POGS - Formsv0 - 12 February2014 Gyne

PHILIPPINE OBSTETRICAL AND GYNECOLOGICAL SOCIET
version 0.12
Overview
Hospital Information
Name
Code
Location
Data Period
Instructions
1. The paper Maternal Mortality Form and the paper Gestational Trophoblastic Disease Form STILL HAVE T
LOGICAL SOCIETY
ic Disease Form STILL HAVE TO BE SUBMITTED.

version 0.12
Maternal Fetal Form
PATIENT DATA
CASE NO
LASTNAME
FIRSTNAME
Birthday
Age
Service
OGICAL SOCIETY
HISTORY
ADMIT DATE
OB Score
Gravidity
Parity
Term
Preterm
Abortion
Alive
ADMISSION AOG
Weeks
MEDICAL/SURGICAL HISTORY
Days
Last Year of Pregnancy
Category
OBSTETRIC HISTORY
Condition
Category
Condition
PRENATAL
DELIVERY
Antenatal Procedures
Delivery Date
DELIVERY AOG
Weeks
Days
Route
Malpresentation
VAGINAL DELIVERY - Only for the CURRENT pregnancy.

Delivery
Other Procedures
Episiotomy
CAESAREAN SECTION
Perineal Laceration
Elective/Emergency
Incision
Primary/Repeat
Hysterectomy
Tubal Ligation
Anesthesia
INFANT FETAL DATA
Tubal ligation
Anesthesia Route
Number of Infants
Gender
Fetal Characteristics
Weight (grams)
Length (cm)
Pediatric Age (weeks)
Apgar Score
1min
5min
DISCHARGE STATUS
10min
Neonatal Condition
DISCHARGE DATE
Fetal Neonatal Condition

Mother Condition
Category
Congenital Anomalies
Condition
Yes/No
Major/Minor
Lethal/Non-lethal
Pregnancy
Delivered
Yes/No

version 0.12
Gyne Form
PATIENT DATA
CASE NO
LASTNAME
FIRSTNAME
Birthday
Age
Service
637472 Mandado
638712 Enad
Juliet
Marissa
7/1/1981
6/8/1972
33 Private
42 Private
640394 Retuya
Rosemary
8/6/1954
60 Private
639706 Estrada
641584 Povadora
Jeraldine
Evelyn
9/18/1987
11/2/1968
27 Private
46 Private
640657 Orquina
642841 Alburah
642916 Braswell
Mary June
Sarah
Loraine
12/29/1991
2/1/1965
3/22/1994
23 Private
49 Private
20 Private
643384
643828
643990
645908
646009
646122
Jamola
Ramirez
Ceniza
Lear
Pogo
Lagumon
Fe
Jonah
Geraldine
Elaine
Josefina
Virgie
9/3/1953
4/15/1975
6/5/1967
1/4/1965
2/8/1968
9/25/1955
61
39
46
50
46
59
Private
Private
Private
Private
Private
Private
647159
647511
644298
648050
648447
649358
650578
650190
Nioda
Mijares
Rodila
Dy
Anga
Bayot
Fuentes
Fajardo
Mary Ann
Sarah
Maria
Katherine
Julieta
Camille
Esmeralda
Pacita
7/5/1979
9/2/1965
12/7/1982
6/1/1985
7/19/1956
6/10/1995
9/30/1979
5/28/1959
35
49
32
28
58
19
35
55
Private
Private
Private
Private
Private
Private
Private
Private
652486
653506
653447
653794
654012
Comaingking
Empleo
Yao
Hebia
Aspilla
Melba
Mylene
Sherrie
Peachie
Marlou
1/1/1967
9/2/1963
6/23/1988
1/27/1984
12/14/1972
48
51
26
30
42
Private
Private
Private
Private
Private
654082 Badinas
654475 Bunadi
Kim
Necitas
11/12/1979
1/8/1968
35 Private
47 Private
654143 Mendiola
654904 Kangleon
Anna Maria
Nanette
8/28/1967
12/10/1956
47 Private
58 Private
655682 Estillone
Ma. Marisa
10/17/1967
47 Private
656081
657359
657279
659150
658938
659047
660160
660243
661156
661438
656199
Ylaya
Amalia
Gelig
Gwendolyn
Tano
Corazon
Tamisola
Althea
Ramano
Annalou
Baladyjay
Jocelyn
Relatado
Aisha
Aliac
Aona
ShambandarianYvonne
Estenzo
Felepa
Viray
Sheryle
8/3/1962
4/20/1981
6/5/1970
4/10/1990
7/5/1982
1/30/1967
1/18/1989
1/7/1981
1/2/1988
10/22/1986
8/20/1979
52
33
44
24
32
47
26
34
27
28
35
Private
Private
Private
Private
Private
Charity
Private
Private
Private
Private
Private
OGICAL SOCIETY
HISTORY
ADMIT DATE
FINAL DIAGNOSIS
Gravidity
Parity
2/2/2014
2/3/2014
1
0
2/5/2014
2/5/2014
2/6/2014
2
0
2/6/2014
2/7/2014
2/7/2014
0
4
0
2/8/2014
2/9/2014
2/9/2014
2/11/2014
2/11/2014
2/11/2014
6
0
7
0
4
4
2/12/2014
2/12/2014
2/12/2014
2/13/2014
2/13/2014
2/14/2014
2/16/2014
2/17/2014
0
3
2
1
2
0
3
1
2/18/2014
2/19/2014
2/19/2014
2/19/2014
2/19/2014
5
2
0
1
2
2/20/2014
2/20/2014
3
0
2/20/2014
2/20/2014
4
1
2/21/2014
Category
Condition
1 Other Benign Conditions of the Follicular cyst of ovar

0 Endometriosis
Adenomyosis, endome
Benign Neoplasm of the Uterus Adenomatous or atypic
4 Benign Neoplasm of the Uterus Endometrial hyperplas
Benign Neoplasm of the Uterus Endometrial polyp
Benign Neoplasm of the Uterus Leiomyoma
2 Pelvic Inflammatory Disease Pelvic Abscess
0 Benign Neoplasm of the Uterus Endometrial polyp
4 Other Benign Conditions of the Paratubal serous cyst,
Benign Neoplasm of the Uterus Endometrial hyperplas
5 Malignant Neoplasm of the CervAdenocarcinoma, cer
0 Endometriosis
Pelvic peritoneum, e
5 Other Benign Conditions of the Paratubal serous cyst,
0 Endometriosis
Adenomyosis, endome
3 Endometriosis
Adenomyosis, endome
0 Endometriosis
Endometrial hyperplas
2 Benign Neoplasm of the Uterus Leiomyoma
2 Benign Neoplasm of the Cervix Polyp of cervix uteri
3 Benign Neoplasm of the Cervix Polyp of cervix uteri
4 Endometriosis
Endometriosis unspec
2 Malignant Neoplasm of the OvaOther type neoplasm,
Endometriosis
3 Malignant Neoplasm of the OvaOther type neoplasm,
Pelvic Inflammatory Disease Pelvic inflammatory d
1 Malignant Neoplasm of the Cor Endometrial carcinom
2/21/2014
2/24/2014
2/24/2014
2/25/2014
2/25/2014
2/25/2014
2/26/2014
2/27/2014
2/27/2014
2/28/2014
2/28/2014
4
0
3
0
2
1
0
0
1
1
2
4
0
3
0
2
1
0
0
0
0
2
Endometriosis
Adenomyosis, endome
Endometriosis
Malignant Neoplasm of the OvaOther type neoplasm,
Other Benign Conditions of the Follicular cyst of ovar
Endometriosis
Endometriosis
Diseases of Bartholin's Gland Abscess of Bartholin'
Other Inflammation of Vagina a Vulva condyloma acu
Laterality
For Malignancy For Genital

Only
Prolapse Only
OPERATIONS
Stage
Elective/Emergency
Approach
Elective
Laparotomy Uterus
Elective
Laparotomy Uterus
Elective
Laparotomy Ovary
Elective
Elective
Elective
Elective
Elective
Laparotomy Uterus
Laparotomy Ovary
HysteroscopicUterus
Laparotomy Uterus
HysteroscopicUterus
Elective
Elective
Elective
Laparoscopic Fallopian
Vaginal
Uterus
Laparotomy Uterus
Elective
Vaginal
Uterus
Elective
Vaginal
Uterus
Elective
Vaginal
Uterus
Elective
Elective
Laparotomy Uterus
Laparotomy Uterus
Elective
Laparotomy Other Ope
Elective
Elective
Vaginal
Uterus
Laparotomy Uterus
Elective
Vaginal
Both
NA
NA
NA
NA
NA
Left
NA
NA
Both
Left
Both
NA
NA
III
NA
Left
NA
NA
NA
NA
NA
NA
Right
Both
NA
NA
NA
NA
NA
NA
Unspecified
NA
NA
NA
NA
Right
NA
NA
NA
NA
NA
I
NA
NA
Degree
Organ
Uterus
NA
NA
NA
NA
NA
NA
NA
NA
Right
NA
NA
Elective
Elective
Laparotomy Uterus
Laparotomy Uterus
Elective
Elective
Laparotomy Other Ope

Laparotomy Uterus
Elective
Vaginal
Vulva and
Elective
Vaginal
Vulva and
DISCHARGE
Procedure
Laterality
Hysterectomy
Status
Alive
Alive
TAHBSO (total NA
With hysterectomy Alive
TAHBSO (total NA
Alive
Salpingo-ooph Left
Subtotal hyste Left

Salpingo-ooph Left
Endometrial p NA
Total abdominaNA
Endometrial bi NA
Salpingectomy Both
Fractional cureNA
TAHBSO (total NA
Fractional cureNA
Fractional cureNA
Fractional cureNA
Alive
Without hysterect Alive
Alive
Alive
with hysterectomy Alive
Alive
Alive
Alive
TAHBSO (total NA
TAHBSO (total NA

Alive
Alive
Exploratory la NA
Alive
without hysterecto Alive
Fractional cureNA
TAHBSO (total NA

Endometrial p NA
TAHBSO (total NA
TAHBSO (total NA
Peritoneal flui NA
TAHBSO (total NA
Drainage of vu NA
Other operatio NA

Alive
Alive
Alive
Alive
Alive

version 0.12
Maternal Mortality Form
PATIENT DATA
CASE NO
HISTORY
LASTNAME
FIRSTNAME
Birthday
Age
ADMIT DATE
GICAL SOCIETY
AOG
Weeks
Days
ANTECEDENT AND UNDERLYING CAUSE

Type
Antecedent
Underlying
COMPLICATIONS AND DEATH

Timing of Death
Specific
Immediate Cause
Onset of Complications
Specific

version 0.12
GTD Form
PATIENT DATA
CASE NO
LASTNAME
FIRSTNAME
Birthday
Age
HISTORY
ADMIT DATE
GICAL SOCIETY
Gravidity
Parity
OB Score
Term
Preterm
Abortion
Alive
ADMISSION AOG
Weeks
Days
Last Year of Pregnancy
Diagnosis
HYDATIDIFORM MOLE
Type
Complications
Metastasis
Chemoprophylaxis
Drug
High Risk Factor
Mode of Evacuation
Condition on Discharge
Present Status
Cause of Death
GTN/PSTT/ETT
Histopathology
Antecedent Pregnancy
Baseline hCG levels (mIU/mL)
FIGO Anatomic Stage
Modified WHO Score
Risk
Combined FIGO-WHO Score

Age
Combined FIGO-WHO Score

Antecedent Pregnancy
Interval Months from Index Pregnancy
Pretreatment hCG (mIU/mL)
Largest Tumor Size (cm)
Metastasis
Site of Metastasis
Number of Metastases Identified
Previous Failed Chemotherapy
Total Score
ADDITIONAL TREATMENT
Other Surgical Intervention
Chemotherapy
Radiotherapy
CONDITION
Present Condition
Cause of Death

version 0.12
Obstetric Diseases and Procedures Report
SECTIONS
ONE
TWO
THREE
FOUR
FIVE
SIX
SEVEN
EIGHT
NINE
CONTENTS
ADMISSIONS DATA
DATA ON DELIVERED PATIENTS
OBSTETRIC AND MEDICAL COMPLICATIONS IN DELIVERED PATIENTS
PROBLEMS DURING LABOR
PROBLEMS AMNIOTIC FLUID AND PLACENTA
COMPLICATIONS DURING DELIVERY
COMPLICATIONS DURING POST-PARTAL PERIOD
PROCEDURES
ABORTIONS, ECTOPIC PREGNANCIES, TROPHOBLASTIC DISEASES
SECTION ONE: ADMISSIONS DATA

