Form 1
Variable Name Field Label Identifier?
record_id
Record ID
name_of_the_observer
Name of the Observer
date
Date
district_name
District name
block_name
Block name
name_of_the_facility
Name of the facility
specify_name
Specify name
record_the_time_observatio
Record the time observation started-
rch_id_of_the_pregnant
RCH ID of the pregnant woman
age_of_the_pregnant_woman
Age of the pregnant woman
address_of_pregnant_womn
Address of the pregnant woman
health_worker_greet_pgwn
1. Did the health worker greet the pregnant woman (and other present) in a friendly and respectful way?
health_worker_intrduce
2. Did the health worker introduce him/herself and title
(Nurse, ANM, CHO, MO, specialist etc)
pregnant_woman_asked_about_name
3. Was the pregnant woman asked about her name?
addressed_using_her_name
4. Was she addressed using her appropriate name or title?
was_she_asked_her_age
5. Was she asked her age?
enquired_about_her_age
(Menstrual History) 6. Was she enquired about her age of menarche?
about_when_the_first_day_menstrual
10. Was she asked about when the first day of her last menstrual period and EDD recorded according to EDD?
medical_and_obstetric_hist
Medical and Obstetric History
medical_obstetric_hsty_re_1
Remark
medical_obstetric_hsty_re_2
Remark
medical_obstetric_hsty_re_3
Remark
heavy_bleeding_during
(Did the health worker and pregnant woman discuss any of the following complications for prior pregnancies) a.Heavy bleeding during or after pregnancy
medical_obstetric_hsty_re3a
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medical_obstetric_hsty_re3b
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medical_obstetric_hsty_re3c
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medical_obstetric_hsty_re3d
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medical_obstetric_hsty_re3e
Remark
medical_obstetric_hsty_re3f
Remark
medical_obstetric_hsty_re3g
Remark
medical_obstetric_hsty_re3h
Remark
medical_obstetric_hsty_re3i
Remark
medical_obstetric_hsty_re3j
Remark
prior_abortion_miscarria
k. Prior abortion/miscarriage (loss of pregnancy)
medical_obstetric_hsty_re3k
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medical_obstetric_hsty_re3l
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medical_obstetric_hsty_re3m
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medical_obstetric_hsty_re4
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medical_obstetric_hsty_re5
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family_history_chronic_disease
6. Was she asked about family history of any chronic disease (hypertension, diabetes etc.), presence of any hereditary diseases like (thalassemia, sickle cell anemia, spina bifida etc.)
medical_obstetric_hsty_re6
Remark
did_the_health_worker_ask
Did the health worker ask about or the client mention any of the following for current pregnancy?
o_kidney_disorders_develop
o. Kidney disorders developed during the pregnancy (chronic renal disease)
kidney_disorder_dev_re
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temp_assessed_recorded
(General examination procedures)1. Was temperature assessed and recorded?
bp_assessed_record
2. Was blood pressure assessed and recorded?
did_examiner_check_if_air
4. Did examiner check if air plug is securely inserted in the main unit?
hypertensive_provide_advice_medicine
10. If diagnosed Hypertensive, was advise given/treatment provided? (Drugs/further investigations/follow-up visits/referrals)
respiratory_rate_measured_rec
11. Was respiratory rate measured and recorded?
pgwmn_built_assessed_record
12. Was built of the pregnant woman assessed and recorded? (Obese/average/thin)
nutrition_status_assessed
13. Nutrition status assessed.(Good/average/poor)
previous_records_wt_available
15. Was the previous records for weight available and date
weight_of_the_pgwmn_mesuare_record
a. Was weight of the pregnant woman measured and recorded?
weight_of_the_pgwmn_mesuare_record_a_re
Remark
measured_weight_recorded_in_mcp_card
g. Was the measured weight recorded in the MCP card?
weight_recorded_in_mcp_card_g_re
Remark
measure_ht_pgwmn
16. Was instrument available to measure height of the pregnant woman? (Measure height if not recorded at previous visit) (Measuring tape/stadiometer)
assesed_gums_tonsils_tongue
19. Were her gums, teeth, tonsils and tongue assessed(evidence of malnutrition are evident from glossitis and stomatitis)
neck_examined
20. Is neck examined for assessing neck veins, thyroid gland, lymph glands for any abnormalities.
back_assessed
21. Is back assessed for normalcy of spine and symmetry, Rhomboid of Michaelis
health_worker_wash_hand_wth_soap
4. Did the health worker wash hands with soap and water using appropriate hand washing techniques and dried with clean dry cloth?
