|
| 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. | /__/ |