TOTAL NUMBER OF OBSTETRIC ADMISSIONS
DELIVERED PATIENTS
ANTEPARTAL PATIENTS DISCHARGED NOT DELIVERED
ABORTIONS
ECTOPIC PREGNANCIES
TROPHOBLASTIC DISEASES
AGE RANGE OF PATIENTS

LESS THAN 20
20 TO 34
35 AND ABOVE
PARITY
Nullipara
Para 1-5
MORE THAN 5
MATERNAL OUTCOME
Prepare Maternal Mortality Forms for All Maternal Deaths, Submit forms with this summary
DISCHARGED ALIVE
DISCHARGED ALIVE BUT MORIBUND
DIRECT MATERNAL DEATHS
INDIRECT MATERNAL DEATHS
NONMATERNAL DEATHS
TOTAL
FETAL OUTCOME - BASED ON OBSTETRIC AGE OF GESTATION
LIVE-BIRTHS
STILL BIRTHS
NEONATAL DEATHS
SECTION TWO: OBSTETRIC AND MEDICAL COMPLICATION IN DELIVERED PATIENTS

( using FIGO Committee on Perinatal Health-simplified ICD 10 coding,April 2000)
HYPERTENSIVE DISORDERS in PREGNANCY
010.9
Pre-existing (chronic hypertension with BP 140/90)
011.9
Pre-existing (chronic hypertension with superimposed preeclampsia)
012.1
HELLP Syndrome
012.2
Proteinuria (>0.30 gms/24 hr)
013.x
Edema with proteinuria
Gestational hypertension
014.0
Mild preeclampsia (BP 140/90, protein 0.3 gms/24 hr)
014.1
Severe preeclampsia (BP > 160/110, protein > 0.3gms/24 hr)
014.9
Preeclampsia unspecified
015.9
Eclampsia
Maternal Disorders predominantly related to pregnancy
020.9
Hemorhage in Early Pregnancy (< 22 weeks)

ABORTIONS
Threatened abortion
Incomplete abortion
Inevitable abortion
Imminent abortion
Missed abortion
Blighted ovum
Septic abortion
Induced abortion
Ectopic Pregnancy
Tubal ectopic pregnancy
Abdominal ectopic pregnancy
Ovarian ectopic pregnancy
Ectopic pregnancy, unspecified
021.1
022.0
022.1
022.3
022.4
023.0
Hyperemesis gravidarum, severe

(demanding treatment in hospital)
Venous complications
Varicose veins of lower extremity
Genital varicose veins
Deep vein thrombosis
Hemorrhoids
Urinary Tract Infection
Kidney
Urinary Tract Infection
Acute pyelonephritis
Chronic pyelonephritis
023.1
Bladder
Acute cystitis
Chronic cystitis
Renal or ureteral calculus
Urinary tract infection
Asymptomatic bacteriuria
Other
023.2
098.1
Genital Tract Infection
098.2
Z21.x
098.3
098.6
Syphilis
Gonorrhea
Herpes simplex
Chlamydia
Group B Streptococcus
Bacterial Vaginosis
HIV or AIDS
Other sexually transmitted diseases
Malaria
Herpes gestationalis
Diabetes mellitus
024.0
Diabetes mellitus Insulin dependent
024.1
024.4
Diabetes mellitus non-Insulin dependent

Gestational diabetes mellitus
025.x
026.5
026.6
Malnutrition (BMI less than 19.8)

Supine Hydrotensive syndrome
Liver Disorders
Hepatitis B
Hepatitis A
Acute Fatty Liver
Multiple gestation
Twin
Triplet
030.0
030.1
030.x
032.1
032.1
032.2
032.2
Other
Malpresentation
Frank breech
Complete breech
Footling Breech
Transverse Lie
032.3
Oblique Lie
Face
032.3
Brow
032.3
Chin
Prolapsed Arm
032.5
Multiple gestation with malpresentation for one or more fetus
033.9
Disproportion (known or suspected)
034.2
Previous Caesarian Section
034.3
034.9
035.9
036.0
036.2
036.3
036.4
Cervical Incompetence
Abnormalities of pelvic organs (see later)
Fetal Abnormality and Damage
Rhesus Isoimmunization
Hydrops Fetalis
Fetal Hypoxia
Intrauterine Death (<22 weeks)
Intrauterine Death (>22 weeks)
Poor Fetal Growth
Excessive Fetal Growth
036.5
036.6
040.x
041.0
041.1
042.0
042.1
042.9
044.0
044.1
045.0
045.9
046.8
047.9
048.x
Polyhydramnios
Oligohydramnios
Chorioamnionitis
Premature rapture of membranes
Onset of Labor w/in 24 hours
Onset of Labor after 24 hours
Unspecified
Placenta Previa without Hemorrhage
Placenta Previa with Hemorrhage
Abruptio placenta with coagulation defect
Abruptio placenta (only)
Placenta accreta
Placenta percreta
Placenta increta
Other antepartum hemorrhage
False Labor
Preterm Labor
Post Term >= 42 weeks

TROPHOBLASTIC DISEASES
Complete Mole
Partial Mole
Invasive Mole
Choriocarcinoma
Gestational trophoblastic neoplasia

Placental site trophoblastic tumor
Epithelioid trophoblastic tumor
SECTION THREE: COMPLICATIONS OF LABOR AND DELIVERY

Preterm Delivery (up to 36 weeks)
ABNORMALITIES OF FORCES OF LABOR
Failure of Cervical Dilatation (<1 cm/hr in active phase)

Arrested active phase of labor
(no progress during 2 hrs after initially normal progress)
Precipitate labor
(nulli=<1 hours from 3 cm to delivery; multi=<0.5 hr)
Hypertonic uterine contraction

