Useful notes (O&G, MFM)

Baseline maternal medicine ANC

Age:

Gestational age: weeks 

Conception: 

BMI: 

–

Obstetric history 

Parity: 

First: 

Second: 

–

Summary 

1) 

2) 

–

Current medication 

1) 

2) 

3) 

Allergies:

–

Social history 

Occupation: 

Smoking: 

Vaccinations: all recommended during pregnancy, as offered (pertussis from 16 weeks, RSV 29 weeks, Covid-19/influenza seasonally) 

–

Family history 

Pre-eclampsia / Hypertension / Diabetes / VTE 

–

VTE risk: 

PET screening: 

GDM risk: 

Uterine arteries combined PI: 

Combined trisomy screening: 

PAPP-A: 

Fetal growth: 

Blood pressure: 

Birth preferences: 

–

Plan 

1) 

2) 

3) 

Actions: 

Follow-up: