
39
40
40
25
39
39
38
38
37
39
38-39
34
38
39
40-41
39
39
39
38-39
40
38
36-37

Vaginal
5 Vaginal
1 Vaginal
1 Abdominal
Vaginal
1 Vaginal
Abdominal
1 Vaginal
1 Vaginal
1 Vaginal
1 Abdominal
1 Abdominal
Vaginal
Abdominal
6 Vaginal
5 Vaginal
Vaginal
Vaginal
6 Vaginal
Abdominal
Abdominal
1 Abdominal
2 Abdominal
Vaginal

Malpresentation

38
37

24
41

5 Vaginal
1 Abdominal
Vaginal
3 Vaginal
Vaginal
2 Vaginal
3 Vaginal
Vaginal
4 Vaginal
Vaginal
Vaginal
4 Vaginal

39

1 Abdominal

40

1 Vaginal

38
37
40
38
40
37
37
33
38
38
38

6
6
4
4

39-40
38
37
37
38
37-38
38
38-39

4
1
1
4
5
1

21-22

Vaginal
Vaginal
Vaginal
Abdominal
Vaginal
Abdominal
Vaginal
Vaginal
Vaginal
Abdominal
Abdominal
Vaginal

37
18

2 Vaginal
Vaginal

39
38

Vaginal
4 Vaginal

39
40
37
37
40

3
2
3
6
1

38
37

1 Abdominal
1 Abdominal

39

2 Abdominal

Vaginal
Vaginal
Vaginal
Abdominal
Abdominal

Multiple gestation with

39
39
38
40
36

1
1
6
3
1

39
39
37

5 Vaginal
6 Vaginal
6 Vaginal

39
33
33
35

5 Vaginal
Vaginal
2 Vaginal
Abdominal
5 Vaginal

40
38
38
30

6
2
5
2

33
38
39
38
38

3 Vaginal
Vaginal
1 Vaginal
5 Vaginal
5 Abdominal
2 Vaginal

38
39
38
36

2
5
6
4

Vaginal
Abdominal
Vaginal
Vaginal

43
38
38
39

5
6
5
2

Abdominal
Abdominal
Vaginal
Vaginal

38
38
38

1 Vaginal
4 Abdominal
6 Vaginal
Abdominal
Abdominal
Abdominal
Vaginal
Vaginal
6 Abdominal
4 Abdominal
2 Vaginal
1 Vaginal
5 Abdominal

38-39

39-40

40-41
41
38
38
38-39
38
38
38
38
39

Vaginal
Vaginal
Vaginal
Abdominal
Abdominal

Vaginal
Vaginal
Vaginal
Abdominal

40
39
39
37
39
36
39
36

1
1
3
6
2
3
0
6

37
39
38
40

5 Vaginal
Vaginal
3 Vaginal
1 Vaginal
Vaginal

40
40

4 Vaginal
Vaginal

39
38

Vaginal
5 Abdominal

39
38

2 Abdominal
2 Abdominal

40
40
38
38
38

3 Vaginal
1 Vaginal
1 Vaginal
Vaginal
Abdominal

39

2 Vaginal

39
38

6 Vaginal
Abdominal

36-37

39-40
38
38
39
39
38
37
37
41-42
39
35
39
38
38
37

Vaginal
Vaginal
Vaginal
Vaginal
Abdominal
Abdominal
Abdominal
Abdominal

Vaginal
4 Abdominal
2 Vaginal
6 Vaginal
Vaginal
2 Abdominal
6 Vaginal
3 Vaginal
Abdominal
4 Vaginal
5 Abdominal
2 Abdominal
6 Vaginal
2 Abdominal
3 Vaginal

Frank breech

Transverse lie

36
39

1 Abdominal
6 Vaginal

Frank breech

38
38
39
37
38
40
39
38
40

2 Abdominal
5 Vaginal
Vaginal
3 Abdominal
4 Abdominal
4 Vaginal
3 Vaginal
4 Abdominal
3 Abdominal

Footling breech

37
39
40
39
38
39
39
41
38
37
40
41

5 Vaginal
Vaginal
3 Abdominal
6 Vaginal
2 Vaginal
2 Abdominal
2 Abdominal
5 Vaginal
2 Abdominal
5 Vaginal
Vaginal
4 Abdominal
Abdominal
Vaginal
2 Vaginal
Vaginal
4 Vaginal
Vaginal
Vaginal
Vaginal
Vaginal
4 Vaginal
5 Vaginal
5 Abdominal
Abdominal
6 Abdominal
Abdominal
1 Abdominal
Abdominal
2 Vaginal
5 Vaginal
4 Abdominal
6 Abdominal
Vaginal
Vaginal
Vaginal
1 Vaginal
1 Vaginal
1 Abdominal

34-35
39
32
39
39
38-39
36
38
36-37
38
38
38
38
38
38-39
38
38
38
36
37
38
40
39
38
39
36

Complete breech

Footling breech

Complete breech

37
38
39
38

37

Vaginal
Vaginal
Vaginal
Vaginal
Vaginal
Abdominal
Vaginal
5 Vaginal
Abdominal
1 Abdominal

40
38
39
38
39

3
1
3
6
1

36-37
38
37-38
39
39-40

37
38
39
40
38
39
38-39
38
38-39
38
39
39
38
38
38
38
37

Vaginal
Abdominal
Vaginal
Vaginal
Vaginal
Vaginal
3 Abdominal
6 Abdominal
2 Vaginal
3 Vaginal
Vaginal
6 Vaginal
6 Vaginal
Vaginal
3 Vaginal
Vaginal
3 Vaginal
1 Vaginal
Vaginal
6 Vaginal
Vaginal
1 Abdominal
2 Vaginal
5 Vaginal

VAGINAL DELIVERY - Only for the CURRENT pregnancy.


Delivery

Other Procedures

Episiotomy

Spontaneous vertex delivery


Spontaneous vertex delivery

ME
ME

Spontaneous vertex delivery


Spontaneous vertex delivery
Spontaneous vertex delivery
Spontaneous vertex delivery

None
ME
None
ME

Completion curettage

Spontaneous vertex delivery


Spontaneous vertex delivery

ME
None

Spontaneous vertex delivery


Spontaneous vertex delivery

ME
ME

Spontaneous vertex delivery

ME

Spontaneous vertex delivery


Spontaneous vertex delivery
Spontaneous vertex delivery

ME
ME
ME

Spontaneous vertex delivery


VBAC
Spontaneous vertex delivery
Spontaneous vertex delivery
Spontaneous vertex delivery

None
ME
ME

Spontaneous vertex delivery

ME

Spontaneous vertex delivery


Spontaneous vertex delivery
Spontaneous vertex delivery
Spontaneous vertex delivery
Spontaneous vertex delivery

ME
ME
ME
ME
ME

Spontaneous vertex delivery

ME

Spontaneous vertex delivery

ME

Spontaneous vertex delivery


Spontaneous vertex delivery
Spontaneous vertex delivery
Spontaneous vertex delivery
Spontaneous vertex delivery
Spontaneous vertex delivery
Spontaneous vertex delivery
Spontaneous vertex delivery
Spontaneous breech delivery
Spontaneous vertex delivery
Abortion, spontaneous
Abortion, spontaneous

ME
ME
None
ME
ME
ME
ME
None
ME
Completion curettage

Spontaneous vertex delivery

ME

Spontaneous vertex delivery


Spontaneous vertex delivery
Spontaneous vertex delivery

ME
ME
ME

Spontaneous vertex delivery

ME

Spontaneous vertex delivery


Spontaneous vertex delivery
Spontaneous vertex delivery

ME
None
ME

Multiple delivery, all spontaneous

Completion curettage

Spontaneous vertex delivery


Abortion, spontaneous

None

Spontaneous vertex delivery


Spontaneous vertex delivery

ME
ME

Spontaneous vertex delivery


Spontaneous vertex delivery
Spontaneous vertex delivery

ME
ME
ME

Spontaneous vertex delivery


Spontaneous vertex delivery
Spontaneous vertex delivery

ME
ME
ME

Spontaneous vertex delivery


Spontaneous vertex delivery
Spontaneous vertex delivery

ME
ME
ME

Spontaneous vertex delivery


Spontaneous vertex delivery
Spontaneous vertex delivery

ME
ME

VBAC

ME

Spontaneous vertex delivery


Spontaneous vertex delivery
Spontaneous vertex delivery

ME
ME
ME

Spontaneous vertex delivery


Spontaneous vertex delivery
Spontaneous vertex delivery
Spontaneous vertex delivery

ME
ME
ME
ME

Spontaneous vertex delivery


Spontaneous vertex delivery

ME

Spontaneous vertex delivery


Spontaneous vertex delivery

ME

Spontaneous vertex delivery


Spontaneous vertex delivery

ME
ME

Spontaneous vertex delivery

ME

Spontaneous vertex delivery

ME

Spontaneous vertex delivery


Spontaneous vertex delivery

ME
ME

Spontaneous vertex delivery


Spontaneous vertex delivery

ME
ME

Spontaneous vertex delivery


Spontaneous vertex delivery
Spontaneous vertex delivery
VBAC

ME
ME
ME
ME

Spontaneous vertex delivery


Spontaneous vertex delivery
Spontaneous vertex delivery
Spontaneous vertex delivery
Spontaneous vertex delivery

ME
ME
ME
ME
ME

Spontaneous vertex delivery


Spontaneous vertex delivery

ME
ME

Spontaneous vertex delivery

ME

Spontaneous vertex delivery


Spontaneous vertex delivery
Spontaneous vertex delivery
Spontaneous vertex delivery

ME
ME
ME

Spontaneous vertex delivery

Spontaneous vertex delivery


Spontaneous breech delivery

ME

Spontaneous vertex delivery

ME

Spontaneous vertex delivery


Spontaneous vertex delivery
Spontaneous vertex delivery

ME
ME
ME

Spontaneous vertex delivery


Spontaneous vertex delivery

ME
ME

Spontaneous vertex delivery

ME

Spontaneous vertex delivery

ME

Spontaneous vertex delivery

Spontaneous vertex delivery

ME

Spontaneous vertex delivery


Spontaneous vertex delivery

ME
ME

Spontaneous vertex delivery


Spontaneous vertex delivery

ME
ME

Spontaneous vertex delivery


Spontaneous vertex delivery

ME
ME

Spontaneous vertex delivery


Spontaneous vertex delivery

ME
ME

Spontaneous vertex delivery

ME

Spontaneous vertex delivery


Spontaneous vertex delivery

ME
ME

Spontaneous vertex delivery


Spontaneous vertex delivery
Spontaneous vertex delivery
Spontaneous vertex delivery
Spontaneous vertex delivery
Spontaneous vertex delivery
Spontaneous vertex delivery
Spontaneous vertex delivery
Spontaneous vertex delivery
Spontaneous vertex delivery

ME

Spontaneous vertex delivery


Spontaneous vertex delivery

ME
ME

Spontaneous vertex delivery


Spontaneous vertex delivery
Spontaneous vertex delivery
Spontaneous vertex delivery
Spontaneous vertex delivery

ME
ME
ME
ME

ME
ME
ME
ME
ME
ME
ME

Spontaneous vertex delivery


Spontaneous vertex delivery
Spontaneous vertex delivery
Spontaneous vertex delivery
Spontaneous vertex delivery

ME
ME
ME
ME
ME

Spontaneous vertex delivery


Outlet forceps delivery

ME
ME

Spontaneous vertex delivery


Spontaneous vertex delivery
Spontaneous vertex delivery
Spontaneous vertex delivery
Spontaneous vertex delivery

Spontaneous vertex delivery


Spontaneous vertex delivery
Spontaneous vertex delivery
Spontaneous vertex delivery
Spontaneous vertex delivery
Spontaneous vertex delivery
Spontaneous vertex delivery
Spontaneous vertex delivery
Spontaneous vertex delivery
Spontaneous vertex delivery
Spontaneous vertex delivery
Spontaneous vertex delivery
Spontaneous vertex delivery
Spontaneous vertex delivery
Spontaneous vertex delivery