Long labor
Prolonged first stage
(for nulli > 15 from 3 cm to fully dilated, for multi > 11 h)
Prolonged second stage
(> 2 h from full dilated to delivery)
064.9
065.4
065.9
066.0
066.5
067.9
067.0
068.1
068.9
069.0
069.4
Obstructed Labor
Due to malposition or malpresentation
Due to fetopelvic disproportion
Due to maternal pelvic abnormality
Due to shoulder dystocia
Failed forceps or vacuum extraction
Intrapartum hemorrhage
With coagulation defect
Meconium in amniotic fluid
Fetal Distress
Prolapsed Cord
Vasa previa
070.0
Perineal Laceration
Unspecified
First Degree
( involving fourchette, labia, skin, vagina, vulva)

070.1
070.2
070.3
071.0
071.1
071.2
071.3
071.7
Second Degree
(involving 1st plus pelvic floor, perineal muscle, vaginal muscle)
Third Degree
(involving 2nd plus anal sphincter, rectovaginal septum)
Fourth Degree
(involving 3rd plus anal mucosa , rectal mucosa)
Other Obstetric Trauma
Rupture of uterus before onset of labor
Rupture of uterus during labor
Uterine inversion
Laceration of Cervix
Pelvic, vaginal, or vulvar hematoma
Uterine Dehiscence
072.0
072.1
Postpartum Hemorrhage
Due to Uterine Atony
Due to Retained Placenta
Due to other causes
073.0
074.9
075.9
Retained placenta without hemorrhage

Anesthetic complications, postpartum hemorrhage
Other complications of Labor and Delivery, not elsewhere classified
SECTION FOUR: DELIVERY AND OTHER PROCEDURES

080.0
Spontaneous vertex delivery
080.1
Spontaneous breech delivery
080.9
Spontaneous delivery, unspecified
081.0
Low forceps delivery
081.1
Mid cavity forceps delivery
081.2
Mid cavity forceps delivery with rotation
081.3
Other and unspecified forceps delivery
Elective outlet forceps delivery
081.4
Vacuum extractor delivery
081.5
Combination forceps/vacuum extractor
VBAC
082.0
082.1
082.2
082.9
083.0
083.1
084.0
084.1
084.2
084.8
084.9
Caesarean Section
Elective
Low Segment
Classical
Emergency
Low Segment
Classical
Cesarean Hysterectomy
Unspecified
Breech extraction
Breech Assisting
Multiple delivery, all spontaneous
Multiple delivery, all by forceps and vacuum extractor
Multiple delivery, all by Caesarean section
Other multiple delivery
Multiple delivery, unspecified
Other Procedures
Completion Curettage
Suction Curettage
Induction by prostaglandins
Total hysterectomy
Subtotal hysterectomy
Removal of extra-peritoneal embryo
Others
Salpingectomy
Salpingo-Oophorectomy
Manual extraction of placenta
SECTION FIVE: COMPLICATIONS PREDOMINANTLY RELATED TO PUERPERIUM
085.X
Puerperal Sepsis
086.0
Wound Infection
087.1
Deep Phlebothrombosis
087.2
Hemorrhoids
088.1
Obstetric Air Embolism
090.0
Disruption of Caesarean Section Wound
090.1
Disruption of Perineal Obstetric Wound
090.2
Hematoma
Breast Infection
091.0
Nipple Infection
091.1
Breast abscess
SECTION SIX: OTHER MATERNAL DISEASES CLASSIFIABLE ELSEWHERE
BUT COMPLICATING PREGNANCY
099.0
Anemia
099.1
Disease of blood and immune mechanism
Leukemia
Megaloblastic Anemia
Anti-Phospolipid Antibody Syndrome
Other
Dengue
099.2
Endocrine, nutritional and metabolic diseases

Hyperthyroidism
Hypothyroidism
Nodular Nontoxic Goiter
Diffuse Nontoxic Goiter
Other
Diabetes (see above)
099.3
Mental Disorders and Diseases of the Nervous System

Seizure Disorders
Meningioma
Schizophrenia
Brief Reactive Psychosis
Drug Abuse and Dependency
Other
099.5
Diseases of the Respiratory System

Bronchial Asthma in Remission
Bronchial asthma in acute asthmatic attack
Pneumonia
Pulmonary Tuberculosis
Other
099.4
Diseases of the Circulatory System

Rheumatic heart disease (RHD), mitral stenosis
Rheumatic heart disease (RHD), mitral regurgitation
Rheumatic heart disease (RHD), mitral stenosis with regurgitation
Rheumatic heart disease (RHD), atrial stenosis
Rheumatic heart disease (RHD), atrial regurgitation
Rheumatic heart disease (RHD), others
Congenital Heart Disease, atrial septal defect
Congenital heart disease, ventricular septal defect
Congenital heart disease, patent ductus arteriosus
Congenital heart disease, others
Mitral valve prolapse
Coronary Artery Disease
Others
099.6
Diseases of the Digestive System

Acid Peptic Disease
Other
Surgical Condition
Acute Appendicitis
Acute Cholecystitis
Stab wound
Gun Shot Wound
Others
Gynecological Conditions
Uterine Myoma
Ovarian new growth (ONG), benign
Ovarian new growth (ONG), malignant
Other
Cervical Cancer
SECTION SEVEN: OTHER PROCEDURES

ANTENATAL PROCEDURES
(NUMBER OF PATIENTS, NOT NUMBER OF PROCEDURES)
Electronic Fetal Monitoring
Non-stress testing
Contraction stress testing
Biophysical Profile Scoring
Sonographic biometry
Chronic villi sampling
Amniocentesis
Intrapartal and post-partal procedures
Artificial Rupture of the Membranes
Internal Version
Failed/Trial forceps
Repair of cervical laceration
Reposition of inverted uterus
Evacuation of vulvar hematoma in Pregnancy
GICAL SOCIETY
CHARITY
PRIVATE
0
0
0
0
0
N/A
TOTAL
0
0
0
0
0
N/A
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
IMMATURE
PRETERM
0
0
TERM
0
0
POST-TERM
0
0
0
0
VAGINAL
ABDOMINAL
0
0
0
0
0
0
0
0
0
0
TOTAL
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
VAGINAL
ABDOMINAL
0
0
TOTAL
0
0
0
0
VAGINAL
ABDOMINAL
0
0
0
0
0
VAGINAL
TOTAL
0
0
0
0
0
ABDOMINAL
0
0
0
0
0
0
0
0
0
0
VAGINAL
TOTAL
ABDOMINAL
0
0
0
0
0
0
0
0
0
0
TOTAL
0
0
0
ABDOMINAL
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
VAGINAL
0
0
0
TOTAL
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
VAGINAL
0
0
0
ABDOMINAL
0
0
0
0
0
0
0
0
0
0
0
0
VAGINAL
0
0
0
TOTAL
0
0
0
0
0
0
0
0
0
0
0
0
ABDOMINAL
0
0
0
0
0
0
0
0
0
0
0
0
TOTAL
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
WITH METS
NO METS
0
0
0
0
0
0
0
TOTAL
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

version 0.12
Perinatal Report
PERINATAL STATISTICS BASED ON MANNER OF DELIVERY

Normal
CS
Forceps
Breech
Others
LIVEBIRTHS
-
STILLBIRTHS
-
NEONATAL DEATH
-
DELIVERIES
###
###
###
###
###
NEONATAL DEATH
-
DELIVERIES
###
###
###
###
###
###
###
###
NEONATAL DEATH
-
DELIVERIES
###
###
###
###
###
###
PERINATAL STATISTICS BASED ON BIRTH WEIGHT

500-999
1000-1499
1500-1999
2000-2499
2500-2999
3000-3499
3500-4000
>4000
LIVEBIRTHS
-
STILLBIRTHS
-
PERINATAL STATISTICS BASED ON AGE OF GESTATION

20-21
22-27
28-31
32-36
37-42
>42
LIVEBIRTHS
-
STILLBIRTHS
-
PERINATAL STATISTICS BASED ON FETAL CHARACTERISTICS

Uncomplicated
SGA
LGA
Lethal
LIVEBIRTHS
-
STILLBIRTHS
-
NEONATAL DEATH
-
DELIVERIES
###
###
###
###
GICAL SOCIETY
STILLBIRTH RATE
###
###
###
###
NEONATAL MORTALITY
-
PERINATAL MORTALITY
STILLBIRTH RATE
###
###
###
###
###
###
###
NEONATAL MORTALITY
-
PERINATAL MORTALITY
STILLBIRTH RATE
###
###
###
###
###
NEONATAL MORTALITY
-
PERINATAL MORTALITY
STILLBIRTH RATE
###
###
###
NEONATAL MORTALITY
-
PERINATAL MORTALITY
SURVIVAL RATE
-
SURVIVAL RATE
-
SURVIVAL RATE
-
SURVIVAL RATE
-
PHILIPPINE OBSTETRICAL AND GYNECOLOGICAL SOCIE

version 0.12
Gynecologic Diseases and Procedures Report
SECTIONS
ONE
TWO
THREE
FOUR
FIVE
SIX
SEVEN
EIGHT
CONTENTS
ADMISSIONS AND DISCHARGE DATA
SIGNS AND SYMPTOMS
INFLAMMATORY CONDITIONS
CONGENITAL ANOMALIES
BENIGN CONDITIONS
BENIGN NEOPLASMS
MALIGNANT NEOPLASMS
OPERATIONS
SECTION ONE: ADMISSIONS AND DICHARGE DATA

OPERATED PATIENTS
PATIENTS ADMITTED NOT OPERATED
OTHER PATIENTS
DISCHARGED ALIVE
DISCHARGED ALIVE BUT MORBID
MORTALITIES
TOTAL NUMBER OF GYNECOLOGIC ADMISSIONS
AGE RANGE OF PATIENTS

LESS THAN 20
20 to 34
35 to 50
51 and above
PARITY
0
1-5
MORE THAN 5
CHARITY
SECTION TWO: SIGNS AND SYMPTOMS

PATIENT CHARACTERISTICS AND COMPLAINTS UPON HOSPITAL ADMISSION (DO NOT INCLUDE OUT-PATIENT)
MENSTRUAL DISORDERS
626
Primary Amenorrhea
626.1
Secondary Amenorrhea
Menorrhagia
626.2
Polymenorrhea
Metrorrhagia
626.6
Meno-metrorrhagia
Intermenstrual Bleeding
MENOPAUSE
627.1
Post-Menopausal Bleeding
627
Atrophic/ Senile Vaginitis
628
INFERTILITY
Primary
628.0
628.1
628.2
628.3
628.9
Secondary
Ovarian
Pituitary-Hypothalamic
Tubal
Uterine/ Cervix
Male Factor
Unspecified
PELVIC SYMPTOMS
625.4
Premenstrual Tension Syndrome
SECTION THREE: INFLAMMATORY CONDITIONS

FOR ADMMITTED PATIENTS ONLY, EXCLUDES THOSE ASSOCIATED WITH PREGNANCY
DISEASES OF BARTHOLIN'S GLAND
N76
N75.0
Cyst of Bartholin's Gland
N75.1
Abscess of Bartholin's Gland
N75.8
Other Diseases of Bartholin's Gland
Bartholinitis
N75.9
Diseases of Bartholin's Gland, Unspecified
PELVIC INFLAMMATORY DISEASE
N73
Pelvic Inflamatory Diseases, Prob. Bacterial
Salpingo-Oophoritis
Endometritis
Parametritis
Pelvic Cellulitis
Pelvic Abscess
N74
Other Pelvic Inflammatory Disorders
N74.0
Cervical Tuberculosis (A18.1)
N74.1
Tuberculosis Pelvic Inflammatory Disease (A18.1)
Tuberculosis Endometritis
N74.2
Syphilitic Pelvic Inflammatory Disease (A51.4, A52.7)
N74.3
Gonococcal Pelvic Inflammatory Disease (A54.2)
N74.4
Chlamydial Pelvic Inflammatory Disease (A56.1)
N76
N76.5
N76.6
N77.1
N77.2
OTHER INFLAMMATION OF VAGINA AND VULVA

