Q50.

Have you ever had to do a digestive endoscopy?

Yes = 1

No = 2

[___]

Q51

Have you ever had to do a digestive endoscopy?

Yes = 1

No = 2

[___]

V. CLINICAL SIGNS

Q52

Anorexia

Yes = 1

No = 2

[___]

Q53

Asthenia

Yes = 1

No = 2

[___]

Q54

Fever

Yes = 1

No = 2

[___]

Q55

Polydipsia

Yes = 1

No = 2

[___]

Q56

Polyuria

Yes = 1

No = 2

[___]

Q57

Jaundice

Yes = 1

No = 2

[___]

Q58

Purpura

Yes = 1

No = 2

[___]

Q59

Arthralgia

Yes = 1

No = 2

[___]

Q60

Others

Yes = 1

No = 2

[___] To be specified

Q61.

Data from today’s physical examination (obstetric+++)

VI. Information about current pregnancy

Q62

Age de la grossesse

First trimester = 1

Second trimester = 2

Third trimester = 3

[___]

Q63

Pre-natal consultation

3< = 1

[3; 5[ = 2

>5 = 3

[___]

Q64

Obstetric ultrasound

Yes = 1

No = 2

[___]

Q65

Blood group and Rhesus

Yes = 1

No = 2

[___]

Q66

Hemoglobin electrophoresis

Yes = 1

No = 2

[___]

Q67

HBsAg

Yes = 1

No = 2

[___]

Q68

Anti-HCV antibodies

Yes = 1

No = 2

[___]

Q69

HIV serology

Yes = 1

No = 2

[___]

Q70

Toxoplasmosis serology

Yes = 1

No = 2

[___]

Q71

Rubella serology

Yes = 1

No = 2

[___]

Q72

TPHA-VDRL

Yes = 1

No = 2

[___]