Summary Table

Year ............................ Month .........................

s. Indicator Month 1 Month 2 Month 3 Month 4 Month 5 Month 6 Month 7 Month 8 Month 9 Month 10 Month 11 Month 12
Annual
No.
Total
No. of Deliveries (total)
1

Normal
1.1

Assisted
1.2

Primi
1.3 C-
C-section
Section
Previous C-
Section
Direct in Labor
2
Cases
3
Live Births (total)

4 Stillbirths (total)

Total Partograph
5
filled
6
Oxytocin IM given

7 Episiotomy done

Total inducted
8
Total augmented
9
Maternal
10 complication
Identified
PE/E
10.1

10.2
PPH

Obst. Labour
10.3
lnj. Mg504
11
administered
lnj. Dexamethasone
12 administered

Blood Transfusion
13
done
 Summary Table
Year ............................ Month .........................
s. Indicator Month 1 Month 2 Month 3 Month 4 Month 5 Month 6 Month 7 Month 8 Month 9 Month 10 Month 11 Month 12
Annual
No.
Total
Birth Vaccination
14
given
Zero dose
vaccination given BCG
14.1

Hep B

OPV

Newborn omplications
15 identified
15.1 Pre-term

15.2 LBW

15.3 Asphyxia

Resuscitation required
15.4

Family Planning Acceptors

16 (total)

Maternal Deaths
17
(total)
Newborn Deaths
18
(total)
Referred Out
19
Mother
19.1

19.2 Newborn