S. No. | QUESTION | RESPONSE |
1. | Age at first pregnancies (years): |
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2. | Number of pregnancies (gravid): |
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3. | Parity: |
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4. | Number of living children: |
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5. | Age of the youngest child: |
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6 | Birth interval in months (between the current pregnancy and the previous child) |
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7. | History of abortion: | [1] Yes [2] No |
8. | History of bleeding during the current pregnancy: | [1] Yes [2] No |
9. | History of preterm birth: | [1] Yes [2] No |
10. | Gestational in weeks: |
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