Professional Documents
Culture Documents
PATIENT’S NAME (LAST, FIRST, MIDDLE) DATE OF BIRTH AGE SEX HEIGHT CIVIL STATUS
MALE ___________cm
WEIGHT
FEMALE ___________kg
ATTENDING PHYSICIAN MRN NATIONALITY ROOM / BED NO.
PIN
10 cm
4 cm
FINDINGS: 1 2 3 4 5 6 7 8 9 10 11 12
TIME
Cervical dilatation (cm)
Hours since Ruptured Membranes (Time of the Rupture):
Amniotic Fluid
Vaginal Bleeding (0 / + / + +)
Fetal descent
Contractions in 10 minutes
Fetal Heart Rate (120-160/min is normal)
Temperature
Pulse (beats/minute)
Blood pressure (systolic/diastolic)
Urine Voided (Yes/No)
Delivery of the newborn (time)
Oxytocin (doses & time given)
Delivery of placenta (time)
Problem - onset/description
Management
_________________________________