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Lampiran 1.

LEMBAR IDENTITAS SAMPEL PENELITIAN

NAMA (INISIAL) :
USIA :
ALAMAT :
PEKERJAAN :
PARITAS : G …….. P ……. A …….
INTERVAL PARITAS :
RIWAYAT PREEKLAMPSIA
(KEHAMILAN SEBELUMNYA) :
KLASIFIKASI PREEKLAMPSIA : A.Preeklampsia Rigan
B. Preeklampsia Berat

BENTUK KOMPLIKASI MATERNAL : A. Eklampsia / Kejang

B. HELLP Syndrome
C. Solusio Plasenta
D. Kegagalan Organ
1. Gagal Ginjal
2. Edema Pulmonal
3. Cortical Blindness
4. Ruptur Hepar
E. Normal
F. Lain-lain (Tuliskan)