Ulceration of Vagina
Ulceration of Vulva, Bacterial
Ulceration of Vulva, Herpes
Ulceration of Vulva, Tuberculosis
Vulva Condyloma Acuminata
Vulvovaginitis, Non-bacterial
Vulvovaginitis, Herpes
Vulvovaginitis, Candidiasis
Vulvovaginitis, Foreign Body
SECTION FOUR: CONGENITAL ANOMALIES OF GENITAL ORGANS

ICD NO.
Absence/ Agenesis of the Ovary
Streak Ovary
Cyst of the Oophoron/ Fimbriae

Parovarian Cyst
Gartner's Duct Cyst
Doubling of Uterus
Bicornuate Uterus
Uterus Unicornis
Imperforate Hymen
Congenital Cyst of Canal of Nuck
Embryonal Cyst of the Vagina
Congenital Cyst of the Vulva
ANOMALIES OF VAGINA, CERVIX AND EXTERNAL FEMALE GENITALIA
Agenesis
Uterine Corpus
Cervix
Clitoris
Vagina
Vulva
SECTION FIVE: BENIGN CONDITIONS OF THE FEMALE GENITAL TRACT

ENDOMETRIOSIS
Uterus
Adenomyosis
Ovary
Fallopian tube
Pelvic peritoneum
Rectovaginal septum
Unspecified
Others
STAGE 1
STAGE 2
STAGE 3
UNSPECIFIED STAGE
GENITAL PROLAPSE
FIRST
Cystocoele alone
Rectocoele alone
Cysto-rectocoele
Urethrocoele
Enterocoele
Unspecified
Prolapse of vaginal vault after hysterectomy

Old laceration of muscle of pelvic floor
Others (specify)
Vulvar Hematoma
Relaxed vaginal vault
TOTAL
FISTULA
Female Genital Tract Fistula

specify types vaginal polyp
clitoral mass
SECTION SIX: BENIGN NEOPLASM OF THE GENITAL TRACT
UTERINE
M8890/0
Leiomyoma
N84.0
Endometrial Polyp
N85.0
Endometrial Hyperplasia, Unspecified
Cystic Hyperplasia
Complex Hyperplasia
N85.1
Adenomatous/ Atypical Hyperplasia
N85.4
Malposition of Uterus
N85.5
Uterine Inversion, Non-Obstetric
N85.6
Intrauterine synechiae
N85.7
Hematometra
CERVIX
N84.1
N86
N87
N87.0
N87.1
N87.2
N88.2
N88.3
N88.4
Chronic Cervicitis
Polyp of Cervix Uteri
Erosion and Ectropion of Cervix Uteri
Dysplasia of Cervix Uteri, Not Specified
Mild cervical dysplasia or CIN I
Moderate cervical dysplasia or CIN II
Severe Cervical Dysplasia, Not Elsewhere Classified (Cin lll,
Not Cis)
Stricture and Stenosis of Cervix Uteri
Incompetence of Cervix Uteri
Hypertrophic elongation of cervix uteri
SECTION SEVEN: MALIGNANT NEOPLASM OF GENITOURINARY ORGANS

OVARY
Serous Adenocarcinoma
Mucinous Adenocarcinoma
Endometrioid Adenocarcinoma
Other epithelial
Germ Cell Type
Other Type
Metastatic
CERVIX
UNILATERAL
STAGE I
Squamous Cell, Large Cell, NK
Squamous Cell, Large Cell, Keratinizing
Squamous Cell, Small Cell
Other squamous cell type
Adenocarcinoma
Other Type
FALLOPIAN TUBE
Adenocarcinoma, Specify
Other Type, Specify
ENDOMETRIOD
TUBAL CYST
CORPUS
Endometrial carcinoma
Other Endometrial neoplasm
Leiomyosarcoma
Other
MALIGNANCIES OF THE REST OF FEMALE GENITAL TRACT
Vagina
Greater Vestibular (Bartholin's Gland)
Vulva
Labia Majora
Labia Minora
Clitoris
Other
Site Unspecified
FALLOPIAN TUBE
Paratubal serous cyst
OVARY
EPITHELIAL
M8440/0
Cystadenoma Not Specified
M8441/0
Serous Cystadenoma
M8450/0
Papillary Cystadenoma
M8460/0
Papillary Serous Cystadenoma
M8470/0
Mucinous Cystadenoma
M8471/0
Papillary Mucinous Cystadenoma
M8480/0
Pseudomyxoma peritonei
Endometrial Cyst
GERM CELL TUMORS
M9080/0
Mature cystic teratoma
M9084/0
Dermoid Cyst
M9090/0
Struma Ovarii
OTHER BENIGN CONDITIONS
M8600/0
Fibro-Thecoma
M9000/0
Brenner Tumor
N83.0
Follicular Cyst of Ovary
N83.1
Corpus Luteum Cyst
N83.5
Torsion of Ovary/ Ovarian Pedicle
OTHER PELVIC ORGANS

VAGINA
N89.0
Mild vaginal dysplasia or VAIN I
UNILATERAL
N89.1
N89.2
N89.3
N89.4
N89.5
N89.7
N89.8
VULVA
N90.0
N90.1
N90.2
N90.3
N90.4
N90.5
N90.6
N90.7
N90.8
Moderate vaginal dysplasia or VAIN II

Severe vaginal dysplasia or VAIN III
Dysplasia of Vagina, Unspecified
Leukoplakia of Vagina
Stricture and Atresia of Vagina
Hematocolpos
Others
Mild vulvar dysplasia or VIN I

Moderate vulvar dysplasia or VIN II
Severe vulvar dysplasia or VIN III
Vulvar Dysplasia, Unspecified
Leukoplakia of Vulva
Atrophy of Vulva
Hypertrophy of vulva
Vulvar Cyst
Other Specified Noninflammatory Disorders of
Vulva and Perineum
SECTION EIGHT: OPERATIONS ON FEMALE GENITAL ORGANS