ME
ME
ME
ME

ME
ME
ME
ME
ME
ME
ME
ME
ME
ME
ME

CAESAREAN SECTION
Perineal Laceration

Elective/Emergency

Incision

Primary/Repeat

Elective

Low segmePrimary

Emergency
Emergency
Emergency

Low segmePrimary
Low segmePrimary
Low segmePrimary

Emergency

Low segmePrimary

Emergency

Low segmePrimary

Emergency

Low segmePrimary

Emergency
Emergency

Low segmePrimary
Low segmePrimary

Emergency

Low segmePrimary

Emergency

Low segmePrimary

Elective
Emergency
Elective

Classical Primary
Low segmePrimary
Low segmePrimary

3rd
3rd

3rd
4th
3rd
3rd

3rd

3rd

4th

2nd
Emergency

Low segmePrimary

Emergency

Low segmePrimary

Emergency

Low segmePrimary

2nd
2nd
2nd
2nd
4th
3rd

2nd
3rd
2nd
Elective

Repeat

2nd
3rd
Elective
Emergency

Low segmeRepeat
Low segmePrimary

Emergency
Emergency

Low segmePrimary
Low segmePrimary

Elective
Elective

Low segmeRepeat
Low segmeRepeat

Emergency

Low segmePrimary

4th

4th
2nd

2nd
2nd
Emergency
Emergency

Low segmePrimary
Low segmeRepeat

Emergency

Low segmePrimary

Emergency

Low segmePrimary

Elective

Low segmePrimary

Emergency

Low segmeRepeat

Emergency
Emergency

Low segmePrimary
Low segmePrimary

Emergency

Low segmePrimary

Emergency
Emergency
Emergency

Low segmePrimary
Low segmePrimary
Low segmePrimary

Elective
Emergency

Low segmeRepeat
Low segmePrimary

Emergency

Low segmeRepeat

2nd
2nd
3rd
3rd
3rd
2nd
1st
3rd

2nd
2nd
2nd
2nd

2nd

3rd
3rd
2nd

3rd
2nd
4th
3rd

3rd
Elective
Elective
Elective
Elective

Low segmeRepeat
Low segmePrimary
Low segmePrimary
Low segmePrimary

Emergency

Low segmePrimary

Emergency
Elective

Low segmePrimary
Low segment

Emergency

Low segmePrimary

Elective

Low segmeRepeat

Elective

Low segmeRepeat

Emergency

Low segmePrimary

Emergency
Elective

Low segmePrimary
Low segmeRepeat

Elective

Low segmePrimary

4th
3rd

4th
2nd
2nd

2nd

3rd
2nd
4th

2nd

Elective

Low segmePrimary

Elective

Low segmePrimary

Emergency
Emergency

Low segmePrimary
Low segmePrimary

Emergency
Elective

Low segmePrimary
Low segmePrimary

Elective

Low segmePrimary

Emergency
Emergency

Low segmePrimary
Low segmePrimary

Elective

Low segmePrimary

Emergency
Emergency

Low segmePrimary
Low segmePrimary

Elective
Emergency
Emergency
Emergency
Elective
Elective

Low segmeRepeat
Low segmePrimary
Low segmePrimary
Low segmePrimary
Low segmePrimary
Low segmeRepeat

Emergency
Elective

Low segmePrimary
Low segmeRepeat

Elective

Low segmeRepeat

3rd

4th
3rd
4th

4th
4th

3rd
3rd
3rd

3rd

1st
1st
2nd
3rd
1st

3rd
2nd

Emergency

Low segmePrimary

Elective
Elective

Low segmeRepeat
Low segmePrimary

Elective

Low segmeRepeat

Elective

Low segmePrimary

Elective

Low segmeRepeat

Elective

Low segmeRepeat

3rd
3rd

1st
1st
2nd
1st

4th
3rd
2nd
1st

2nd
3rd
2nd
1st

Hysterectomy

Tubal Ligation

Anesthesia

INFANT FETAL DATA

Tubal ligation

Anesthesia Route

Number of Infants

Local
None
Neuraxial, epidural

Gender

Local
Local

1 Male
1 Male
2 Male
Male
1 Male
1 Male
1 Male
1 Female
1 Male
1 Female
2 Female
Female
1 Female
1 Male

Neuraxial, combined spi


Neuraxial, combined spi
Neuraxial, epidural
Local

1
1
1
1

Female
Female
Male
Male

Local
Neuraxial, epidural
Local
Neuraxial, spinal

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1

Male
Female
Female
Female
Male
Male
Female
Female
Male
Female
Male
Male
Female
Male
Female
Male
Male
Female
Male
Male

1
1
1
1

Male
Male
Female
Female

None
Local
Neuraxial, epidural
Local
Neuraxial, spinal
Neuraxial, spinal
Neuraxial, spinal

Neuraxial, epidural
Neuraxial, epidural
Local
Neuraxial, combined spi
Neuraxial, epidural
Local
Neuraxial, combined spi
Neuraxial, epidural
Local
Local
Local

Neuraxial, epidural
Neuraxial, epidural
None

None
Neuraxial, epidural
Local
Local
Neuraxial, epidural
Local
Local
Neuraxial, epidural
Local

1
1
1
1
1
1
1
1
1
1
1
1

Female
Male
Male
Male
Male
Female
Female
Male
Male
Male
Female
Male

1 Female
Neuraxial, epidural

1 Female

Neuraxial, epidural

1
1
1
1
1
1
1
1
1
1
1

Neuraxial, epidural
Neuraxial, epidural
Local
Local
Local
Neuraxial, combined spi
Neuraxial, epidural
Neuraxial, spinal

Male
Male
Female
Male
Female
Male
Female
Female
Male
Female
Male

Local
Local

2 Male
Male
1 Male
2 Female
Female
1 Male
1 Female

Neuraxial, epidural
Local
None
Neuraxial, epidural
Neuraxial, epidural

1
1
1
1
1

Neuraxial, epidural
Neuraxial, spinal

1 Female
1 Female

Local

Male
Female
Female
Female
Male

1 Female

Neuraxial, epidural
Local

Yes

Neuraxial, epidural
Neuraxial, epidural

1
1
1
1
1

Neuraxial, epidural
Local

1 Female
1 Female
1 Male

Local
Local
Local
Neuraxial, spinal
Local

1
1
1
1
1

Male
Female
Female
Male
Male

Local
Neuraxial, epidural
Neuraxial, epidural
Neuraxial, spinal

1
1
1
1

Male
Male
Male
Male

None
None
None
None
Neuraxial, spinal

1
1
1
1
1
1

Male
Male
Female
Male
Male
Female

Local

1
1
1
1

Male
Male
Male
Male

Local
Local

1
1
1
1

Male
Female
Female
Female

Local
Neuraxial, epidural
None
Neuraxial, epidural
Neuraxial, epidural
Neuraxial, epidural
Local
Local
Neuraxial, spinal
Neuraxial, spinal
Local
Local
Neuraxial, combined spi

1
1
1
1
1
1
1
1
1
1
1
1
1

Male
Male
Female
Male
Male
Female
Female
Female
Female
Male
Female
Male
Female

Local
Local
Neuraxial, epidural

Male
Male
Female
Female
Female

Local
Local
Local
Local
Neuraxial, epidural
Neuraxial, spinal
Neuraxial, epidural
Neuraxial, combined spi

1
1
1
1
1
1
1
2

Local
Local
Neuraxial, epidural
Local
Local

1
1
1
1
1

Local
Local

1 Male
1 Male

Without hysterect No

Local
Neuraxial, spinal

1 Female
1 Male

Without hysterect No
Without hysterect No

Neuraxial, epidural
Neuraxial, epidural

1 Female
1 Male

Without hysterect No

Local
Local
Local
Local
Neuraxial, spinal

1
1
1
1
1

Neuraxial, epidural

1 Male

Neuraxial, epidural
Local

1 Female
1 Male

Local
Neuraxial, combined spi
Local
Local
Local
Neuraxial, epidural
Local
Local
Neuraxial, epidural
Local
Neuraxial, spinal
Neuraxial, combined spi
Local
Neuraxial, spinal
Local

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1

Without hysterect
Without hysterect
Without hysterect
Without hysterect

No
No
No
No

Without hysterect No

Without hysterect Yes


Without hysterect No
Without hysterect No
Without hysterect No
Without hysterect No

Female
Male
Female
Female
Male
Female
Male
Male
Male
Male
Female
Male
Female
Female

Male
Female
Male
Male
Female

Female
Male
Male
Female
Male
Male
Female
Female
Male
Female
Male
Female
Male
Male
Male

Without hysterect No

Neuraxial, epidural
Local

1 Male
1 Female

Without hysterect No

Neuraxial, spinal
Local
Local
Neuraxial, epidural
Neuraxial, epidural
Local
Local
Neuraxial, combined spi
Neuraxial, epidural

1
1
1
1
1
1
1
1
1

Female
Male
Male
Female
Male
Female
Female
Male
Female

Local
Local
Neuraxial, spinal
Local
Local
Neuraxial, spinal
Neuraxial, epidural
Local
Neuraxial, epidural
Local
Local
Neuraxial, epidural
General, intubated
Local
Local
Local
Local
Local
Local
Local
Local
Local
Local
Neuraxial, spinal
Neuraxial, spinal
Neuraxial, spinal
Neuraxial, epidural
Neuraxial, epidural
Neuraxial, epidural
Local
Local
Neuraxial, spinal
Neuraxial, spinal
Local
Local
Local
Local
Local
Neuraxial, combined spi

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
2

Male
Female
Male
Female
Male
Female
Male
Male
Female
Female
Female
Male
Male
Male
Male
Male
Male
Male
Female
Female
Female
Female
Female
Male
Male
Male
Male
Male
Female
Female
Female
Female
Male
Female
Male
Male
Female
Male
Female

Without hysterect No
Without hysterect No
Without hysterect No
Without hysterect No

Without hysterect No
Without hysterect No
Without hysterect No
Without hysterect No
Without hysterect No
Without hysterect No

Without hysterect
Without hysterect
Without hysterect
Without hysterect
Without hysterect
Without hysterect

No
No
No
No
No
No

Without hysterect No
Without hysterect No

Without hysterect No

Without hysterect No
Without hysterect No
Without hysterect No
Without hysterect No

Without hysterect No
Without hysterect No

Without hysterect No

Local
Local
Local
Local
Local
Local
Local
Neuraxial, epidural
Neuraxial, combined spi
Neuraxial, epidural

1
1
1
1
1
1
1
1
1
2

Local
Neuraxial, spinal
Local
Local
Local
Local
Neuraxial, spinal

1
1
1
1
1
1
1

Male
Female
Female
Female
Female
Male
Male
Male
Female
Female
Female
Female
Female
Male
Female
Male
Male
Female
Female

Neuraxial, combined spi


Local
Local
Local
Local
Local
Local
Neuraxial, epidural
Local
Local
Local
Local
Local
Local
Neuraxial, spinal
Local
Local

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1

Male
Male
Female
Male
Male
Male
Male
Female
Male
Male
Male
Male
Male
Male
Male
Male
Female

Fetal Characteristics

Weight (grams)

Length (cm)

Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated

2900
3000
2450
2350
2200
2900
2850
3300
3250
2850
2550
2500
2750
3500

Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated

Pediatric Age (weeks)

47
51
48
49
46
52
51
50.5
49

37-38
39-40
36-37
36
38-39
38-39
40
39
39-40
39-40

47
49
49 38-39
53 38-39

37
37

3350
2650
2850
3450

53
51
46
51 39-40

40
39
40

Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated

2400
2800
2500
2950
3200
750
3150
2900
2950
2550
3000
3200
3300
1850
2800
2400
3400
3150
2650
3650

46
50 38-39
46
49
49 39-40
26-27
49 39-40
49.5 39-40
53
49
50
53 39-40
52
40 33-34
48 39-40
50 39-40
53 40-41
51
48 38-39

39

Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated

3400
3850
3100
2900

48
55 40-41
34 39-40
49

39
39

38
39
37
40

39
39
40
38

Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated

2850
3600
3850
3250
2850
2500
2850
2400
2900
2600
750
3250

51
51
51
49
48
47
51
47
39
49
35
53

Uncomplicated

3800

53 40-41

Uncomplicated

3800

53 40-41

Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated

2800
3450
2800
2950
3150
3000
2950
1750
3100
3150
3500

49
51
50
48
51
51
51
40
48
49
54

Lethal
Lethal
Uncomplicated
Lethal
Lethal
Uncomplicated
Uncomplicated

250 none
250 none
2450
none
none
3350
2860

none
none

38-39
36-37
40-41
38-39
39
38-39
38
38
39
39
28
39-40

40
39
39
36
38
38-39
39
33-34
41
38-39
38-39
none
none

49

40
none
none

50
48 38-39

Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated

3150
3050
2800
3050
2800

52 37-38
51
49 38-39
57
49.5

Uncomplicated
Uncomplicated

2800
2800

48 38-39
47 37-38

Uncomplicated

3050

52 38-39

38

39
37
40

Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated

3250
3200
2850
2800
3600

51
52
50
45
53 38-39

39
39
40
39

Uncomplicated
Uncomplicated
Uncomplicated

3600
3000
2800

50
50
49 38-39

40
40

Uncomplicated
Uncomplicated
Lethal
Uncomplicated
Uncomplicated

2700
3800
2800
1100
2300

51 39-40
52 38-39
52
39
48 35-36

Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated

4000
3100
2700
1250

55
49 38-39
50
36 30-32

Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated

2100
3950
3050
3300
3550
2680

48
53
49
52
54
48

Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated

2550
2800
3350
2850

50 39-40
52 38-39
49 36-37

Uncomplicated
Uncomplicated
SGA
Uncomplicated

4150
3400
2300
3150

55 40-41
56 39-40
47
51

Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated

2950
3150
2600
3550
3400
3200
3100
3400
2550
2600
2850
2550
3150

49
51
49
54
52
57
52
51
50
49
51
47
47

34
40
40

35-36
39-40
38-39
38-39
39
38-39
39

38
39

38-39
38-39
39-40
39-40
39
40
38-39
38-39
38-39
39
38-39
38-39
39

Uncomplicated
Uncomplicated
Uncomplicated
SGA
Uncomplicated
Uncomplicated
Uncomplicated
SGA
SGA
Uncomplicated
SGA
Uncomplicated
Uncomplicated
Uncomplicated

3050
3200
2600
2250
2950
2700
3300
2450
2400
3000
2300
3200
2750
2750

49
39
50
43
51
47
52
46
46
49
48
47
50
48

38-39

Uncomplicated
Uncomplicated

4050
3100

57
50 38-39

41

Uncomplicated
SGA

3000
2200

51
49

39
38

SGA
SGA

2300
2350

47 38-39
48 38-39

Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated

3250
2700
3100
3300
2600

52
50
50 38-39
51
49 38-39

Uncomplicated

3350

55 38-39

Uncomplicated
Uncomplicated

2500
2600

49 38-39
49 38-39

Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
SGA
Uncomplicated
Uncomplicated
SGA
Uncomplicated
Uncomplicated
Uncomplicated
SGA