assessed_standings_at_pgwm_rt_hnd_side
6. Did health worker assess standing at the pregnant woman's right-hand side.
assessed_scars
7. Was pregnant woman visually accessed for any scars, skin condition of abdomen for evidence of any ringworm or scabies, and identification for pubic symphysis.
check_linea_nigra_and_stria
8. Check for Linea nigra and stria gravidarum.
fundal_height_measured
10. Was fundal height measured: (in inches)Using the ulnar border of the left hand, the examiner should ideally start palpating gently from the xiphisternum downwards till they meet the first resistance (fundus of the uterus)
fundal_grip
12. Fundal grip: (facing the pregnant woman's face)Whole of fundal area is palpated using both hands laid flat on over the fundus and determined which pole of the foetus is lying in the fundus.Broad, soft, irregular mass: breechSmooth, hard or globular mass: headIn transverse lie neither of the foetal poles are palpated in the fundus
lateral_grip_facing_the_pr
13. Lateral grip: (facing the pregnant woman's face)After examining fundal grip, the examiner has to slip/slide their hands to both lateral sides of abdomen. Keep a hand on one side of the abdomen and palpate the other side of the abdomen with the other hand and repeat the manoeuvre to identify which side is the back, limbs and anterior shoulder of the foetus and determine the lie.Smooth curve resistant feel: Back of the foetusComparatively empty and small knob like irregular parts: limb side of the foetus.
first_pelvic_grip
14. First pelvic grip: (facing the face of the mother)Four fingers of both hands are placed on either side of midline in lower pole of uterus and parallel to inguinal ligament. The fingers are pressed downwards and backwards in a manner of approximation of fingertips to palpate the part occupying the lower pole of uterus. Divergence of fingers indicate head is engaged.Convergence of fingers indicate head is not engaged.
second_pelvic_grip
15. Second pelvic grip (Pawlik's grip): (facing the legs of the mother).
Turn towards the feet of the woman, slightly extending the woman's legs. Keep both hands on either side of the presenting part with fingers towards the pelvis
fetal_heart_sound_measered
1.Was fetal heart sound measured (fetoscope placed on the abdomen)(The foetal heart sounds are best audible on the back, left scapular region) In occiput anterior position place fetoscope in the middle of the spino umbilical line on the same side.
examiner_listen_to_heart_sound
2. Did the examiner listen to heart sound for one full minute.
supine_position
2. In the supine position, was the women asked to uncover her body from the waist up, and place her arms at her side?
name_of_device
Test for Hemoglobin (Hb) Note type/name of device that health worker uses to measure Hb
first_drop_blood_discard
5. Did the health worker discard the first drop of blood. (The punctured finger should not be pressed).
machine_kept_in_ziplock
6. Is the machine (TruHB and HaemoCue) kept in Ziplock bags? (Poor results on digital Hb meters are due to dust?
results_of_hb_test_record_in_mcp
7. Were results of Hb test recorded in the MCP card?
hb_result_recorde_based_on_severity
9. Was Hb test result recorded based on level of severity?
diagnosed_anemic_was_advise_given
10. If diagnosed anemic, was advise given/treatment provided?
blood_glucose_measured_record_in_mcp_card
5. Was blood glucose measured recorded in the MCP card?
diagnosed_diabetic_advise_given
7. If diagnosed Diabetic was advise given/treatment provided? (Drugs/ injections/ investigations/ follow-up visits/ referrals)
ask_about_hiv_status
1. Did the health worker ask about or the pregnant woman mention her HIV status?
health_worker_perform_pgwmn_hiv_test
2. Did the health worker perform or refer the pregnant woman for HIV test?
is_hiv_positive
3. Is the pregnant woman HIV positive?(Listen and record answer, choose "Don't know" if HIV status is unknown or status is not discussed)
health_worker_provide_couselling_for_hiv
4. Did the health worker provide any counselling for HIV/PMTCT?
couselling_on_hiv_pmtct
Did the health worker provide counselling on the following HIV/PMTCT topics?
advantages_side_effect_of_art
e)Explains the advantages and side effects of ART
strip_dipped_in_urine_sample
3. Was the indicator side of the strip dipped in the urine sample, and taped at the edge of the container to remove excess urine?
sugar_reagent_part_compared_with_sugar_chart
4. Was the sugar reagent part compared with the sugar chart on the container?
albumin_reagent_part_compared_alb_reslut_chart
5. Was the albumin reagent part compared with the albumin results chart on the side of the bottle?
results_explained_record_case_sheet
Were the results explained to the patient and recorded on the case sheet/OPD slip?
blood_grp_recorded_in_mcp
2. Was blood group recorded in the MCP card?
name_of_facility
4. Name of facility
name_of_the_facility_crnt
8. Name of the facility?
hstr_of_immunization
1. Did the health worker ask for a history of immunization in the current pregnancy
prescribed_of_tt
2. Was pregnant woman prescribed or given an inj. of tetanus toxoid (TT).
perscrible_of_folic_acid
4. Did the health worker prescribe the pregnant woman for folic acid?
number_of_folic_acid
What was the number of tablets issued?
number_of_folic_acid_2
What was the number of tablets issued?
prescribe_ifa
5. Did the health worker prescribe the pregnant woman for iron folic acid tablets (IFA)?
she_given_supply_of_ifa
6. Was she given supply of iron folic acid?
dosage_advice
What dosage she was advised?
dosage_advice_2
What dosage she was advised?
prescribe_ifa_appropriate
8. Is ANM/CHO/MO prescribing the appropriate number (< =11 gm/dl should be given double dose per day) of IFA tablets for their Hb values (checking from records)
explained_side_effect
9. Was she explained the side effects of IFA tablets?
ifa_issuing_record_on_mcp_card
10. Was the issuing of IFA tablets recorded on the MCP card?
explained_the_side_effects_deworming
14. Was she explained the side effects of deworming tablets?
issuing_record_of_deworming_on_mcp_card
15. Was the issuing of deworming tablet recorded on the MCP card?
health_worker_info_progress_of_pregnancy
1. Did the health worker inform the pregnant woman about the progress of the pregnancy?
health_worker_counsel_to_pgwm_on_following_condition
2. Did the health worker counsel the pregnant woman in any of the following reasons to seek immediate medical care?
counsel_abt_birth_preparation
3. Did the health worker counsel the pregnant woman in any of the following ways about birth preparation?
where_she_will_deliver_and_encoraged_to_have_facility_delevery
a. Asked the client where she will deliver and encouraged her to have a facility delivery?
advised_prepare_for_delivery
b. Advised the client to prepare for delivery?(set aside money, arrange for emergency transportation)
discuss_nutrition_and_healrthy_eating_during_preg
4. Did the health worker discuss nutrition and healthy eating during pregnancy?
guidence_for_intake_hcm
5. Did the health worker provide guidance for intake of Hot cooked Meals (HCM)/Take home rations (THR) from AWCs?
discuss_breastfeeding
6. Did the health worker discuss breastfeeding?
discuss_on_family_planning
7. Did the health worker discuss family planning for use after delivery?
discuss_on_nxt_visit
8. Did the health worker counsel on when to return for next visit?
ask_any_other_question
9. Did the health worker ask whether the pregnant woman had any questions?
use_visual_aids_for_education
10. Did the health worker use any visual aids for health education or counselling during the consultation?
speak_easy_to_understand
11. Did the health worker speak using easy-to-understand language for the health worker?
look_at_pgmn_mcp_health_card
12. Did the health worker look at the pregnant woman's MCP/ health card/booklet, either before beginning the consultation or while collecting information or examining her?(Choose "Not assessed" if MCP card not available)
write_on_clients_health_card
13. Did the health worker write on the client's health card? (Choose "Not assessed" if no card/booklet)
identification_of_high_ris
Identification of High Risk
identified_as_high_risk
1. Was the pregnant woman identified as High risk? (Did the facility recognise/record the woman as High risk)
high_risk_identification1
Remark
management_given_complied
3. Management given Complied
hgh_risk_idntfction_re_3
Remark
how_pgwmn_manged
4. How was the pregnant woman managed?
other_managed_women
Other
facility_describe_management
If managed at the facility, describe the management (Drugs administered/injections administered/other investigations/counselling provided)
high_risk_identification4
Remark
course_of_managemet_of_hrp
4. Was the course of management and nature of HRP explained to the family members?
hgh_risk_idntfction_re_4
Remark
record_the_outcome_of_the_consulation
Record the outcome of the consultation-
referral_was_slip_provide
In case of referral was referral slip provided?
referral_was_slip_provide_2
In case of referral was referral slip provided?
name_of_field_officer
Name of field officer
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