Causes obstétricales directes

575

Direct causes

a-HBP; 1 = Yes 2 = No

/__/

b-Infection; 1 = Yes 2 = No

/__/

c-Hemorrhage; 1 = Yes 2 = No

/__/

d-Complications of anaesthesia; 1 = Yes 2 = No

/__/

e-Embolic diseases; 1 = Yes 2 = No

/__/

f-Other; 1 = Yes 2 = No

If yes specify /__________________________/

/__/

576

Hemorrhages

a-Uterine atony; 1 = Yes 2 = No

/__/

b-Cervical tears; 1 = Yes 2 = No

/__/

c-DIC; 1 = Yes 2 = No

/__/

d-Uterine rupture; 1 = Yes 2 = No

/__/

e-Placenta praevia; 1 = Yes 2 = No

/__/

f-Placenta abruptio; 1 = Yes 2 = No

/__/

g-Abortion; 1 = Yes 2 = No

/__/

h-Ectopic Pregnancy; 1 = Yes 2 = No

/__/

i-Other; 1 = Yes 2 = No

If yes specify /__________________________/

/__/

577

HBP

a-Pre-eclampsia; 1 = Yes 2 = No

/__/

b-Eclampsia; 1 = Yes 2 = No

/__/

c-HELLP syndrom; 1 = Yes 2 = No

/__/

d-Stroke; 1 = Yes 2 = No

/__/

g-Other; 1 = Yes 2 = No

If yes specify /__________________________/

/__/

578

Thromboembolic disease

a-Pulmonary embolism; 1 = Yes 2 = No

/__/

b-Cerebral venous thrombosis; 1 = Yes 2 = No

/__/

c-Amniotic embolism; 1 = Yes 2 = No

/__/

579

Infections

a-Septic abortion; 1 = Yes 2 = No

/__/

b-Post-operative infection; 1 = Yes 2 = No

/__/

c-Puerperal sepsis; 1 = Yes 2 = No

/__/

d-Septic shock; 1 = Yes 2 = No

/__/

e-Chorioamniotitis; 1 = Yes 2 = No

/__/

Indirect obstetric causes

580

Indirect causes

1 = Malaria; 2 = Decompensated heart disease; 3 = Valvulopathy; 4 = Intestinal obstruction; 5 = Severe pneumonia; 6 = Encephalopathy;

7 = Toxic; 8 = HIV-related complications;

9 = Trauma; 10 = Other ...............(please specify); 11 = N.A (Not Applicable)

/__/

Undetermined causes

581

Supporting factors

1 = Community related;

2 = Related to health services; 3 = 1 + 2;

4 = No responsibility determined

/__/