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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


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Maternal Fetal Form
PATIENT DATA
CASE NO

LASTNAME

FIRSTNAME

Birthday

Age

Service

OGICAL SOCIETY
HISTORY
ADMIT DATE

OB Score
Gravidity

Parity

Term

Preterm

Abortion

Alive

ADMISSION AOG
Weeks

MEDICAL/SURGICAL HISTORY
Days

Last Year of Pregnancy

Category

OBSTETRIC HISTORY
Condition

Category

Condition

PRENATAL

DELIVERY

Antenatal Procedures

Delivery Date

DELIVERY AOG
Weeks

Days

Route

Malpresentation

VAGINAL DELIVERY - Only for the CURRENT pregnancy.


Delivery

Other Procedures

Episiotomy

CAESAREAN SECTION
Perineal Laceration

Elective/Emergency

Incision

Primary/Repeat

Hysterectomy

Tubal Ligation

Anesthesia

INFANT FETAL DATA

Tubal ligation

Anesthesia Route

Number of Infants

Gender

Fetal Characteristics

Weight (grams)

Length (cm)

Pediatric Age (weeks)

Apgar Score
1min

5min

DISCHARGE STATUS
10min

Neonatal Condition

DISCHARGE DATE

Fetal Neonatal Condition


Mother Condition

Category

Congenital Anomalies
Condition

Yes/No

Major/Minor

Lethal/Non-lethal

Pregnancy
Delivered
Yes/No

PHILIPPINE OBSTETRICAL AND GYNECOLOGICAL SOCIET


version 0.12
Gyne Form

PATIENT DATA
CASE NO

LASTNAME

FIRSTNAME

Birthday

Age

Service

637472 Mandado
638712 Enad

Juliet
Marissa

7/1/1981
6/8/1972

33 Private
42 Private

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
653506
653447
653794
654012

Comaingking
Empleo
Yao
Hebia
Aspilla

Melba
Mylene
Sherrie
Peachie
Marlou

1/1/1967
9/2/1963
6/23/1988
1/27/1984
12/14/1972

48
51
26
30
42

Private
Private
Private
Private
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

655682 Estillone

Ma. Marisa

10/17/1967

47 Private

656081
657359
657279
659150
658938
659047
660160
660243
661156
661438
656199

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

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

52
33
44
24
32
47
26
34
27
28
35

Private
Private
Private
Private
Private
Charity
Private
Private
Private
Private
Private

OGICAL SOCIETY

HISTORY
ADMIT DATE

FINAL DIAGNOSIS
Gravidity

Parity

2/2/2014
2/3/2014

1
0

2/5/2014

2/5/2014
2/6/2014

2
0

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

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

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

2/18/2014
2/19/2014
2/19/2014
2/19/2014
2/19/2014

5
2
0
1
2

2/20/2014
2/20/2014

3
0

2/20/2014
2/20/2014

4
1

2/21/2014

Category

Condition

1 Other Benign Conditions of the Follicular cyst of ovar


0 Endometriosis
Adenomyosis, endome
Benign Neoplasm of the Uterus Adenomatous or atypic
4 Benign Neoplasm of the Uterus Endometrial hyperplas
Benign Neoplasm of the Uterus Endometrial polyp
Benign Neoplasm of the Uterus Leiomyoma
2 Pelvic Inflammatory Disease Pelvic Abscess
0 Benign Neoplasm of the Uterus Endometrial polyp
Benign Neoplasm of the Uterus Leiomyoma
0 Other Benign Conditions of the Follicular cyst of ovar
4 Other Benign Conditions of the Paratubal serous cyst,
0 Other Benign Conditions of the Follicular cyst of ovar
Benign Neoplasm of the Uterus Endometrial hyperplas
5 Malignant Neoplasm of the CervAdenocarcinoma, cer
0 Endometriosis
Pelvic peritoneum, e
5 Other Benign Conditions of the Paratubal serous cyst,
0 Endometriosis
Adenomyosis, endome
3 Endometriosis
Adenomyosis, endome
3 Benign Neoplasm of the Uterus Endometrial hyperplas
Benign Neoplasm of the Uterus Leiomyoma
0 Endometriosis
Endometrial hyperplas
3 Benign Neoplasm of the Uterus Endometrial polyp
2 Benign Neoplasm of the Uterus Leiomyoma
1 Other Benign Conditions of the Follicular cyst of ovar
2 Benign Neoplasm of the Cervix Polyp of cervix uteri
0 Other Benign Conditions of the Follicular cyst of ovar
3 Benign Neoplasm of the Cervix Polyp of cervix uteri
1 Benign Neoplasm of the Uterus Leiomyoma
Benign Neoplasm of the Uterus Endometrial polyp
4 Endometriosis
Endometriosis unspec
2 Malignant Neoplasm of the OvaOther type neoplasm,
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

