Get the free Obstetrical History Supplement - bswobgynbbcomb

Obstetrical History (Supplement) (To Be Completed if Currently Pregnant) Patient Name What was the FIRST day of your last menstrual period Cycles regular Yes No Is this date definite Yes No Cycle

How to fill out obstetrical history supplement

How to fill out obstetrical history supplement:

1. Start by gathering all relevant medical records and information about your obstetrical history, including previous pregnancies, pregnancies that ended in miscarriage or stillbirth, and any complications or medical conditions during pregnancy.
2. Fill out the basic information section of the obstetrical history supplement, including your name, date of birth, contact information, and the date of the current visit.
3. Provide a detailed account of your previous pregnancies, starting with the most recent. Include the year of each pregnancy, the number of weeks you were pregnant, the outcome (live birth, miscarriage, stillbirth), the mode of delivery (vaginal or cesarean), and any complications or medical interventions that occurred during the pregnancy or delivery.
4. If applicable, indicate any medical conditions or complications you experienced during pregnancy, such as gestational diabetes, preeclampsia, or placenta previa. Include the treatment or management plan for these conditions.
5. Document any issues or complications with previous pregnancies, such as preterm labor, premature rupture of membranes, or fetal growth restriction.
6. Note any genetic disorders or birth defects that were detected during your previous pregnancies, as well as any family history of genetic conditions.
7. Provide information about any surgeries or procedures related to your reproductive health, such as tubal ligation or fertility treatments.
8. Include any relevant information about your current pregnancy, such as the estimated due date, any prenatal care you have received, and any complications or concerns that have arisen.

Who needs obstetrical history supplement:

1. Pregnant women who are receiving prenatal care should complete an obstetrical history supplement.
2. Women who have had previous pregnancies, regardless of the outcome, should fill out the obstetrical history supplement to provide healthcare providers with important information about their reproductive health.
3. Women with a history of medical conditions or complications during pregnancy, such as gestational diabetes or preeclampsia, should ensure that their healthcare providers have this information by completing the obstetrical history supplement.

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What is obstetrical history supplement?

The obstetrical history supplement is a form that collects detailed information about a pregnant woman's obstetrical history, including previous pregnancies, deliveries, complications, and prenatal care.

Who is required to file obstetrical history supplement?

Pregnant women are required to file the obstetrical history supplement in order to provide healthcare providers with important background information.

How to fill out obstetrical history supplement?

The obstetrical history supplement can be filled out by the pregnant woman herself, with assistance from healthcare providers if needed. The form should be completed accurately and honestly.

What is the purpose of obstetrical history supplement?

The purpose of the obstetrical history supplement is to help healthcare providers assess the risks and needs of a pregnant woman during prenatal care and delivery.

What information must be reported on obstetrical history supplement?

Information such as previous pregnancies, deliveries, complications, prenatal care received, and any relevant medical history must be reported on the obstetrical history supplement.