3200
3400
2550
3250
2500
3250
2900
2350
2900
2800
2200
2950
3050
2800
2350

50
49
49
51
48
51
52
47
48
49
48
51
51
49
49

39
39
38-39
39
37-38
38
36-37
36-37
40
36
41
38
40

39
40
40

39
38-39
40
38-39
39
40
39-40
38
42
40-41
36-37
40
38-39
38-39
38

Uncomplicated
Uncomplicated

2650
3250

47 36-37
51 38-39

Uncomplicated
Uncomplicated
Uncomplicated
SGA
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated

3000
2650
2750
2400
3100
3550
3050
2700
2950

51
48
50
48
50
50
51
50
50

Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
SGA
Uncomplicated
SGA
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
SGA
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
SGA

3100
3100
3000
3000
3800
3450
3200
3150
3000
2625
3400
3900
2300
3250
1850
3600
3150
2850
2600
2600
2350
3350
2800
2700
3250
2700
3200
3650
3150
3200
3700
2900
3350
2950
3200
3000
3300
2600
2400

50
50
51
51
52
52
52
48
49
48.5
50
53
46
52
43
53
49
48
47
49
47
50
48
49
50
49
51
52
50
50
53
50
48
48
50
51
50
50
44

38-39
38-39
39
38
39
40
38-39
38-39
38-39
38
38
38
40
38-39
38-39
38-39
38-39
38
38
40
40
31-32
40
34
38-39
38-39
39
36-37
39
37
39
39-40
37-38
38-39
38-39
38-39
39-40
39
39
38
38
39
40
39
36
38-39
40
37

Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
SGA
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
SGA
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated

2750
2650
3000
2650
2650
2350
3000
4050
3200
3100
2350
2900
2700
3400
3400
2650
3650
2750
2750

48
48
49
47
49
46
50
53
52
50
50
49
46
52
54
48
53
49
51

Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
SGA
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated
Uncomplicated

2850
3200
3300
2750
3000
3000
3800
2900
3300
3100
2900
2400
2750
3350
3000
3050
2550

50
49
50
52
48
50
52
52
49
49.5
48
45
52
49
49
49
51

36-37
36-37
38
38-39
38-39
36
38-39
39
39
38-39
36-37
37-38
38-39
38
39
39
38-39
39
37
38
39
38-39
38-39
39
39
39
38-39
38-39
39
38-39
38
38-39
39
38-39
40
37

Apgar Score
1min

DISCHARGE STATUS

5min

10min

Neonatal Condition

DISCHARGE DATE

8
9
8
8
9
9
9
9
7
8
8
8
8
8

9
9
9
9
9
9
9
9
9
9
9
9
9
9

Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth

1/4/2014
1/4/2014
1/5/2014
1/5/2014
1/4/2014
1/6/2014
1/6/2014
1/6/2014

8
8
8
9

9
9
9
9

Livebirth
Livebirth
Livebirth
Livebirth

1/8/2014
1/7/2014
1/8/2014
1/7/2014

8
8
8
8
8

9
9
9
9
9

1/7/2014
1/8/2014
1/8/2014
1/9/2014
1/8/2014
1/9/2014

9
8
9
8
9
8
9
4
9
8
9
9
9
9

10
9
9
9
9
9
9
7
9
9
9
9
9
9

Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
9 Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth

1/12/2014
1/11/2014
1/10/2014
1/14/2014
1/10/2014
1/10/2014
1/11/2014
1/11/2014
1/11/2014
1/12/2014

9
9
9
8

9
9
9
9

Livebirth
Livebirth
Livebirth
Livebirth

1/14/2014
1/13/2014
1/13/2014
1/12/2014

8
8
9
9
9
8
9
9
9
9
3
8

9
9
9
9
9
9
9
10
9
9
5
9

Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
6 Livebirth
Livebirth

Livebirth

Livebirth

7
8
9
9
9
9
9
7
8
9
9

9
9
9
9
9
9
9
9
9
9
9

Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
9 Livebirth
Livebirth
Livebirth
Livebirth

1/19/2014

Stillbirth
Stillbirth
Livebirth

8
9

9
9

Livebirth
Livebirth

1/20/2014
1/20/2014
1/21/2014

9
9
9
8
8

9
9
9
9
9

Livebirth
Livebirth
Livebirth
Livebirth
Livebirth

8
8

9
9

Livebirth
Livebirth

Livebirth

none
none

none
none
8

none
none

none
none

1/13/2014
1/13/2014
1/13/2014
1/13/2014

1/15/2014
1/15/2014
1/14/2014
1/15/2014
1/14/2014
1/15/2014
1/15/2014
1/16/2014

1/16/2014
1/18/2014
1/18/2014
1/17/2014

1/22/2014

1/19/2014
1/19/2014

1/18/2014
1/20/2014
1/21/2014
1/20/2014
1/21/2014
1/23/2014
1/20/2014
1/24/2014
1/23/2014
1/22/2014
1/24/2014

9
9
9
1
8

9
9
10
5
9

Livebirth
Livebirth
Livebirth
9 Livebirth
Livebirth

9
9
8

9
9
9

Livebirth
Livebirth
Livebirth

9
9

9
9

8
9

9
9

Livebirth
Livebirth
Stillbirth
Livebirth
Livebirth

8
8
8
2

9
9
9
5

Livebirth
Livebirth
Livebirth
7 Livebirth

8
4
8
9
8
9

9
6
9
9
9
9

Livebirth
9 Livebirth
Livebirth
Livebirth
Livebirth
Livebirth

9
8
9
8

9
9
9
9

Livebirth
Livebirth
Livebirth
Livebirth

9
9
8
7

9
9
9
9

Livebirth
Livebirth
Livebirth
Livebirth

9
9
8
8
9
8
9
9
8
9
8
8
9

9
9
9
9
9
9
10
9
9
9
9
9
9

Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth

1/22/2014
1/23/2014
1/23/2014
1/24/2014
1/25/2014
1/27/2014
1/24/2014
1/27/2014
1/25/2014
1/25/2014
1/25/2014
1/26/2014
1/26/2014
1/26/2014
1/29/2014
1/27/2014
1/27/2014
1/28/2014
1/28/2014
2/1/2014
1/26/2014
1/31/2014
1/30/2014
1/28/2014
1/29/2014
2/2/2014
1/29/2014
2/4/2014
1/29/2014
1/31/2014
1/31/2014
1/31/2014
1/30/2014
2/3/2014
2/2/2014
1/31/2014
2/2/2014
2/1/2014
1/30/2014
2/1/2014
2/3/2014
2/3/2014
2/3/2014
2/3/2014
2/2/2014
2/3/2014
2/3/2014
2/4/2014
2/3/2014
2/5/2014

9
8
9
9
8
8
8
7
8
9
8
8
9
8

9
9
9
9
9
9
9
8
9
10
9
9
10
9

Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth

2/5/2014
2/4/2014
2/4/2014
2/4/2014

8
8

9
9

Livebirth
Livebirth

7
8

9
9

Livebirth
Livebirth

2/5/2014
2/8/2014
2/5/2014
2/5/2014
2/5/2014
2/5/2014
2/5/2014
2/7/2014
2/6/2014
2/8/2014
2/8/2014

7
8

9
9

Livebirth
Livebirth

2/9/2014
2/8/2014

8
8
8
8
8

9
9
9
9
9

Livebirth
Livebirth
Livebirth
Livebirth
Livebirth

2/7/2014
2/7/2014
2/8/2014
2/7/2014
2/9/2014

10

Livebirth

8
8

9
9

Livebirth
Livebirth

7
9
8
8
8
8
8
4
7
8
7
7
8
7
9

9
10
9
9
9
9
9
7
9
9
9
9
9
9
10

Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
9 Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth

2/7/2014
2/6/2014
2/6/2014
2/14/2014
2/8/2014
2/8/2014
2/7/2014
2/7/2014
2/13/2014
2/9/2014
2/9/2014
2/12/2014
2/10/2014
2/10/2014
2/11/2014
2/13/2014
2/11/2014
2/13/2014
2/13/2014
2/12/2014
2/14/2014
2/13/2014

2/6/2014
2/7/2014

8
8

9
9

Livebirth
Livebirth

8
8
8
8
6
8
8
8
7

9
9
9
9
9
9
9
9
9

Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth

2/14/2014
2/12/2014
2/12/2014
2/13/2014
2/13/2014
2/13/2014
2/14/2014
2/15/2014
2/14/2014
2/12/2014
2/15/2014
2/18/2014

8
8
8
8
8
8
9
7
7
8
9
8
2
6
9
9
9
8
9
9
6
9
8
8
8
9
8
8
9
8
8
8
8
8
9
8
8
9
9

9
9
9
9
9
9
9
9
9
9
10
9
3
8
9
9
9
9
10
10
8
9
9
9
9
10
9
9
10
9
9
9
9
9
9
9
9
9
9

Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
4 Livebirth
9 Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
9 Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth

2/14/2014
2/14/2014
2/15/2014
2/16/2014
2/15/2014
2/18/2014
2/17/2014
2/17/2014
2/17/2014
2/17/2014
2/18/2014
2/23/2014
2/17/2014
2/18/2014
2/21/2014
2/18/2014
2/21/2014
2/18/2014
2/18/2014
2/18/2014
2/18/2014
2/18/2014
2/19/2014
2/21/2014
2/21/2014
2/20/2014
2/20/2014
2/20/2014
2/21/2014
2/20/2014
2/20/2014
2/21/2014
2/21/2014
2/21/2014
2/21/2014
2/21/2014
2/21/2014
2/22/2014
2/22/2014

9
8
7
8
9
7
8
8
8
8
8
8
9
8
9
9
9
9
8

9
9
9
9
10
9
9
9
9
9
9
9
10
9
10
10
9
9
9

Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth

8
9
9
8
8
9
8
8
8
9
6
8
9
8
9
8
7

9
10
9
9
9
9
9
9
9
10
7
9
9
9
9
9
9

Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
9 Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth
Livebirth

2/22/2014
2/23/2014
2/22/2014
2/22/2014
2/22/2014
2/23/2014
2/24/2014
2/24/2014
2/25/2014
2/24/2014
2/25/2014
2/24/2014
2/25/2014
2/24/2014
2/24/2014
2/25/2014
2/24/2014
2/25/2014
2/27/2014
2/26/2014
2/26/2014
2/28/2014
2/26/2014
2/26/2014
2/27/2014
2/28/2014
2/29/2014
2/28/2014
3/1/2014
3/1/2014
3/1/2014
3/3/2014
3/3/2014
3/5/2014
3/2/2014
3/1/2014

Fetal Neonatal Condition


Mother Condition

Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive

Category

Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive

Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive

Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive

Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive

Central Nervous System

Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Alive

Congenital Anomalies
Condition

Yes/No

Major/Minor

Lethal/Non-lethal

Major

Non-lethal

No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
Yes
No
No
No
No
No
No
No
No
No
No

No
No
No
No
No
No
No
No
No
No
No
No

No
No
No
No
No
No
No
No
No
No
No
No
No

No
No
No

No
No
No
No
No
No
No
No

No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No

No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No

No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No

No
No
No
No
No
No
No
NO
No
No
No

Intracranial hemorrhage

No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No

No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
NO
No

Pregnancy
Delivered
Yes/No

Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes

Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
Yes
Yes
No
No
Yes
Yes
Yes
Yes
Yes
No
Yes
Yes
No
Yes

No
Yes
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes

Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
Yes
Yes
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
Yes
Yes
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes

Yes
Yes
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes

Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
yes
yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes

PHILIPPINE OBSTETRICAL AND GYNECOLOGICAL SOCIET


version 0.12
Gyne Form

PATIENT DATA
CASE NO

LASTNAME

FIRSTNAME

PTN000607886
PTN000608739
PTN000608624
PTN000608113
PTN000606872
PTN000608662
PTN000610044
PTN000610213
PTN000610153
PTN000610000
PTN000610154
PTN000608098
PTN000611733
PTN000612722
PTN000613068
PTN000611418
PTN000611031
PTN000613688
PTN000614984
PTN000613894
PTN000614831
PTN000616026
PTN000616633
PTN000617962
PTN000618293
PTN000618335
PTN000619464
PTN000620155
PTN000620554
PTN000620535
PTN000621459
PTN000621771
PTN000622378
PTN000622928
PTN000624779
PTN0006248
PTN0006250
PTN000625721
PTN000625905
PTN000626296
PTN000627141
PTN000627967
PTN000628255

Escorial
Uy
Mosqueda
Ramirez
Trinidad
Maglasang
Vega
Tenebro
Sungahid
Medaros
Violin
Labesores
Rosell
Tan
Nampeng
Garcia
Galagar
Baring
Cabahug
Payongayong
Sabordo
Carcallas
Aya-ay
Basilio
Campugan
Tiu
Empleo
Perez
Devocion
Bersabal
Tinapay
Alba
Remitar
Mesias
Gonzales
Alburan
Barcial
Caballes
Aballe
Bacus
Besmanos
Paje
Hongoy

Merlie
Erna
Ana Mae
Veven
Lara
Arsenia
Rochie
Maria
Teresita
Lilibeth
Charisma
Ma. Bernatte
Daisy
Janice
Parichart
Dana
Evilyn
Camila
Tita
Espie
Ma. Aiza
Ma. Hazel
Marissa
Josefina
Nonelie
Marlene
Mylene
Tedelina
Rita
Lorgette
Consuelo
Rosemarie
Cristina
Noreena
Ester
Sarah
Rebecca
Marijo
Ea
Rebecca
Avelina
Emelita
Loida

