Cebu Institute Of Technology – University

c o l l e g e o f n u r s i n g and allied health sciences

RECORD OF LABOR MONITORING

Name of Institution : ___________________ Case/Hospital Number : _____________________

Name of Mother: __________________________ Age : ________ Marital Status: _______________
Address : _______________________________________ Contact # : __________________
Gravida : ________________ Parity: ___________ G-T-P-A-L-M: ____________________
LMP : _________________ EDC : ______________ AOG : ________________________
Vital Signs : T = __________ PR = __________ RR = ___________ BP = _______________
Fetal Presentation: ________________Membranes : Intact ( ) Ruptured ( )
Date & Time of Rupture: ____________

Time Time
contraction contraction Duration Interval Frequency Intensity Dilatation Effacement FHT
starts ends

___________________________________ _______________________________________
Name & Signature of Student Name & Signature of D.R. Staff Nurse

___________________________________ _______________________________________
Name & Signature of Supervising Name & Signature of D.R. Supervisor
Clinical Instructor