Your Pregnancy Outcome

Mother's Full Name :

BFMC ID:

Email ID:

what was the outcome of the pregnancy?
Live Birth
Termination of Pregnancy
Stillbirth
Miscarriage

Date of Delivery

Where Did You Delivery?

How Did You Deliver?
Vaginal Caesarean section

What is the sex of the baby?
Male Female

What was the baby's birth weight?

What was the baby's birth weight after 5 Mins?

Did the baby need treatment in the special baby care unit?
Yes No

If Yes Please Specify

At what age did the baby come home at ?

- Days On

Did the baby have any problems?
Yes No

Tests during the course of the pregnancy?
Amniocentesis
Chorion villus sampling ( CVS)
Fetal blood sampling
Maternal biochemistry (Triple test)

Illnesses during the course of the pregnancy?
Diabetes
Insulin
Blood Pressure
Any other illness

Time Period

Name of the Baby