Birthday

3/23/1974
5/26/1947
3/26/1994
8/7/1978
1/19/1985
8/29/1967
5/15/1992
5/9/1980
10/3/1954
7/8/1963
7/18/1977
5/2/1994
3/18/1974
2/11/1984
11/4/1992
7/17/1986
6/8/1961
10/7/1965
3/31/1949
10/7/1982
11/24/1983
9/2/1977
1/4/1967
1/16/1962
6/2/1990
9/2/1978
9/2/1963
3/18/1976
5/22/1970
9/3/1974
5/11/1968
10/2/1962
7/24/1975
12/18/1984
9/19/1963
2/1/1965
5/5/1955
8/9/1968
2/5/1995
5/26/1949
11/18/1965
4/10/1966
7/25/1977

Age

Service

40
67
20
36
30
47
22
34
60
51
37
20
40
30
22
28
53
49
65
32
31
37
48
53
24
36
51
38
44
40
46
52
39
30
50
49
59
46
19
65
49
48
37

Private
Private
Charity
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Charity
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Charity

PTN000628205
PTN0006293
PTN0006292
PTN000629113
PTN000629404
PTN000629580
PTN000630463
PTN000630480
PTN000630731
PTN000631954
PTN000631599
PTN000632097
PTN000632095
PTN000631103
PTN0006332
PTN0006332
PNT000633893
PTN000634293
PTN000635121
PNT000634000
PTN000635250
637472
638712

Sagpang
Vocales
Raganas
Larrazabal
Pardillo
Licmo-an
Margaja
Vijandre
Galo
Augusto
Alojacin
Lumapas
Mepa
Salarda
Montero
Soledad
Paires
Virtudazo
Majan
Sinadjan
Uy
Mandado
Enad

Virgie
Amada
Rhodora
Amabella
Ma. Ruth
Marijoy
Cristina
Sherlene
Monica
Shirly
Ana
Jingky
Mary
Lynne
Martha
Geraldine
Anecita
Nenet
Jenelyn
Marivic
Debbie
Juliet
Marissa

10/12/1961
8/10/1950
3/7/1985
3/23/1972
5/3/1965
3/18/1976
4/7/1983
12/27/1982
5/4/1942
12/22/1955
6/4/1978
1/11/1984
9/9/1970
5/5/1979
7/29/1969
12/30/1974
8/17/1968
7/12/1976
12/17/1987
3/21/1988
11/20/1961
7/1/1981
6/8/1972

640394 Retuya

Rosemary

8/6/1954

60 Private

639706 Estrada
641584 Povadora

Jeraldine
Evelyn

9/18/1987
11/2/1968

27 Private
46 Private

640657 Orquina
642841 Alburah
642916 Braswell

Mary June
Sarah
Loraine

12/29/1991
2/1/1965
3/22/1994

23 Private
49 Private
20 Private

643384
643828
643990
645908
646009
646122

Jamola
Ramirez
Ceniza
Lear
Pogo
Lagumon

Fe
Jonah
Geraldine
Elaine
Josefina
Virgie

9/3/1953
4/15/1975
6/5/1967
1/4/1965
2/8/1968
9/25/1955

61
39
46
50
46
59

Private
Private
Private
Private
Private
Private

647159
647511
644298
648050
648447
649358
650578
650190

Nioda
Mijares
Rodila
Dy
Anga
Bayot
Fuentes
Fajardo

Mary Ann
Sarah
Maria
Katherine
Julieta
Camille
Esmeralda
Pacita

7/5/1979
9/2/1965
12/7/1982
6/1/1985
7/19/1956
6/10/1995
9/30/1979
5/28/1959

35
49
32
28
58
19
35
55

Private
Private
Private
Private
Private
Private
Private
Private

652486 Comaingking
653506 Empleo

Melba
Mylene

1/1/1967
9/2/1963

53
64
28
42
49
38
30
32
72
59
36
31
44
35
45
39
46
38
27
26
53
33
42

Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private
Private

48 Private
51 Private

653447 Yao
653794 Hebia
654012 Aspilla

Sherrie
Peachie
Marlou

6/23/1988
1/27/1984
12/14/1972

26 Private
30 Private
42 Private

654082 Badinas
654475 Bunadi

Kim
Necitas

11/12/1979
1/8/1968

35 Private
47 Private

654143 Mendiola
654904 Kangleon

Anna Maria
Nanette

8/28/1967
12/10/1956

47 Private
58 Private

Estillone
Ma. Marisa
Ylaya
Amalia
Gelig
Gwendolyn
Tano
Corazon
Tamisola
Althea
Ramano
Annalou
Baladyjay
Jocelyn
Relatado
Aisha
Aliac
Aona
ShambandarianYvonne
Estenzo
Felepa
Viray
Sheryle

10/17/1967
8/3/1962
4/20/1981
6/5/1970
4/10/1990
7/5/1982
1/30/1967
1/18/1989
1/7/1981
1/2/1988
10/22/1986
8/20/1979

47
52
33
44
24
32
47
26
34
27
28
35

655682
656081
657359
657279
659150
658938
659047
660160
660243
661156
661438
656199

Private
Private
Private
Private
Private
Private
Charity
Private
Private
Private
Private
Private

OGICAL SOCIETY

HISTORY
ADMIT DATE

1/1/2014
1/2/2014
1/2/2014
1/2/2014
1/2/2014
1/2/2014
1/3/2014
1/3/2014
1/3/2014
1/3/2014
1/4/2014
1/4/2014
1/6/2014
1/6/2014
1/7/2014
1/5/2014
1/4/2014
1/7/2014
1/9/2014
1/8/2014
1/9/2014
1/9/2014
1/10/2014
1/11/2014
1/12/2014
1/12/2014
1/13/2014
1/14/2014
1/14/2014
1/14/2014
1/15/2014
1/16/2014
1/16/2014
1/17/2014
1/20/2014
1/20/2014
1/20/2014
1/21/2014
1/21/2014
1/21/2014
1/22/2014
1/23/2014
1/23/2014

FINAL DIAGNOSIS
Gravidity

Parity

1
4
1
3
0
4
0
2
1
0
1
0
2
0
0
1
2
3
3
0
2
2
0
5
0
1
2
2
0
0
0
3
1
3
2
4
0
2
0
7
4
2
2

Category

0
3
1
2
0
4
0
2
1
0
1
0
2
0
0
1
2
3
3
0
2
1
0
5
0
1
2
2
0
0
0
3
1
2
1
4
0
2
0
3
4
1
2

Condition

Benign Neoplasm of the Uterus Leiomyoma


Malignant Neoplasm of the Cor Endometrial carcinom
Malignant Neoplasm of the OvaGerm cell type, ovary
Pelvic Symptoms
Benign Neoplasm of the Uterus Leiomyoma
Benign Neoplasm of the Uterus Leiomyoma
Pelvic Inflammatory Disease Pelvic inflammatory diseases, prob. Bacteria
Pelvic Symptoms
Malignant Neoplasm of the CervAdenocarcinoma, cer
Benign Neoplasm of the Uterus Endometrial polyp
Benign Neoplasm of the Cervix
Pelvic Symptoms
Epithelial Neoplasm of the OvarCystadenoma not spec
Pelvic Symptoms
Other Benign Conditions of the Follicular cyst of ovar
Other Benign Conditions of the Follicular cyst of ovar
Menstrual Disorders
Intermenstrual bleedi
Endometriosis
Adenomyosis, endome
Benign Neoplasm of the Uterus Endometrial polyp
Other Benign Conditions of the Follicular cyst of ovar
Endometriosis
Uterus, endometriosi
Malignant Neoplasm of the Cor Other endometrial neoplasm, corpus
Menstrual Disorders
Intermenstrual bleedi
Menstrual Disorders
Polymenorrhea
Pelvic Inflammatory Disease Pelvic inflammatory d
Benign Neoplasm of the Uterus Endometrial polyp
Other Benign Conditions of the Follicular cyst of ovar
Endometriosis
Adenomyosis, endome
Benign Neoplasm of the Uterus Leiomyoma
Endometriosis
Pelvic peritoneum, e
Benign Neoplasm of the Uterus Endometrial hyperplas
Benign Neoplasm of the Uterus Endometrial hyperplas
Endometriosis
(Stage 1, 2,3, unspe
Benign Neoplasm of the Uterus Leiomyoma
Malignant Neoplasm of the Cor Endometrial carcinom
Benign Neoplasm of the Uterus Leiomyoma
Benign Neoplasm of the Uterus Endometrial polyp
Benign Neoplasm of the Uterus Leiomyoma
Benign Neoplasm of the Uterus Endometrial polyp
Genital Prolapse
Old laceration of musc
Benign Neoplasm of the Uterus Leiomyoma
Malignant Neoplasm of the CervAdenocarcinoma, cer
Epithelial Neoplasm of the OvarCystadenoma not spec

1/23/2014
1/24/2014
1/24/2014
24-Jan
1/24/2014
1/24/2014
1/25/2014
1/25/2014
1/26/2014
1/27/2014
1/27/2014
1/27/2014
1/27/2014
1/27/2014
1/28/2014
1/28/2014
1/29/2014
1/29/2014
1/30/2014
1/30/2014
1/30/2014
2/2/2014
2/3/2014

1
9
0
4
3
1
0
0
6
0
0
0
0
0
2
2
11
4
3
0
2
1
0

1
9
0
4
3
1
0
0
6
0
0
0
0
0
2
2
10
4
2
0
2
1
0

2/5/2014

2/5/2014
2/6/2014

2
0

2
0

2/6/2014
2/7/2014
2/7/2014

0
4
0

0
4
0

2/8/2014
2/9/2014
2/9/2014
2/11/2014
2/11/2014
2/11/2014

6
0
7
0
4
4

5
0
5
0
3
3

2/12/2014
2/12/2014
2/12/2014
2/13/2014
2/13/2014
2/14/2014
2/16/2014
2/17/2014

0
3
2
1
2
0
3
1

0
3
2
1
2
0
3
1

2/18/2014
2/19/2014

5
2

4
2

Benign Neoplasm of the Uterus Leiomyoma


Malignant Neoplasm of the OvaOther type neoplasm,
Benign Neoplasm of the Uterus Leiomyoma
Benign Neoplasm of the Uterus Leiomyoma
Benign Neoplasm of the Uterus Endometrial hyperplas
Benign Neoplasm of the Uterus Leiomyoma
Endometriosis
Adenomyosis, endome
Other Benign Conditions of the Corpus luteum cyst,
Epithelial Neoplasm of the OvarCystadenoma not spec
Malignant Neoplasm of the Cor Endometrial carcinom
Malignant Neoplasm of the Cor Endometrial carcinom
Other Inflammation of Vagina a Vulva condyloma acu
Malignant Neoplasm of the Cor Endometrial carcinom
Epithelial Neoplasm of the OvarMucinous cystadenom
Benign Neoplasm of the Uterus Endometrial polyp
Epithelial Neoplasm of the OvarMucinous cystadenom
Other Benign Conditions of the Corpus luteum cyst,
Germ Cell Tumors
Mature cystic teratom
Other Benign Conditions of the Corpus luteum cyst,
Benign Neoplasm of the Uterus Leiomyoma
Benign Neoplasm of the Uterus Leiomyoma
Other Benign Conditions of the Follicular cyst of ovar
Endometriosis
Adenomyosis, endome
Benign Neoplasm of the Uterus Adenomatous or atypic
Benign Neoplasm of the Uterus Endometrial hyperplas
Benign Neoplasm of the Uterus Endometrial polyp
Benign Neoplasm of the Uterus Leiomyoma
Pelvic Inflammatory Disease Pelvic Abscess
Benign Neoplasm of the Uterus Endometrial polyp
Benign Neoplasm of the Uterus Leiomyoma
Other Benign Conditions of the Follicular cyst of ovar
Other Benign Conditions of the Paratubal serous cyst,
Other Benign Conditions of the Follicular cyst of ovar
Benign Neoplasm of the Uterus Endometrial hyperplas
Malignant Neoplasm of the CervAdenocarcinoma, cer
Endometriosis
Pelvic peritoneum, e
Other Benign Conditions of the Paratubal serous cyst,
Endometriosis
Adenomyosis, endome
Endometriosis
Adenomyosis, endome
Benign Neoplasm of the Uterus Endometrial hyperplas
Benign Neoplasm of the Uterus Leiomyoma
Endometriosis
Endometrial hyperplas
Benign Neoplasm of the Uterus Endometrial polyp
Benign Neoplasm of the Uterus Leiomyoma
Other Benign Conditions of the Follicular cyst of ovar
Benign Neoplasm of the Cervix Polyp of cervix uteri
Other Benign Conditions of the Follicular cyst of ovar
Benign Neoplasm of the Cervix Polyp of cervix uteri
Benign Neoplasm of the Uterus Leiomyoma
Benign Neoplasm of the Uterus Endometrial polyp
Endometriosis
Endometriosis unspec
Malignant Neoplasm of the OvaOther type neoplasm,

2/19/2014
2/19/2014
2/19/2014

0
1
2

2/20/2014
2/20/2014

3
0

2/20/2014
2/20/2014

4
1

2/21/2014
2/21/2014
2/24/2014
2/24/2014
2/25/2014
2/25/2014
2/25/2014
2/26/2014
2/27/2014
2/27/2014
2/28/2014
2/28/2014

2
4
0
3
0
2
1
0
0
1
1
2

0 Other Benign Conditions of the Follicular cyst of ovar


1 Benign Neoplasm of the Uterus Leiomyoma
2 Benign Neoplasm of the Uterus Leiomyoma
Endometriosis
Pelvic peritoneum, e
3 Malignant Neoplasm of the OvaOther type neoplasm,
0 Benign Neoplasm of the Uterus Leiomyoma
Benign Neoplasm of the Uterus Endometrial polyp
Pelvic Inflammatory Disease Pelvic inflammatory d
4 Benign Neoplasm of the Uterus Endometrial hyperplas
1 Malignant Neoplasm of the Cor Endometrial carcinom
Benign Neoplasm of the Uterus Leiomyoma
2 Benign Neoplasm of the Uterus Endometrial polyp
4 Endometriosis
Adenomyosis, endome
0 Endometriosis
Pelvic peritoneum, e
3 Malignant Neoplasm of the OvaOther type neoplasm,
0 Other Benign Conditions of the Follicular cyst of ovar
2 Endometriosis
Pelvic peritoneum, e
1 Endometriosis
Pelvic peritoneum, e
0 Pelvic Inflammatory Disease Pelvic inflammatory d
0 Pelvic Inflammatory Disease Pelvic inflammatory d
0 Diseases of Bartholin's Gland Abscess of Bartholin'
0 Benign Neoplasm of the Uterus Leiomyoma
2 Other Inflammation of Vagina a Vulva condyloma acu

Laterality

For Malignancy For Genital


Only
Prolapse Only

OPERATIONS

Stage

Elective/Emergency

Approach

Elective
Elective
Elective

Laparotomy Uterus
Other Ope
Laparotomy Ovary

Elective

HysteroscopicUterus

Elective

Laparotomy Ovary

Elective
Elective

Laparotomy Uterus
HysteroscopicUterus

Elective

Vaginal

Elective

HysteroscopicUterus

Elective
Elective

Laparotomy Uterus
Laparotomy Ovary

Elective
Elective

HysteroscopicUterus
Laparotomy Ovary

Elective
Elective
Elective

Vaginal
Uterus
Vaginal
Uterus
Laparotomy Uterus

Elective
Elective
Elective

Vaginal
Uterus
Laparotomy Other Ope
Laparotomy Ovary

Degree

NA
NA
IV
Right
I
NA
Unspecified

mmatory diseases, prob. Bacterial


NA
Unspecified I
Unspecified

Left
NA
Unspecified
Unspecified
NA
Unspecified
Unspecified
Left
Right
ometrial neoplasm, corpus
Unspecified
Unspecified
Unspecified
Unspecified
Unspecified
Unspecified
Unspecified
Unspecified
Unspecified
Unspecified
Unspecified
Unspecified
Unspecified II
Unspecified
Unspecified
Unspecified
Unspecified
Unspecified
Unspecified
Unspecified III
Left

Organ

Uterus

Complete

Unspecified
Unspecified
Unspecified
Unspecified
Unspecified
Unspecified
Unspecified
NA
Left
Unspecified
Unspecified
Unspecified
Unspecified
Right
Unspecified
Left
Left
Right
Right
Unspecified
Unspecified
Both
NA
NA
NA
NA
NA
Left
NA
NA
Both
Left
Both
NA
NA
NA
Left
NA
NA
NA
NA
NA
NA
Right
Both
NA
NA
NA
NA
NA
NA
Unspecified

IV

I
II

Elective
Elective

Laparotomy Uterus
Laparotomy Other Ope

Elective
Elective
Elective

Vaginal
Uterus
Laparotomy Uterus
Laparotomy Uterus

Elective
Elective
Elective
Elective

Laparotomy
Laparotomy
Laparotomy
Vaginal

Elective
Elective
Elective

Laparotomy Ovary
Vaginal
Uterus
Laparotomy Ovary

Elective

Laparotomy Ovary

Elective

Laparotomy Uterus

Elective

Laparotomy Uterus

Elective

Laparotomy Uterus

Elective

Laparotomy Ovary

Elective
Elective
Elective
Elective
Elective

Laparotomy Uterus
Laparotomy Ovary
HysteroscopicUterus
Laparotomy Uterus
HysteroscopicUterus

Elective
Elective
Elective

Laparoscopic Fallopian
Vaginal
Uterus
Laparotomy Uterus

Elective

Vaginal

Uterus

Elective

Vaginal

Uterus

Elective

Vaginal

Uterus

Uterus
Uterus
Uterus
Other Ope

IV

III

NA
NA
NA
NA
Right
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Right
NA
NA

Elective
Elective

Laparotomy Uterus
Laparotomy Uterus

Elective

Laparotomy Other Ope

Elective
Elective

Vaginal
Uterus
Laparotomy Uterus

Elective
Elective
Elective

Vaginal
Uterus
Laparotomy Uterus
Laparotomy Uterus

Elective
Elective

Laparotomy Other Ope


Laparotomy Uterus

Elective

Vaginal

Vulva and

Elective

Vaginal

Vulva and

DISCHARGE
Procedure

Laterality

TAHBSO (total Both


Other operatio NA
Salpingo-ooph Right

Endometrial polypectomy
Salpingo-ooph Left

Total abdominaUnspecified
Endometrial p Unspecified
Simple curetta Unspecified

Endometrial p Unspecified
TAHBSO (total Unspecified
Ovarian cyste Both
Diagnostic cur Unspecified
Salpingo-ooph Left
Fractional cureUnspecified
Myomectomy Unspecified
TAHBSO (total Unspecified

Diagnostic cur Unspecified


Other operatio NA
Salpingo-ooph Left

Hysterectomy

Status

With hysterectomy Alive


Without hysterect Alive
Without hysterect Alive
Alive
Alive
Alive
Alive
Alive
Alive
Without hysterect Alive
Alive
Alive
Without hysterect Alive
Alive
Alive
Alive
Alive
With hysterectomy Alive
Without hysterect Alive
Alive
Alive
Without hysterect Alive
Alive
Alive
Alive
Without hysterect Alive
Alive
Alive
Without hysterect Alive
Without hysterect Alive
Alive
Without hysterect Alive
Without hysterect Alive
Alive
Without hysterect Alive
Without hysterect Alive
With hysterectomy Alive
Alive
Alive
Alive
Without hysterect Alive
Without hysterect Alive
Without hysterect Alive

TAHBSO (total Both


With hysterectomy Alive
Partial omente Unspecified Without hysterect Alive
Alive
Myomectomy Unspecified Without hysterect Alive
Fractional cureUnspecified Without hysterect Alive
Myomectomy Unspecified Without hysterect Alive
Alive
Alive
TAHBSO (total Both
With hysterectomy Alive
Total abdominaUnspecified With hysterectomy Alive
TAHBSO (total Both
With hysterectomy Alive
Other operatio Unspecified Without hysterect Alive
Alive
Ovarian cyste Both
Without hysterect Alive
Simple curetta Unspecified Without hysterect Alive
Ovarian cyste Left
Without hysterect Alive
Alive
Salpingo-ooph Right
Without hysterect Alive
Alive
Alive
Total abdominaUnspecified With hysterectomy Alive
Alive
Alive
TAHBSO (total NA

With hysterectomy Alive

TAHBSO (total NA

Alive
With hysterectomy Alive

Salpingo-ooph Left

Subtotal hyste Left


Salpingo-ooph Left
Endometrial p NA
Total abdominaNA
Endometrial bi NA
Salpingectomy Both
Fractional cureNA
TAHBSO (total NA
Fractional cureNA
Fractional cureNA
Fractional cureNA

Alive
Without hysterect Alive
Alive
Alive
With hysterectomy Alive
Without hysterect Alive
Without hysterect Alive
With hysterectomy Alive
Without hysterect Alive
Without hysterect Alive
Without hysterect Alive
with hysterectomy Alive
Alive
Without hysterect Alive
Alive
Without hysterect Alive
Alive
Without hysterect Alive
Alive

TAHBSO (total NA
TAHBSO (total NA

Alive
With hysterectomy Alive
Without hysterect Alive

Exploratory la NA

Alive
without hysterecto Alive

Fractional cureNA
TAHBSO (total NA

Without hysterect Alive


with hysterectomy Alive

Endometrial p NA
TAHBSO (total NA
TAHBSO (total NA

Without hysterect Alive


With hysterectomy Alive
With hysterectomy Alive
Alive
Alive
Without hysterect Alive
with hysterectomy Alive
Alive
Alive
Without hysterect Alive
Alive
Without hysterect Alive

Peritoneal flui NA
TAHBSO (total NA
Drainage of vu NA
Other operatio NA

PHILIPPINE OBSTETRICAL AND GYNECOLOGICAL SOCIET


version 0.12
Maternal Mortality Form

PATIENT DATA
CASE NO

HISTORY
LASTNAME

FIRSTNAME

Birthday

Age

ADMIT DATE

GICAL SOCIETY

AOG
Weeks

Days

ANTECEDENT AND UNDERLYING CAUSE


Type
Antecedent
Underlying

COMPLICATIONS AND DEATH


Timing of Death
Specific

Immediate Cause

Onset of Complications

Specific

PHILIPPINE OBSTETRICAL AND GYNECOLOGICAL SOCIET


version 0.12
GTD Form

PATIENT DATA
CASE NO

LASTNAME

FIRSTNAME

Birthday

Age

HISTORY
ADMIT DATE

GICAL SOCIETY

Gravidity

Parity

OB Score
Term

Preterm

Abortion

Alive

ADMISSION AOG
Weeks
Days

Last Year of Pregnancy

Diagnosis

HYDATIDIFORM MOLE
Type
Complications

Metastasis

Chemoprophylaxis

Drug

High Risk Factor

Mode of Evacuation

Condition on Discharge

Present Status

Cause of Death

GTN/PSTT/ETT
Histopathology

Antecedent Pregnancy

Baseline hCG levels (mIU/mL)

FIGO Anatomic Stage

Modified WHO Score

Risk

Combined FIGO-WHO Score


Age

Combined FIGO-WHO Score


Antecedent Pregnancy

Interval Months from Index Pregnancy

Pretreatment hCG (mIU/mL)

Largest Tumor Size (cm)

Metastasis

Site of Metastasis

Number of Metastases Identified

Previous Failed Chemotherapy

Total Score

ADDITIONAL TREATMENT
Other Surgical Intervention

Chemotherapy

Radiotherapy

CONDITION
Present Condition

Cause of Death

PHILIPPINE OBSTETRICAL AND GYNECOLOGICAL SOCIET


version 0.12
Obstetric Diseases and Procedures Report

SECTIONS
ONE
TWO
THREE
FOUR
FIVE
SIX
SEVEN
EIGHT
NINE

CONTENTS
ADMISSIONS DATA
DATA ON DELIVERED PATIENTS
OBSTETRIC AND MEDICAL COMPLICATIONS IN DELIVERED PATIENTS
PROBLEMS DURING LABOR
PROBLEMS AMNIOTIC FLUID AND PLACENTA
COMPLICATIONS DURING DELIVERY
COMPLICATIONS DURING POST-PARTAL PERIOD
PROCEDURES
ABORTIONS, ECTOPIC PREGNANCIES, TROPHOBLASTIC DISEASES

SECTION ONE: ADMISSIONS DATA


TOTAL NUMBER OF OBSTETRIC ADMISSIONS
DELIVERED PATIENTS
ANTEPARTAL PATIENTS DISCHARGED NOT DELIVERED
ABORTIONS
ECTOPIC PREGNANCIES
TROPHOBLASTIC DISEASES

AGE RANGE OF PATIENTS


LESS THAN 20
20 TO 34
35 AND ABOVE
PARITY
Nullipara
Para 1-5
MORE THAN 5
MATERNAL OUTCOME
Prepare Maternal Mortality Forms for All Maternal Deaths, Submit forms with this summary
DISCHARGED ALIVE
DISCHARGED ALIVE BUT MORIBUND
DIRECT MATERNAL DEATHS
INDIRECT MATERNAL DEATHS
NONMATERNAL DEATHS
TOTAL
FETAL OUTCOME - BASED ON OBSTETRIC AGE OF GESTATION
LIVE-BIRTHS
STILL BIRTHS

NEONATAL DEATHS

SECTION TWO: OBSTETRIC AND MEDICAL COMPLICATION IN DELIVERED PATIENTS


( using FIGO Committee on Perinatal Health-simplified ICD 10 coding,April 2000)
HYPERTENSIVE DISORDERS in PREGNANCY
010.9
Pre-existing (chronic hypertension with BP 140/90)
011.9
Pre-existing (chronic hypertension with superimposed preeclampsia)
012.1
HELLP Syndrome
012.2
Proteinuria (>0.30 gms/24 hr)
013.x
Edema with proteinuria
Gestational hypertension
014.0
Mild preeclampsia (BP 140/90, protein 0.3 gms/24 hr)
014.1
Severe preeclampsia (BP > 160/110, protein > 0.3gms/24 hr)
014.9
Preeclampsia unspecified
015.9
Eclampsia
Maternal Disorders predominantly related to pregnancy
020.9

Hemorhage in Early Pregnancy (< 22 weeks)


ABORTIONS
Threatened abortion
Incomplete abortion
Inevitable abortion
Imminent abortion
Missed abortion
Blighted ovum

Septic abortion
Induced abortion
Ectopic Pregnancy
Tubal ectopic pregnancy
Abdominal ectopic pregnancy
Ovarian ectopic pregnancy
Ectopic pregnancy, unspecified
021.1

