| S3Q26 | Gestational diabetes | |__| |
| S3Q27 | Chronic nephropathies | |__| |
| S3Q28 | HIV infection | |__| |
| S3Q29 | Hepatitis B | |__| |
| S3Q30 | Hepatitis C | |__| |
| S3Q31 | Other medical history(s) |
|
| Surgical (Except S3Q33A, 1 = Yes, 2 = No) | ||
| S3Q32 | Pelvic surgery | |__| |
| S3Q33 | Cesarean (if no go to S3Q34) | |__| |
| S3Q33A | Indication of cesarean | |__|(1 = Mechanical dystocia, 2 = Shoulder dystocia, 3 = Cervical dystocia, 4 = AFD) |
| Toxicologic (1 = yes, 2 = No) | ||
| S3Q34 | Alcohol consumption | |__| |
| S3Q35 | Tobacco | |__| |
| S3Q36 | Traditional potions | |__| |
| SECTION 4: CLINICAL EXAM | ||
| Anthropometric data of the mother | ||
| S4Q01 | Weight at the start of pregnancy (in kg) | |__||__|,|__||__||__| |
| S4Q02 | Weight at the end of pregnancy (in Kg) | |__||__|,|__||__||__| |
| S4Q03 | Weight gain | |__||__|,|__||__||__| |
| S4Q04 | Maternal height (in metres) |
|
| S4Q05 | BMI (in Kg/m2) |
|
| Vital parameters on admission | ||
| S4Q06 | Blood pressure (in mm Hg) |
|
| S4Q06A | Right arm |
|
| S4Q06B | Left arm |
|
| S4Q07 | Pulse (in bpm) |
|
| S4Q08 | Respiratory frequency (in cycles/min) |
|
| S4Q09 | Axillary temperature (in ˚C) |
|
| Obstetrical exam | ||
| S4Q10 | Uterine height (in cm) |
|
| S4Q11 | Abdominal circumference (in cm) |
|
| S4Q12 | EFW (according Johnson) |
|
| S4Q13 | Presentation | |__| (1 = Cephalic, 2 = breech; 3 = Transverse) |