Patient No: Room/Bed No: 4

12 - 890675

Name: Sofia Diana DG. Gines Age: 28

G1 P0 ( 0 0 0 1 ) LMP: September 04,2019 EDC: June 11,2020 AOG: 18 weeks, 0 days
T P A L

ALERT ACTION DANGER

Use this form for monitoring active labor
10 cm

9cm

8cm

7cm

6cm

5cm

4cm
FINDINGS
6pm 7pm 8pm 9pm 10pm 11pm 12am 1am 2am 3am 4am 5am
Time
Hours in active labor 1 2 3 4 5 6 7 8 9 10 11 12
Hours since ruptured membranes
Rapid assessment
Vaginal bleeding (0+++)
Amniotic fluid (meconium stained)
Contractions in 10 minutes
Fetal heart rate (beats/minute)
Urine voided
T (axillary)
Pulse (beats/minute)

Blood pressure (systolic/diastolic)

130/80 130/80 130/80 130/80
Cervical Dilation (cm)
Delivery of Placenta (time)
Oxytocin (time/given)
Problem-note onset/describe below
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Name of Nurse/Midwife