$Unique_ID{PAR00266}
$Font{NP}
$Pretitle{}
$Title{Information Charts:  History of Pregnancy and Delivery}
$Subtitle{}
$Author{
Lansky, Vicki}
$Subject{Information Charts PREGNANCY DELIVERY HISTORY}
$Log{}

Complete Pregnancy and Baby Book


Information Charts:

HISTORY OF PREGNANCY AND DELIVERY

Obstetrician                           Pediatrician

Name _______________________________   Name _______________________________

Address ____________________________   Address ____________________________

City/State _________________________   City/State _________________________

Length of pregnancy (full term, eight months, other) ______________________

___________________________________________________________________________

Medications taken during pregnancy, if any
(sleeping pills, aspirin, cough medicine, other) __________________________

___________________________________________________________________________

Complications during pregnancy (bleeding, swelling, high blood pressure,
infections, illness, exposure to German measles or other infectious diseases)

___________________________________________________________________________

___________________________________________________________________________

Onset of labor (specify premature, spontaneous, induced) __________________

___________________________________________________________________________

Length of labor ___________________________________________________________

Medical assistance during delivery (specify forceps, episiotomy, anesthesia)

___________________________________________________________________________

Type of delivery (vaginal, cesarean) ______________________________________

Position of baby during birth (head first, breech) ________________________

Condition of baby at birth (specify color, spontaneous respiration, immediate
crying)
___________________________________________________________________________

Medical treatment necessary (oxygen, resuscitation, blood transfusion, other)

___________________________________________________________________________

Congenital abnormalities __________________________________________________

Hospital nursery used (specify newborn, premature, high risk) _____________

___________________________________________________________________________