Q73 | Bleeding during pregnancy | Yes = 1 No = 2 | [___] |
Q74 | Breaking of water | Yes = 1 No = 2 | [___] |
Q75 | Lumbopelvic pain | Yes = 1 No = 2 | [___] |
Q76 | Growth retardation in utero? | Yes = 1 No = 2 |
|
Q77 | Pregnancy stopped? | Yes = 1 No = 2 |
|
Q78 | Prematurity | Yes = 1 No = 2 |
|
Q79 | Full-term pregnancy? | Yes = 1 No = 2 |
|
VII. SEROLOGICAL MARKERS | |||
Q80 Q81 | Anti-HCV Ab by RDOT | Positive = 1 Negative = 2 | [___] |
Q82 | If RDOT+: ELISA test result | Positive = 1 Negative = 2 | [___] |
Q83 | HBsAg by RDOT | Positive = 1 Negative = 2 | [___] |
Q84 | If RDOT+: ELISA test result | Positive = 1 Negative = 2 | [___] |
Q85 | HIV serology | Positive = 1 Negative = 2 | [___] |