National Safe Motherhood Program

PREGNANCY TRACKING
Year:
Region:
Province:
Municipality:
Barangay:
Birthing center:
Address:
Referral Center:
Address:
Mother and Child Postnatal Check
Expected Date of Antenatal Care Check-Ups Pregnancy Outcome Ups Civil Registration
Name Age Gravidity Parity Delivery Day of Early
8-12 weeks 24-26 weeks 32 weeks 36-38 weeks Preterm Discharge /24 Within 7 days Maternal Stillbirth Newborn
2-4 months 6-6.6 months 8 months 9-9.5 months Live birth birth stillbirth Abortion hour after birth after birth Death Death (0
days)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Name of BHW:
Name of Midwife:
Barangay Health Station:
Rural Health Unit: