Top of clerking- Name
- Age
- Occupation
- Gravida / Para
- LMP
- EDD
- Gestational age
- Gestational age at booking
- Cycle
- Cervical smear
- Contraception
- Planned/unplanned pregnancy
Complaints
Current pregnancy history - 1st trimester
- Booking visit
- Blood test
- Nuchal scan
- Bleeding
- Vomiting
- Abdominal pain
- 2nd trimester
- Anomaly scan
- Placental position
- Foetal movements
- Bleeding
- Abdominal pain
- Watery discharge PV
- Associated problems with pregnancy
- 3rd trimester
- Foetal movements
- Bleeding
- Abdominal pain
- Watery discharge PV
- Associated problems with pregnancy
Obstetric history Menstrual history - Menarche
- Timing
- Regularity
- Amount
- Clots
- IMB
- PCB
- Associated pain
Sexual history - Partner
- Previous partners
- Previous contraception
General medical history Family history - Multiple pregnancy
- Ectopic pregnancy
- Miscarriages
- Diabetes
- Hypertension
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