022.0
022.1
022.3
022.4

023.0

Hyperemesis gravidarum, severe


(demanding treatment in hospital)
Venous complications
Varicose veins of lower extremity
Genital varicose veins
Deep vein thrombosis
Hemorrhoids
Urinary Tract Infection
Kidney
Urinary Tract Infection

Acute pyelonephritis

Chronic pyelonephritis

023.1

Bladder
Acute cystitis
Chronic cystitis
Renal or ureteral calculus
Urinary tract infection
Asymptomatic bacteriuria
Other

023.2
098.1

Genital Tract Infection

098.2

Z21.x
098.3
098.6

Syphilis
Gonorrhea
Herpes simplex
Chlamydia
Group B Streptococcus
Bacterial Vaginosis
HIV or AIDS
Other sexually transmitted diseases
Malaria
Herpes gestationalis
Diabetes mellitus

024.0

Diabetes mellitus Insulin dependent

024.1
024.4

Diabetes mellitus non-Insulin dependent


Gestational diabetes mellitus

025.x
026.5
026.6

Malnutrition (BMI less than 19.8)


Supine Hydrotensive syndrome
Liver Disorders
Hepatitis B
Hepatitis A
Acute Fatty Liver
Multiple gestation
Twin
Triplet

030.0
030.1
030.x
032.1
032.1
032.2
032.2

Other
Malpresentation
Frank breech
Complete breech
Footling Breech
Transverse Lie

032.3

Oblique Lie
Face

032.3

Brow

032.3

Chin
Prolapsed Arm

032.5

Multiple gestation with malpresentation for one or more fetus

033.9

Disproportion (known or suspected)

034.2

Previous Caesarian Section

034.3
034.9
035.9
036.0
036.2
036.3
036.4

Cervical Incompetence
Abnormalities of pelvic organs (see later)
Fetal Abnormality and Damage
Rhesus Isoimmunization
Hydrops Fetalis
Fetal Hypoxia
Intrauterine Death (<22 weeks)
Intrauterine Death (>22 weeks)
Poor Fetal Growth
Excessive Fetal Growth

036.5
036.6

040.x
041.0
041.1
042.0
042.1
042.9
044.0
044.1
045.0
045.9

046.8
047.9
048.x

Polyhydramnios
Oligohydramnios
Chorioamnionitis
Premature rapture of membranes
Onset of Labor w/in 24 hours
Onset of Labor after 24 hours
Unspecified
Placenta Previa without Hemorrhage
Placenta Previa with Hemorrhage
Abruptio placenta with coagulation defect
Abruptio placenta (only)
Placenta accreta
Placenta percreta
Placenta increta
Other antepartum hemorrhage
False Labor
Preterm Labor

Post Term >= 42 weeks


TROPHOBLASTIC DISEASES
Complete Mole
Partial Mole
Invasive Mole
Choriocarcinoma

Gestational trophoblastic neoplasia


Placental site trophoblastic tumor
Epithelioid trophoblastic tumor

SECTION THREE: COMPLICATIONS OF LABOR AND DELIVERY


Preterm Delivery (up to 36 weeks)
ABNORMALITIES OF FORCES OF LABOR

Failure of Cervical Dilatation (<1 cm/hr in active phase)


Arrested active phase of labor
(no progress during 2 hrs after initially normal progress)
Precipitate labor
(nulli=<1 hours from 3 cm to delivery; multi=<0.5 hr)

Hypertonic uterine contraction


Long labor
Prolonged first stage
(for nulli > 15 from 3 cm to fully dilated, for multi > 11 h)
Prolonged second stage
(> 2 h from full dilated to delivery)

064.9
065.4
065.9
066.0
066.5
067.9
067.0
068.1
068.9
069.0
069.4

Obstructed Labor
Due to malposition or malpresentation
Due to fetopelvic disproportion
Due to maternal pelvic abnormality
Due to shoulder dystocia
Failed forceps or vacuum extraction
Intrapartum hemorrhage
With coagulation defect
Meconium in amniotic fluid
Fetal Distress
Prolapsed Cord
Vasa previa

070.0

Perineal Laceration
Unspecified
First Degree

( involving fourchette, labia, skin, vagina, vulva)


070.1
070.2
070.3

071.0
071.1
071.2
071.3
071.7

Second Degree
(involving 1st plus pelvic floor, perineal muscle, vaginal muscle)
Third Degree
(involving 2nd plus anal sphincter, rectovaginal septum)
Fourth Degree
(involving 3rd plus anal mucosa , rectal mucosa)
Other Obstetric Trauma
Rupture of uterus before onset of labor
Rupture of uterus during labor
Uterine inversion
Laceration of Cervix
Pelvic, vaginal, or vulvar hematoma
Uterine Dehiscence

072.0
072.1

Postpartum Hemorrhage
Due to Uterine Atony
Due to Retained Placenta
Due to other causes

073.0
074.9
075.9

Retained placenta without hemorrhage


Anesthetic complications, postpartum hemorrhage
Other complications of Labor and Delivery, not elsewhere classified

SECTION FOUR: DELIVERY AND OTHER PROCEDURES


080.0
Spontaneous vertex delivery
080.1
Spontaneous breech delivery
080.9
Spontaneous delivery, unspecified
081.0
Low forceps delivery
081.1
Mid cavity forceps delivery
081.2
Mid cavity forceps delivery with rotation
081.3
Other and unspecified forceps delivery
Elective outlet forceps delivery
081.4
Vacuum extractor delivery
081.5
Combination forceps/vacuum extractor
VBAC

082.0

082.1

082.2
082.9
083.0
083.1
084.0
084.1
084.2
084.8
084.9

Caesarean Section
Elective
Low Segment
Classical
Emergency
Low Segment
Classical
Cesarean Hysterectomy
Unspecified
Breech extraction
Breech Assisting
Multiple delivery, all spontaneous
Multiple delivery, all by forceps and vacuum extractor
Multiple delivery, all by Caesarean section
Other multiple delivery
Multiple delivery, unspecified
Other Procedures
Completion Curettage
Suction Curettage
Induction by prostaglandins
Total hysterectomy
Subtotal hysterectomy
Removal of extra-peritoneal embryo
Others
Salpingectomy

Salpingo-Oophorectomy
Manual extraction of placenta
SECTION FIVE: COMPLICATIONS PREDOMINANTLY RELATED TO PUERPERIUM
085.X
Puerperal Sepsis
086.0
Wound Infection
087.1
Deep Phlebothrombosis
087.2
Hemorrhoids
088.1
Obstetric Air Embolism
090.0
Disruption of Caesarean Section Wound
090.1
Disruption of Perineal Obstetric Wound
090.2
Hematoma
Breast Infection
091.0
Nipple Infection
091.1
Breast abscess
SECTION SIX: OTHER MATERNAL DISEASES CLASSIFIABLE ELSEWHERE
BUT COMPLICATING PREGNANCY
099.0
Anemia
099.1
Disease of blood and immune mechanism
Leukemia
Megaloblastic Anemia
Anti-Phospolipid Antibody Syndrome

Other
Dengue
099.2

Endocrine, nutritional and metabolic diseases


Hyperthyroidism
Hypothyroidism
Nodular Nontoxic Goiter
Diffuse Nontoxic Goiter
Other
Diabetes (see above)

099.3

Mental Disorders and Diseases of the Nervous System


Seizure Disorders
Meningioma
Schizophrenia
Brief Reactive Psychosis
Drug Abuse and Dependency
Other

099.5

Diseases of the Respiratory System


Bronchial Asthma in Remission
Bronchial asthma in acute asthmatic attack
Pneumonia
Pulmonary Tuberculosis
Other

099.4

Diseases of the Circulatory System


Rheumatic heart disease (RHD), mitral stenosis
Rheumatic heart disease (RHD), mitral regurgitation
Rheumatic heart disease (RHD), mitral stenosis with regurgitation
Rheumatic heart disease (RHD), atrial stenosis
Rheumatic heart disease (RHD), atrial regurgitation
Rheumatic heart disease (RHD), others
Congenital Heart Disease, atrial septal defect
Congenital heart disease, ventricular septal defect
Congenital heart disease, patent ductus arteriosus
Congenital heart disease, others
Mitral valve prolapse
Coronary Artery Disease
Others

099.6

Diseases of the Digestive System


Acid Peptic Disease
Other
Surgical Condition
Acute Appendicitis
Acute Cholecystitis
Stab wound
Gun Shot Wound
Others
Gynecological Conditions
Uterine Myoma
Ovarian new growth (ONG), benign
Ovarian new growth (ONG), malignant
Other
Cervical Cancer

SECTION SEVEN: OTHER PROCEDURES


ANTENATAL PROCEDURES
(NUMBER OF PATIENTS, NOT NUMBER OF PROCEDURES)
Electronic Fetal Monitoring
Non-stress testing
Contraction stress testing
Biophysical Profile Scoring
Sonographic biometry
Chronic villi sampling
Amniocentesis
Intrapartal and post-partal procedures
Artificial Rupture of the Membranes
Internal Version

Failed/Trial forceps
Repair of cervical laceration
Reposition of inverted uterus
Evacuation of vulvar hematoma in Pregnancy

GICAL SOCIETY

CHARITY

PRIVATE
0
0
0
0
0
N/A

TOTAL
0
0
0
0
0
N/A

0
0
0
0
0
0

0
0
0
0
0
0

0
0
0
0
0
0

IMMATURE

PRETERM
0
0

TERM
0
0

POST-TERM
0
0

0
0

VAGINAL

ABDOMINAL

0
0
0
0
0
0
0
0
0
0

TOTAL

0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0

VAGINAL

ABDOMINAL

0
0

TOTAL

0
0

0
0

VAGINAL

ABDOMINAL

0
0
0
0
0

VAGINAL

TOTAL

0
0
0
0
0

ABDOMINAL

0
0
0
0
0
0
0
0
0
0
VAGINAL

TOTAL

ABDOMINAL

0
0
0
0
0
0
0
0
0
0
TOTAL

0
0
0
ABDOMINAL

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0

0
0
0
VAGINAL

0
0
0
TOTAL

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
VAGINAL

0
0
0
ABDOMINAL

0
0
0
0
0
0
0
0
0
0
0
0
VAGINAL

0
0
0
TOTAL

0
0
0
0
0
0
0
0
0
0
0
0
ABDOMINAL

0
0
0
0
0
0
0
0
0
0
0
0
TOTAL

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0

0
0
0

0
0
0

WITH METS

NO METS

0
0
0
0
0
0
0

TOTAL

0
0
0
0
0
0
0

0
0
0
0
0
0
0

0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0

0
0
0
0

0
0
0
0
0
0
0

0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0

0
0

0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0

0
0
0
0
0
0

0
0
0
0
0
0

0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0

0
0

0
0
0
0
0

0
0
0
0
0

0
0
0
0
0
0
0
0
0
0

0
0
0
0

PHILIPPINE OBSTETRICAL AND GYNECOLOGICAL SOCIET


version 0.12
Perinatal Report

PERINATAL STATISTICS BASED ON MANNER OF DELIVERY


Normal
CS
Forceps
Breech
Others

LIVEBIRTHS
-

STILLBIRTHS
-

NEONATAL DEATH
-

DELIVERIES
###
###
###
###
###

NEONATAL DEATH
-

DELIVERIES
###
###
###
###
###
###
###
###

NEONATAL DEATH
-

DELIVERIES
###
###
###
###
###
###

PERINATAL STATISTICS BASED ON BIRTH WEIGHT


500-999
1000-1499
1500-1999
2000-2499
2500-2999
3000-3499
3500-4000
>4000

LIVEBIRTHS
-

STILLBIRTHS
-

PERINATAL STATISTICS BASED ON AGE OF GESTATION


20-21
22-27
28-31
32-36
37-42
>42

LIVEBIRTHS
-

STILLBIRTHS
-

PERINATAL STATISTICS BASED ON FETAL CHARACTERISTICS


Uncomplicated
SGA
LGA
Lethal

LIVEBIRTHS
-

STILLBIRTHS
-

NEONATAL DEATH
-

DELIVERIES
###
###
###
###

GICAL SOCIETY

STILLBIRTH RATE
###
###
###
###

NEONATAL MORTALITY
-

PERINATAL MORTALITY

STILLBIRTH RATE
###
###
###
###
###
###
###

NEONATAL MORTALITY
-

PERINATAL MORTALITY

STILLBIRTH RATE
###
###
###
###
###

NEONATAL MORTALITY
-

PERINATAL MORTALITY

STILLBIRTH RATE
###
###
###

NEONATAL MORTALITY
-

PERINATAL MORTALITY

SURVIVAL RATE
-

SURVIVAL RATE
-

SURVIVAL RATE
-

SURVIVAL RATE
-

PHILIPPINE OBSTETRICAL AND GYNECOLOGICAL SOCIET


version 0.12
Gynecologic Diseases and Procedures Report

SECTIONS
ONE
TWO
THREE
FOUR
FIVE
SIX
SEVEN
EIGHT

CONTENTS
ADMISSIONS AND DISCHARGE DATA
SIGNS AND SYMPTOMS
INFLAMMATORY CONDITIONS
CONGENITAL ANOMALIES
BENIGN CONDITIONS
BENIGN NEOPLASMS
MALIGNANT NEOPLASMS
OPERATIONS

SECTION ONE: ADMISSIONS AND DICHARGE DATA


OPERATED PATIENTS
PATIENTS ADMITTED NOT OPERATED
OTHER PATIENTS

DISCHARGED ALIVE
DISCHARGED ALIVE BUT MORBID
MORTALITIES
TOTAL NUMBER OF GYNECOLOGIC ADMISSIONS

AGE RANGE OF PATIENTS


LESS THAN 20
20 to 34
35 to 50
51 and above
PARITY
0
1-5
MORE THAN 5

CHARITY

PRIVATE

###

SECTION TWO: SIGNS AND SYMPTOMS


PATIENT CHARACTERISTICS AND COMPLAINTS UPON HOSPITAL ADMISSION (DO NOT INCLUDE OUT-PATIENT)

MENSTRUAL DISORDERS
626
Primary Amenorrhea
626.1
Secondary Amenorrhea
Menorrhagia
626.2
Polymenorrhea
Metrorrhagia
626.6
Meno-metrorrhagia

Intermenstrual Bleeding
MENOPAUSE

627.1
627
628

628.0
628.1
628.2
628.3
628.9

Post-Menopausal Bleeding
Atrophic/ Senile Vaginitis
INFERTILITY
Primary
Secondary
Ovarian
Pituitary-Hypothalamic
Tubal
Uterine/ Cervix
Male Factor
Unspecified

PELVIC SYMPTOMS
625.4
Premenstrual Tension Syndrome

SECTION THREE: INFLAMMATORY CONDITIONS


FOR ADMMITTED PATIENTS ONLY, EXCLUDES THOSE ASSOCIATED WITH PREGNANCY
DISEASES OF BARTHOLIN'S GLAND
N76
N75.0
Cyst of Bartholin's Gland
N75.1
Abscess of Bartholin's Gland
N75.8
Other Diseases of Bartholin's Gland
Bartholinitis
N75.9
Diseases of Bartholin's Gland, Unspecified
PELVIC INFLAMMATORY DISEASE
N73
Pelvic Inflamatory Diseases, Prob. Bacterial
Salpingo-Oophoritis
Endometritis
Parametritis
Pelvic Cellulitis
Pelvic Abscess
N74
Other Pelvic Inflammatory Disorders
N74.0
Cervical Tuberculosis (A18.1)
N74.1
Tuberculosis Pelvic Inflammatory Disease (A18.1)
Tuberculosis Endometritis
N74.2
Syphilitic Pelvic Inflammatory Disease (A51.4, A52.7)
N74.3
Gonococcal Pelvic Inflammatory Disease (A54.2)
N74.4
Chlamydial Pelvic Inflammatory Disease (A56.1)
N76
N76.5
N76.6
N77.1

N77.2

OTHER INFLAMMATION OF VAGINA AND VULVA


Ulceration of Vagina
Ulceration of Vulva, Bacterial
Ulceration of Vulva, Herpes
Ulceration of Vulva, Tuberculosis
Vulva Condyloma Acuminata
Vulvovaginitis, Non-bacterial
Vulvovaginitis, Herpes

Vulvovaginitis, Candidiasis
Vulvovaginitis, Foreign Body
SECTION FOUR: CONGENITAL ANOMALIES OF GENITAL ORGANS
ICD NO.
Absence/ Agenesis of the Ovary
Streak Ovary
Cyst of the Oophoron/ Fimbriae
Parovarian Cyst
Gartner's Duct Cyst
Doubling of Uterus
Bicornuate Uterus
Uterus Unicornis
Imperforate Hymen
Congenital Cyst of Canal of Nuck
Embryonal Cyst of the Vagina
Congenital Cyst of the Vulva

ANOMALIES OF VAGINA, CERVIX AND EXTERNAL FEMALE GENITALIA


Agenesis

Aplasia

Uterine Corpus
Cervix
Clitoris
Vagina
Vulva

SECTION FIVE: BENIGN CONDITIONS OF THE FEMALE GENITAL TRACT


ENDOMETRIOSIS
Uterus
Adenomyosis
Ovary
Fallopian tube
Pelvic peritoneum
Rectovaginal septum
Unspecified
Others

STAGE 1
STAGE 2
STAGE 3
UNSPECIFIED STAGE
GENITAL PROLAPSE
FIRST
Cystocoele alone
Rectocoele alone
Cysto-rectocoele

SECOND

Urethrocoele
Enterocoele
Unspecified

Prolapse of vaginal vault after hysterectomy


Old laceration of muscle of pelvic floor
Others (specify)
Vulvar Hematoma
Relaxed vaginal vault

Female Genital Tract Fistula


specify types vaginal polyp

TOTAL

FISTULA

clitoral mass
SECTION SIX: BENIGN NEOPLASM OF THE GENITAL TRACT
UTERINE
M8890/0
Leiomyoma
N84.0
Endometrial Polyp
N85.0
Endometrial Hyperplasia, Unspecified
Cystic Hyperplasia
Complex Hyperplasia
N85.1
Adenomatous/ Atypical Hyperplasia
N85.4
Malposition of Uterus
N85.5
Uterine Inversion, Non-Obstetric
N85.6
Intrauterine synechiae
N85.7
Hematometra

CERVIX
N84.1
N86
N87
N87.0
N87.1
N87.2
N88.2
N88.3
N88.4

Chronic Cervicitis
Polyp of Cervix Uteri
Erosion and Ectropion of Cervix Uteri
Dysplasia of Cervix Uteri, Not Specified
Mild cervical dysplasia or CIN I
Moderate cervical dysplasia or CIN II
Severe Cervical Dysplasia, Not Elsewhere Classified (Cin lll,
Not Cis)
Stricture and Stenosis of Cervix Uteri
Incompetence of Cervix Uteri
Hypertrophic elongation of cervix uteri

SECTION SEVEN: MALIGNANT NEOPLASM OF GENITOURINARY ORGANS


OVARY
Serous Adenocarcinoma
Mucinous Adenocarcinoma
Endometrioid Adenocarcinoma
Other epithelial

UNILATERAL BILATERAL

Germ Cell Type


Other Type
Metastatic

CERVIX

STAGE I
Squamous Cell, Large Cell, NK
Squamous Cell, Large Cell, Keratinizing
Squamous Cell, Small Cell
Other squamous cell type
Adenocarcinoma
Other Type

FALLOPIAN TUBE
Adenocarcinoma, Specify
Other Type, Specify
ENDOMETRIOD
TUBAL CYST
CORPUS
Endometrial carcinoma
Other Endometrial neoplasm
Leiomyosarcoma
Other
MALIGNANCIES OF THE REST OF FEMALE GENITAL TRACT
Vagina
Greater Vestibular (Bartholin's Gland)
Vulva
Labia Majora
Labia Minora
Clitoris
Other
Site Unspecified
FALLOPIAN TUBE
Paratubal serous cyst

OVARY
EPITHELIAL
M8440/0
Cystadenoma Not Specified
M8441/0
Serous Cystadenoma
M8450/0
Papillary Cystadenoma
M8460/0
Papillary Serous Cystadenoma
M8470/0
Mucinous Cystadenoma
M8471/0
Papillary Mucinous Cystadenoma
M8480/0
Pseudomyxoma peritonei

STAGE II

UNILATERAL BILATERAL

Endometrial Cyst
GERM CELL TUMORS
M9080/0
Mature cystic teratoma
M9084/0
Dermoid Cyst
M9090/0
Struma Ovarii
OTHER BENIGN CONDITIONS
M8600/0
Fibro-Thecoma
M9000/0
Brenner Tumor
N83.0
Follicular Cyst of Ovary
N83.1
Corpus Luteum Cyst
N83.5
Torsion of Ovary/ Ovarian Pedicle

OTHER PELVIC ORGANS


VAGINA
N89.0
Mild vaginal dysplasia or VAIN I
N89.1
Moderate vaginal dysplasia or VAIN II
N89.2
Severe vaginal dysplasia or VAIN III
N89.3
Dysplasia of Vagina, Unspecified
N89.4
Leukoplakia of Vagina
N89.5
Stricture and Atresia of Vagina
N89.7
Hematocolpos
N89.8
Others
VULVA
N90.0
Mild vulvar dysplasia or VIN I
N90.1
Moderate vulvar dysplasia or VIN II
N90.2
Severe vulvar dysplasia or VIN III
N90.3
Vulvar Dysplasia, Unspecified
N90.4
Leukoplakia of Vulva
N90.5
Atrophy of Vulva
N90.6
Hypertrophy of vulva
N90.7
Vulvar Cyst
N90.8
Other Specified Noninflammatory Disorders of
Vulva and Perineum

SECTION EIGHT: OPERATIONS ON FEMALE GENITAL ORGANS


OPERATIONS ON THE UTERUS
Myomectomy
Subtotal Hysterectomy
Total Abdominal Hysterectomy
Vaginal Hysterectomy
Uterine Suspension
Fractional Curettage
Simple Curettage
Radical Abdominal Hysterectomy
Radical Vaginal Hysterectomy
Pelvic Exenteration

Diagnostic Curettage
TAHBSO
Endometrial biopsy

OPERATIONS ON OVARY
Oophorectomy
Salpingo-Oophorectomy
Ovarian cystectomy/oophoro-cystectomy
Partial Oophorectomy
Wedge Resection
Repair of the Ovary
Adhesiolysis of Ovary
OPERATIONS ON THE CERVIX
Cervical biopsy
Endocervical Curettage
Conization of the Cervix
Excision of Cervical Polyp
Amputation of Cervix
Cervicectomy
Encirclement Suture or Cerclage
Other Repair of Cervix
Late Repair of Obstetric Laceration
Repair of Non-Obstetric Laceration
LEEP
OPERATIONS ON FALLOPIAN TUBE
Salpingectomy
Salpingostomy
Fimbriectomy
Cornual Resection
Repair of Fallopian Tube
Insufflation
Tubal Ligation, Interval
Reanastomosis of ligated tubes
Endoscopic Destruction or Occlusion
By Culdoscopy
By Laparoscopy
Unspecified
OPERATIONS ON VAGINA
Culdocentesis
Incision of the Vagina
Colpotomy
Culdotomy
Hymenotomy
Hymenectomy

UNILATERAL BILATERAL

UNILATERAL BILATERAL

Obliteration and Total Excision of the Vagina


Colpectomy
Colpocleisis
Repair of Cystocoele
Repair of Rectocoele
Repair of Enterocoele

OPERATIONS ON VULVA AND PERINEUM


Incision of Vulva and Perineum
Drainage of Vulvar Abscess
Removal of Foreign Body from Vulva
Marsupialization of Bartholin's Gland
Excision of Bartholin's Gland
Radical Vulvectomy
Simple Vulvectomy
Perineorrhaphy
Other Operations on Female Genital Organs

OTHER OPERATIONS AND PROCEDURES


Partial Omentectomy
Peritoneal Biopsy
Peritoneal Fluid Sampling
Hartman's Procedure
Exploratory Laparotomy Alone
Bilaterial pelvic lymph node dissection
Bilateral Groin Node Dissection
Chemotherapy
Other operations

LAPAROSCOPIC PROCEDURES
Video Laparoscopic
Diagnostic
Operative
Hysterograms or hysterosalpingography
Hysteroscopy
Colposcopy
Others

CAL SOCIETY

TOTAL

COMPLETE

WITHOUT

###
###
###

BORDERLINE

###
###
###
###

STAGE III

STAGE IV

TOTAL

###
###
###
###
###
###

WITH
HYSTERECTOMY

TOTAL

PHILIPPINE OBSTETRICAL AND GYNECOLOGICAL SOCIET


version 0.12
Maternal Mortality Report

0%
0
0

MATERNAL MORTALITY RATE


AVERAGE AGE (years)
AVERAGE AOG (weeks)
CAUSE OF DEATH
I. DIRECT MATERNAL DEATHS

VALUE
-

A. HEMORRHAGE
1. Spontaneous abortion
2. Induced abortion
3. Retained secundiness
4. Ectopic pregnancy
5. Abruptio placenta
6. Placenta previa
7. Placenta accreta
8. Uterine rupture
9. Cervico-vaginal lacerations
10. Uterine inversion
11. Uterine atony
12. Postop from surgical procedure
13. Trophoblastic disease
14. Abdominal pregnancy
15. Coagulopathy
16. Other hemorrhage

0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%

B. HYPERTENSION
1. Preeclampsia
2. Eclampsia
3. Preexisting hypertension
4. Combination
5. HELLP syndrome

0%
0%
0%
0%
0%
0%

C. INFECTION
1. Induced abortion
2. Pelvic abscess
3. Puerperal infection
4. Chorioamnionitis
5. Adnexal infection
6. Pelvic thrombophlebitis
7. Septic embolism

0%
0%
0%
0%
0%
0%
0%
0%

D. VASCULAR ACCIDENTS
1. Amniotic fluid embolism
2. Puerperal nonseptic embolism

0%
0%
0%

3. Air embolism

0%

E.
1.
2.
3.

0%
0%
0%
0%

0%
0%
0%
0%
0%
0%

A. CARDIAC
1. Rheumatic heart disease
2. Hypertensive heart disease
3. Congenital heart disease
4. Atherosclerotic heart disease
5. Undiagnosed
6. Other cardiac

0%
0%
0%
0%
0%
0%
0%
0%

B. VASCULAR
1. Preexisting hypertension
2. Vascular thrombosis/embolism
3. Thrombophlebitis

0%
0%
0%
0%

C. REPRODUCTIVE TRACT
1. Uterine anomalies
2. Uterine myoma
3. Ovarian cysts
4. Reproductive tract malignancy
5. Other reproductive tract

0%
0%
0%
0%
0%
0%

D. URINARY TRACT
1. Glomerulonephritis
2. Urinary tract infection
3. Hydronephrosis
4. Renal malignancy
5. Other urinary tract