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

4
0
3
0
2
1
0
0
1
1
2

4
0
3
0
2
1
0
0
0
0
2

Endometriosis
Adenomyosis, endome
Endometriosis
Pelvic peritoneum, e
Malignant Neoplasm of the OvaOther type neoplasm,
Other Benign Conditions of the Follicular cyst of ovar
Endometriosis
Pelvic peritoneum, e
Endometriosis
Pelvic peritoneum, e
Pelvic Inflammatory Disease Pelvic inflammatory d
Pelvic Inflammatory Disease Pelvic inflammatory d
Diseases of Bartholin's Gland Abscess of Bartholin'
Benign Neoplasm of the Uterus Leiomyoma
Other Inflammation of Vagina a Vulva condyloma acu

Laterality

For Malignancy For Genital


Only
Prolapse Only

OPERATIONS

Stage

Elective/Emergency

Approach

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

Elective
Elective

Laparotomy Uterus
Laparotomy Uterus

Elective

Laparotomy Other Ope

Elective
Elective

Vaginal
Uterus
Laparotomy Uterus

Elective

Vaginal

Both
NA
NA
NA
NA
NA
Left
NA
NA
Both
Left
Both
NA
NA
III
NA
Left
NA
NA
NA
NA
NA
NA
Right
Both
NA
NA
NA
NA
NA
NA
Unspecified
NA
NA
NA
NA
Right
NA
NA
NA
NA
NA
I
NA
NA

Degree

Organ

Uterus

NA
NA
NA
NA
NA
NA
NA
NA
Right
NA
NA

Elective
Elective

Laparotomy Uterus
Laparotomy Uterus

Elective
Elective

Laparotomy Other Ope


Laparotomy Uterus

Elective

Vaginal

Vulva and

Elective

Vaginal

Vulva and

DISCHARGE
Procedure

Laterality

Hysterectomy

Status

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

TAHBSO (total NA
TAHBSO (total NA

Without hysterect Alive


Alive
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

Without hysterect Alive

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

With hysterectomy Alive


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

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 SOCIE


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

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
Post-Menopausal Bleeding
627
Atrophic/ Senile Vaginitis
628
INFERTILITY
Primary

628.0
628.1
628.2
628.3
628.9

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

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
Urethrocoele
Enterocoele
Unspecified

Prolapse of vaginal vault after hysterectomy


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

TOTAL

FISTULA

Female Genital Tract Fistula


specify types vaginal polyp

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
Germ Cell Type
Other Type
Metastatic

CERVIX

UNILATERAL

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
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

UNILATERAL

N89.1
N89.2
N89.3
N89.4
N89.5
N89.7
N89.8
VULVA
N90.0
N90.1
N90.2
N90.3
N90.4
N90.5
N90.6
N90.7
N90.8

Moderate vaginal dysplasia or VAIN II


Severe vaginal dysplasia or VAIN III
Dysplasia of Vagina, Unspecified
Leukoplakia of Vagina
Stricture and Atresia of Vagina
Hematocolpos
Others

Mild vulvar dysplasia or VIN I


Moderate vulvar dysplasia or VIN II
Severe vulvar dysplasia or VIN III
Vulvar Dysplasia, Unspecified
Leukoplakia of Vulva
Atrophy of Vulva
Hypertrophy of vulva
Vulvar Cyst
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

UNILATERAL

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

UNILATERAL

OPERATIONS ON VAGINA
Culdocentesis
Incision of the Vagina
Colpotomy
Culdotomy
Hymenotomy
Hymenectomy
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

COLOGICAL SOCIETY

PRIVATE

TOTAL

Aplasia

SECOND

COMPLETE

WITHOUT

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

BILATERAL

BORDERLINE

STAGE II

STAGE III

STAGE IV

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

BILATERAL

TOTAL

WITH
HYSTERECTOMY

BILATERAL

BILATERAL

TOTAL

PHILIPPINE OBSTETRICAL AND GYNECOLOGICAL SOCIE


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
3. Air embolism

0%
0%
0%
0%

E. ANESTHESIA

0%

1. Neurogenic cardiac arrest


2. Post-aspiration asphyxia
3. Respiratory insufficiency

0%
0%
0%

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

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%

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

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%

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%
0%
0%
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.
2.
3.
4.

Antepartal
Intrapartal
Postpartal
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%

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%

OLOGICAL SOCIETY

PHILIPPINE OBSTETRICAL AND GYNECOLOGICAL SOCIE


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

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

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

Others

No data

TOTAL

0
0
0
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

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

Partial response

0
0
0
0
0

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

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

WHO PROGNOSTIC SCORE


Low risk

High risk

0
0
0

No data

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

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