n-Peritonitis; 1 = yes 2 = no

/__/

o-Post-operative peritonitis; 1 = yes 2 = no

/__/

p-Cardiopathy; 1 = yes 2 = no

/__/

q-Malaria in pregnancy; 1 = yes 2 = no

/__/

r-Severe anaemia; 1 = yes 2 = no

/__/

s-In utero Fetal Death; 1 = yes 2 = no

/__/

t-Encephalopathy; 1 = yes 2 = no

/__/

u-Acute Lung Edema; 1 = yes 2 = no

/__/

v-Post abortum uterine perforation; 1 = yes 2 = no

/__/

w-Other; 1 = yes 2 = no

(if yes specify).........................................................

/__/

434

Duration of hospitalization

/_________/ hours or /__/ days

V-CIRCUMSTANCE OF DEATH

546

Date of death

/______________/

547

Time of death

/______________/

548

time to management

1 = /_____________/; 2 = Not management

560

Period of death

a-Pregnancy; 1 = Yes 2 = No

/__/

b-Delivery; 1 = Yes 2 = No

/__/

c-Post-partum; 1 = Yes 2 = No

/__/

d-Post-operative; 1 = Yes 2 = No

/__/

e-Per-operative; 1 = Yes 2 = No

/__/

f-Post-abortum; 1 = Yes 2 = No

/__/

561

Vaginal Delivery route

1 = Yes; 2 = No; 3 = Not specified

/__/

Date

/___________/

/__/

Moment of delivery

1 = Before admission; 2 = After admission

/__/

Active Management of the Third Period of Childbirth (AMTPC) done

1 = Yes; 2 = No; 3 = N.I (Not informed)

/__/

562

Surgical intervention

1 = Yes; 2 = No

/__/

563

Type of surgery

1 = Caesarean section; 2 = Laparotomy; 3 = D&C/Curettage;

/__/

564

Date

/_______________/

565

Time

1 = /___________/; 2 = N.I (Not informed)

/__/

570

Condition of the newborn

a-Alive; 1 = Yes 2 = No

/__/

b-Macerated; 1 = Yes 2 = No

/__/

c-Intrapartum death; 1 = Yes 2 = No

/__/

d-Neonatal death; 1 = Yes 2 = No

/__/

e-Not specified; 1 = Yes 2 = No

/__/

572

Blood transfusion

1 = Yes; 2 = No

/__/

573

Number of blood bags

/_____/pockets

/__/

574

Cause of death

1 = Direct obstetric causes; 2 = Indirect obstetric causes.

/__/