0%
0%
0%
0%
0%
0%

E.
1.
2.
3.
4.
5.

0%
0%
0%
0%
0%
0%

ANESTHESIA
Neurogenic cardiac arrest
Post-aspiration asphyxia
Respiratory insufficiency

F. OTHERS
1. Peri/postpartum cardiomyopathy
2. Transfusion hemolysis
3. Electrolyte imbalance
4. Pregnancy anemia
5. Others (specify)
II. INDIRECT MATERNAL DEATHS

HEPATIC
Infectious hepatitis
Liver cirrhosis
Hepatic abscess
Hepatic malignancy
Other hepatic

F. PULMONARY
1. Tuberculosis
2. Pneumonia
3. Bronchial asthma
4. Lung cancer
5. Malignancy, with lung metastasis
6. Other pulmonary

0%
0%
0%
0%
0%
0%
0%

G. METABOLIC
1. Diabetes mellitus
2. Thyroid storm
3. Adrenal dysfunction
4. Other metabolic

0%
0%
0%
0%
0%

H. HEMATOLOGIC
1. Leukemia
2. Aplastic anemia
3. Other hematologic

0%
0%
0%
0%

I. GASTROINTESTINAL
1. Acute gastroenteritis
2. Appendicitis
3. Gastrointestinal tract malignancy
4. Other gastrointestinal

0%
0%
0%
0%
0%

J. OTHER CAUSES

0%

A. ACCIDENTS
1. Stab wound
2. Gunshot wound
3. Vehicular accident
4. Accidental poisoning

0%
0%
0%
0%
0%
0%

B. SUICIDE/MURDER
1. Suicide
2. Murder

0%
0%
0%

0%
0%
0%

0%

III. NONMATERNAL DEATHS

MORTALITY BASED ON
I. TIMING OF DEATH
A. TRIMESTER

1. First trimester
2. Second trimester
3. Third trimester
B. SPECIFIC

1. Antepartal

2. Intrapartal
3. Postpartal
4. Puerperal
II. IMMEDIATE CAUSE OF DEATH
A. Shock
B. Congestive heart failure
C. Respiratory failure
D. Hepatic failure
E. DIC
F. Intracranial bleeding
G. Multiorgan failure
H. Others (specify)

0%
0%
0%

0%
0%
0%
0%
0%
0%
0%
0%

0%
0%
0%

0%
0%
0%
0%

III. ONSET OF COMPLICATIONS


A. TRIMESTER

1. First trimester
2. Second trimester
3. Third trimester
B. SPECIFIC

1.
2.
3.
4.

Antepartal
Intrapartal
Postpartal
Puerperal

NO. OF LIVE BIRTHS


NO. OF MATERNAL DEATHS
MATERNAL MORTALITY RATE

0%

ICAL SOCIETY

PHILIPPINE OBSTETRICAL AND GYNECOLOGICAL SOCIET


version 0.12
Gestational Trophoblastic Disease Report

SECTIONS
ONE
TWO
THREE
FOUR
FIVE

CONTENTS
CASE BY DIAGNOSIS
HYDATIDIFORM MOLE
GESTATIONAL TROPHOBLASTIC TUMOR
PLACENTAL SITE TROPHOBLASTIC TUMOR
CROSS TABULATION OF VARIOUS CLINICAL CHARACTERISTICS OF GTT

SECTION ONE: CASE BY DIAGNOSIS

Hydatidiform Mole
Complete
Partial
No data
Gestational Trophoblastic Neoplasia
Invasive mole
Choriocarcinoma
Unspecified
No data
Placental Site Trophoblastic Tumor
Epithelioid Trophoblastic Tumor
TOTAL

SECTION TWO: HYDATIDIFORM MOLE


AGE GROUP
15-19
20-29

30-39
40-49
>= 50
No data
TOTAL
GRAVIDITY
01
25
6 10
11 16
No data
TOTAL

AOG AT DIAGNOSIS (in weeks)


<= 12 weeks
12-26 weeks
> 26 weeks
No data
TOTAL
COMPLICATIONS
Anemia
Hyperemesis gravidarum
Pre-eclampsia
Hyperthyroidism
Theca lutein cyst
Pulmonary embolism
Infectious
No data
TOTAL
HIGH RISK FACTOR
Age > 35 years
Uterus > AOG
Recurrent mole
Uterus >= 5 months AOG size
Precurettage hCG >= 100,000 mIU/mL
Theca lutein cyst >= 6cm
Others (specify)
No data
TOTAL
MODE OF EVACUATION
Suction curettage
Hysterectomy
D and C
Others (specify)
No data
TOTAL
USE OF CHEMOPROPHYLAXIS
No
Yes
No data
TOTAL
PROPHYLACTIC AGENT
Methotrexate (oral + parenteral)
Actinomycin D
No data
TOTAL

CONDITION ON DISCHARGE
No evidence of disease
Partial response
Progressive disease
Death
No data
TOTAL
PRESENT STATUS
OPD followup with no evidence of disease
Unknown/Lost to followup
Readmitted/Referred with evidence of malignant degeneration
No data
TOTAL
CAUSES OF DEATH

SECTION THREE: GESTATIONAL TROPHOBLASTIC NEOPLASIA


AGE GROUP
15-19
20-29

30-39
40-49
>= 50
No data
TOTAL
GRAVIDITY
01
25
6 10
11 16
No data
TOTAL
ANTECEDENT PREGNANCY
Term
Abortion
Ectopic pregnancy
Molar (complete + partial)
No data
TOTAL
BASELINE bHCG TITER (mIU/ML)
< 100

100 1,000
1,001 10,000

10,001 100,000
100,001 1,000,000
> 1,000,000
No data
TOTAL
WHO PROGNOSTIC SCORE
Low risk
High risk
No data
TOTAL
FIGO ANATOMIC STAGE
Stage I
Stage II
Stage III

Stage IV
No data

TOTAL
SURGICAL PROCEDURE
Curettage
TAH
Others (thoracotomy + craniotomy + others)
No data
TOTAL
CHEMOTHERAPY

Single agent (oral methotrexate + parenteral methotrexate + actinomycin D


MAC
EMACO (true + modified)
Others
No data
TOTAL
RADIOTHERAPY

Yes
No
No data
TOTAL
CONDITION ON DISCHARGE
No evidence of disease
Partial response
Progressive disease
Death

No data
TOTAL
CAUSES OF DEATH

SECTION FOUR: PLACENTAL SITE TROPHOBLASTIC TUMOR


AGE GROUP
15-19
20-29

30-39
40-49
>= 50
No data
TOTAL
GRAVIDITY
01
25
6 10
11 16
No data
TOTAL
ANTECEDENT PREGNANCY
Term
Abortion
Ectopic pregnancy
Molar (complete + partial)
No data
TOTAL
BASELINE bHCG TITER (mIU/ML)
< 100
100 1,000
1,001 10,000

10,001 100,000
100,001 1,000,000
> 1,000,000
No data
TOTAL
WHO PROGNOSTIC SCORE
Low risk
High risk
No data
TOTAL

FIGO ANATOMIC STAGE


Stage I
Stage II
Stage III

Stage IV
No data

TOTAL
SURGICAL PROCEDURE
Curettage
TAH
Others (thoracotomy + craniotomy + others)
No data
TOTAL
CHEMOTHERAPY

Single agent (oral methotrexate + parenteral methotrexate + actinomycin D


MAC
EMACO (true + modified)
Others
No data
TOTAL
RADIOTHERAPY

Yes
No
No data
TOTAL
CONDITION ON DISCHARGE
No evidence of disease
Partial response
Progressive disease
Death
No data
TOTAL

SECTION FIVE: CROSS TABULATION OF VARIOUS CLINICAL CHARACTERISTICS OF GTN


FIGO ANATOMIC STAGE/CONDITION ON DISCHARGE

FIGO ANATOMIC STAGE


Stage I
Stage II
Stage III

Stage IV
No data

TOTAL
FIGO ANATOMIC STAGE/SURGICAL PROCEDURE

FIGO ANATOMIC STAGE


Stage I
Stage II
Stage III

Stage IV
No data
TOTAL
FIGO ANATOMIC STAGE/WHO PROGNOSTIC SCORE

FIGO ANATOMIC STAGE


Stage I
Stage II
Stage III

Stage IV
No data
TOTAL
WHO PROGNOSTIC SCORE/SURGICAL PROCEDURE

WHO PROGNOSTIC SCORE


Low risk
High risk
No data
TOTAL
WHO PROGNOSTIC SCORE/CONDITION ON DISCHARGE

WHO PROGNOSTIC SCORE


Low risk
High risk
No data
TOTAL
WHO PROGNOSTIC SCORE/CHEMOTHERAPY

WHO PROGNOSTIC SCORE


Low risk
High risk
No data
TOTAL
DIAGNOSIS/CONDITION ON DISCHARGE

DIAGNOSIS
Invasive mole
Choriocarcinoma
Unspecified
No data
TOTAL

SECTION SIX: CROSS TABULATION OF VARIOUS CLINICAL CHARACTERISTICS OF PSTT


FIGO ANATOMIC STAGE/CONDITION ON DISCHARGE

FIGO ANATOMIC STAGE


Stage I
Stage II
Stage III

Stage IV
No data
TOTAL
FIGO ANATOMIC STAGE/SURGICAL PROCEDURE

FIGO ANATOMIC STAGE


Stage I
Stage II
Stage III

Stage IV
No data
TOTAL
FIGO ANATOMIC STAGE/WHO PROGNOSTIC SCORE

FIGO ANATOMIC STAGE


Stage I
Stage II
Stage III

Stage IV
No data
TOTAL
WHO PROGNOSTIC SCORE/SURGICAL PROCEDURE

WHO PROGNOSTIC SCORE


Low risk
High risk
No data
TOTAL
WHO PROGNOSTIC SCORE/CONDITION ON DISCHARGE

WHO PROGNOSTIC SCORE


Low risk
High risk
No data
TOTAL
WHO PROGNOSTIC SCORE/CHEMOTHERAPY

WHO PROGNOSTIC SCORE


Low risk

High risk
No data
TOTAL
DIAGNOSIS/CONDITION ON DISCHARGE

DIAGNOSIS
Invasive mole
Choriocarcinoma
Unspecified
No data
TOTAL

GICAL SOCIETY

FREQUENCY

PERCENT
-

CONDITION ON DISCHARGE
No evidence of disease

0
0
0
0
0

Partial response

Progressive

0
0
0
0
0

Dead

0
0
0
0
0

No data

0
0
0
0
0

TOTAL

0
0
0
0
0

0
0
0
0
0

SURGICAL PROCEDURE
Curettage

TAH

0
0
0
0
0
0

Others

0
0
0
0
0
0

No data

0
0
0
0
0
0

TOTAL

0
0
0
0
0
0

0
0
0
0
0
0

WHO PROGNOSTIC SCORE


Low risk

High risk

0
0
0
0
0
0

No data

0
0
0
0
0
0

TOTAL

0
0
0
0
0
0

0
0
0
0
0
0

SURGICAL PROCEDURE
Curettage

TAH

0
0
0
0

Others

0
0
0
0

No data

0
0
0
0

TOTAL

0
0
0
0

0
0
0
0

CONDITION ON DISCHARGE
No evidence of disease

Partial response

0
0
0
0

Progressive

0
0
0
0

Dead

0
0
0
0

No data

0
0
0
0

TOTAL

0
0
0
0

0
0
0
0

CHEMOTHERAPY
Single

Triple

0
0
0
0

EMACO

0
0
0
0

Others

0
0
0
0

No data

0
0
0
0

TOTAL

0
0
0
0

0
0
0
0

CONDITION ON DISCHARGE
No evidence of disease

0
0
0
0
0

Partial response

Progressive

0
0
0
0
0

Dead

0
0
0
0
0

No data

0
0
0
0
0

TOTAL

0
0
0
0
0

0
0
0
0
0

CONDITION ON DISCHARGE
No evidence of disease

Partial response

0
0
0
0
0
0

Progressive

0
0
0
0
0
0

Dead

0
0
0
0
0
0

No data

0
0
0
0
0
0

TOTAL

0
0
0
0
0

0
0
0
0
0
0

SURGICAL PROCEDURE
Curettage

TAH

0
0
0
0
0
0

Others

0
0
0
0
0
0

No data

0
0
0
0
0
0

TOTAL

0
0
0
0
0
0

0
0
0
0
0
0

WHO PROGNOSTIC SCORE


Low risk

High risk

0
0
0
0
0
0

No data

0
0
0
0
0
0

TOTAL

0
0
0
0
0
0

0
0
0
0
0
0

SURGICAL PROCEDURE
Curettage

TAH

0
0
0
0

Others

0
0
0
0

No data

0
0
0
0

TOTAL

0
0
0
0

0
0
0
0

CONDITION ON DISCHARGE
No evidence of disease

Partial response

0
0
0
0

Progressive

0
0
0
0

Dead

0
0
0
0

No data

0
0
0
0

TOTAL

0
0
0
0

0
0
0
0

CHEMOTHERAPY
Single

Triple

EMACO

Others

No data

TOTAL

0
0
0

0
0
0

0
0
0

0
0
0

0
0
0

0
0
0

CONDITION ON DISCHARGE
No evidence of disease

0
0
0
0
0

Partial response

Progressive

0
0
0
0
0

Dead

0
0
0
0
0

No data

0
0
0
0
0

TOTAL

0
0
0
0
0

0
0
0
0
0

You might also like