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

[___]