OPERATIONS ON THE UTERUS
Myomectomy
Subtotal Hysterectomy
Total Abdominal Hysterectomy
Vaginal Hysterectomy
Uterine Suspension
Fractional Curettage
Simple Curettage
Radical Abdominal Hysterectomy
Radical Vaginal Hysterectomy
Pelvic Exenteration
Diagnostic Curettage
TAHBSO
Endometrial biopsy
OPERATIONS ON OVARY
Oophorectomy
Salpingo-Oophorectomy
Ovarian cystectomy/oophoro-cystectomy
Partial Oophorectomy
Wedge Resection
Repair of the Ovary
Adhesiolysis of Ovary
OPERATIONS ON THE CERVIX
Cervical biopsy
Endocervical Curettage
Conization of the Cervix
Excision of Cervical Polyp
UNILATERAL
Amputation of Cervix
Cervicectomy
Encirclement Suture or Cerclage
Other Repair of Cervix
Late Repair of Obstetric Laceration
Repair of Non-Obstetric Laceration
LEEP
OPERATIONS ON FALLOPIAN TUBE
Salpingectomy
Salpingostomy
Fimbriectomy
Cornual Resection
Repair of Fallopian Tube
Insufflation
Tubal Ligation, Interval
Reanastomosis of ligated tubes
Endoscopic Destruction or Occlusion
By Culdoscopy
By Laparoscopy
Unspecified
UNILATERAL
OPERATIONS ON VAGINA
Culdocentesis
Incision of the Vagina
Colpotomy
Culdotomy
Hymenotomy
Hymenectomy
Obliteration and Total Excision of the Vagina
Colpectomy
Colpocleisis
Repair of Cystocoele
Repair of Rectocoele
Repair of Enterocoele
OPERATIONS ON VULVA AND PERINEUM

Incision of Vulva and Perineum
Drainage of Vulvar Abscess
Removal of Foreign Body from Vulva
Marsupialization of Bartholin's Gland
Excision of Bartholin's Gland
Radical Vulvectomy
Simple Vulvectomy
Perineorrhaphy
Other Operations on Female Genital Organs
OTHER OPERATIONS AND PROCEDURES

Partial Omentectomy
Peritoneal Biopsy
Peritoneal Fluid Sampling
Hartman's Procedure
Exploratory Laparotomy Alone
Bilaterial pelvic lymph node dissection
Bilateral Groin Node Dissection
Chemotherapy
Other operations
LAPAROSCOPIC PROCEDURES
Video Laparoscopic
Diagnostic
Operative
Hysterograms or hysterosalpingography
Hysteroscopy
Colposcopy
Others
COLOGICAL SOCIETY
PRIVATE
TOTAL
Aplasia
SECOND
COMPLETE
WITHOUT
###
###
###
###
###
###
###
BILATERAL
BORDERLINE
STAGE II
STAGE III
STAGE IV
###
###
###
###
###
###
BILATERAL
TOTAL
WITH
HYSTERECTOMY
BILATERAL
BILATERAL
TOTAL

version 0.12
Maternal Mortality Report
0%
0
0
MATERNAL MORTALITY RATE

AVERAGE AGE (years)
AVERAGE AOG (weeks)
CAUSE OF DEATH
I. DIRECT MATERNAL DEATHS
VALUE
-
A. HEMORRHAGE
1. Spontaneous abortion
2. Induced abortion
3. Retained secundiness
4. Ectopic pregnancy
5. Abruptio placenta
6. Placenta previa
7. Placenta accreta
8. Uterine rupture
9. Cervico-vaginal lacerations
10. Uterine inversion
11. Uterine atony
12. Postop from surgical procedure
13. Trophoblastic disease
14. Abdominal pregnancy
15. Coagulopathy
16. Other hemorrhage
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
B. HYPERTENSION
1. Preeclampsia
2. Eclampsia
3. Preexisting hypertension
4. Combination
5. HELLP syndrome
0%
0%
0%
0%
0%
0%
C. INFECTION
1. Induced abortion
2. Pelvic abscess
3. Puerperal infection
4. Chorioamnionitis
5. Adnexal infection
6. Pelvic thrombophlebitis
7. Septic embolism
0%
0%
0%
0%
0%
0%
0%
0%
D. VASCULAR ACCIDENTS
1. Amniotic fluid embolism
2. Puerperal nonseptic embolism
3. Air embolism
0%
0%
0%
0%
E. ANESTHESIA
0%
1. Neurogenic cardiac arrest

2. Post-aspiration asphyxia
3. Respiratory insufficiency
0%
0%
0%
F. OTHERS
1. Peri/postpartum cardiomyopathy
2. Transfusion hemolysis
3. Electrolyte imbalance
4. Pregnancy anemia
5. Others (specify)
0%
0%
0%
0%
0%
0%
A. CARDIAC
1. Rheumatic heart disease
2. Hypertensive heart disease
3. Congenital heart disease
4. Atherosclerotic heart disease
5. Undiagnosed
6. Other cardiac
0%
0%
0%
0%
0%
0%
0%
0%
B. VASCULAR
1. Preexisting hypertension
2. Vascular thrombosis/embolism
3. Thrombophlebitis
0%
0%
0%
0%
C. REPRODUCTIVE TRACT
1. Uterine anomalies
2. Uterine myoma
3. Ovarian cysts
4. Reproductive tract malignancy
5. Other reproductive tract
0%
0%
0%
0%
0%
0%
D. URINARY TRACT
1. Glomerulonephritis
2. Urinary tract infection
3. Hydronephrosis
4. Renal malignancy
5. Other urinary tract
0%
0%
0%
0%
0%
0%
E.
1.
2.
3.
4.
5.
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
II. INDIRECT MATERNAL DEATHS
HEPATIC
Infectious hepatitis
Liver cirrhosis
Hepatic abscess
Hepatic malignancy
Other hepatic
F. PULMONARY
1. Tuberculosis
2. Pneumonia
3. Bronchial asthma
4. Lung cancer
5. Malignancy, with lung metastasis
6. Other pulmonary
0%
G. METABOLIC
1. Diabetes mellitus
2. Thyroid storm
3. Adrenal dysfunction
4. Other metabolic
0%
0%
0%
0%
0%
H. HEMATOLOGIC
1. Leukemia
2. Aplastic anemia
3. Other hematologic
0%
0%
0%
0%
I. GASTROINTESTINAL
1. Acute gastroenteritis
2. Appendicitis
3. Gastrointestinal tract malignancy
4. Other gastrointestinal
0%
0%
0%
0%
0%
J. OTHER CAUSES
0%
A. ACCIDENTS
1. Stab wound
2. Gunshot wound
3. Vehicular accident
4. Accidental poisoning
0%
0%
0%
0%
0%
0%
B. SUICIDE/MURDER
1. Suicide
2. Murder
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
III. NONMATERNAL DEATHS
MORTALITY BASED ON
I. TIMING OF DEATH
A. TRIMESTER
1. First trimester
2. Second trimester
3. Third trimester
B. SPECIFIC
1.
2.
3.
4.
Antepartal
Intrapartal
Postpartal
Puerperal
II. IMMEDIATE CAUSE OF DEATH

A. Shock
B. Congestive heart failure
C. Respiratory failure
D. Hepatic failure
E. DIC
F. Intracranial bleeding
G. Multiorgan failure
H. Others (specify)
0%
0%
0%
0%
0%
0%
0%
0%
0%
III. ONSET OF COMPLICATIONS

A. TRIMESTER
1. First trimester
2. Second trimester
3. Third trimester
B. SPECIFIC
1.
2.
3.
4.
Antepartal
Intrapartal
Postpartal
Puerperal
NO. OF LIVE BIRTHS

NO. OF MATERNAL DEATHS
MATERNAL MORTALITY RATE
0%
OLOGICAL SOCIETY

version 0.12
Gestational Trophoblastic Disease Report
SECTIONS
ONE
TWO
THREE
FOUR
FIVE
CONTENTS
CASE BY DIAGNOSIS
HYDATIDIFORM MOLE
GESTATIONAL TROPHOBLASTIC TUMOR
PLACENTAL SITE TROPHOBLASTIC TUMOR
CROSS TABULATION OF VARIOUS CLINICAL CHARACTERISTICS OF GTT
SECTION ONE: CASE BY DIAGNOSIS
Hydatidiform Mole
Complete
Partial
No data
Gestational Trophoblastic Neoplasia
Invasive mole
Choriocarcinoma
Unspecified
No data
Placental Site Trophoblastic Tumor
Epithelioid Trophoblastic Tumor
TOTAL
SECTION TWO: HYDATIDIFORM MOLE

AGE GROUP
15-19
20-29
30-39
40-49
>= 50
No data
TOTAL
GRAVIDITY
01
25
6 10
11 16
No data
TOTAL
AOG AT DIAGNOSIS (in weeks)
<= 12 weeks
12-26 weeks
> 26 weeks
No data
TOTAL
COMPLICATIONS
Anemia
Hyperemesis gravidarum
Pre-eclampsia
Hyperthyroidism
Theca lutein cyst
Pulmonary embolism
Infectious
No data
TOTAL
HIGH RISK FACTOR
Age > 35 years
Uterus > AOG
Recurrent mole
Uterus >= 5 months AOG size
Precurettage hCG >= 100,000 mIU/mL
Theca lutein cyst >= 6cm
Others (specify)
No data
TOTAL
MODE OF EVACUATION
Suction curettage
Hysterectomy
D and C
Others (specify)
No data
TOTAL
USE OF CHEMOPROPHYLAXIS
No
Yes
No data
TOTAL
PROPHYLACTIC AGENT
Methotrexate (oral + parenteral)
Actinomycin D
No data
TOTAL
CONDITION ON DISCHARGE
No evidence of disease
Partial response
Progressive disease
Death
No data
TOTAL
PRESENT STATUS
OPD followup with no evidence of disease
Unknown/Lost to followup
Readmitted/Referred with evidence of malignant degeneration
No data
TOTAL
CAUSES OF DEATH
SECTION THREE: GESTATIONAL TROPHOBLASTIC NEOPLASIA

AGE GROUP
15-19
20-29
30-39
40-49
>= 50
No data
TOTAL
GRAVIDITY
01
25
6 10
11 16
No data
TOTAL
ANTECEDENT PREGNANCY
Term
Abortion
Ectopic pregnancy
Molar (complete + partial)
No data
TOTAL
BASELINE bHCG TITER (mIU/ML)
< 100
100 1,000
1,001 10,000
10,001 100,000
100,001 1,000,000
> 1,000,000
No data
TOTAL
WHO PROGNOSTIC SCORE
Low risk
High risk
No data
TOTAL
FIGO ANATOMIC STAGE
Stage I
Stage II
Stage III
Stage IV
No data
TOTAL
SURGICAL PROCEDURE
Curettage
TAH
Others (thoracotomy + craniotomy + others)
No data
TOTAL
CHEMOTHERAPY
Single agent (oral methotrexate + parenteral methotrexate + actinomycin D

MAC
EMACO (true + modified)
Others
No data
TOTAL
RADIOTHERAPY
Yes
No
No data
TOTAL
Partial response
Progressive disease
Death
No data
TOTAL
CAUSES OF DEATH
SECTION FOUR: PLACENTAL SITE TROPHOBLASTIC TUMOR

AGE GROUP
15-19
20-29
30-39
40-49
>= 50
No data
TOTAL
GRAVIDITY
01
25
6 10
11 16
No data
TOTAL
ANTECEDENT PREGNANCY
Term
Abortion
Ectopic pregnancy
Molar (complete + partial)
No data
TOTAL
BASELINE bHCG TITER (mIU/ML)
< 100
100 1,000
1,001 10,000
10,001 100,000
100,001 1,000,000
> 1,000,000
No data
TOTAL
Low risk
High risk
No data
TOTAL
FIGO ANATOMIC STAGE
Stage I
Stage II
Stage III
Stage IV
No data
TOTAL
SURGICAL PROCEDURE
Curettage
TAH
Others (thoracotomy + craniotomy + others)
No data
TOTAL
CHEMOTHERAPY
Single agent (oral methotrexate + parenteral methotrexate + actinomycin D

MAC
EMACO (true + modified)

Others
No data
TOTAL
RADIOTHERAPY
Yes
No
No data
TOTAL
Partial response
Progressive disease
Death
No data
TOTAL
SECTION FIVE: CROSS TABULATION OF VARIOUS CLINICAL CHARACTERISTICS OF GTN

FIGO ANATOMIC STAGE/CONDITION ON DISCHARGE
FIGO ANATOMIC STAGE

Stage I
Stage II
Stage III
Stage IV
No data
TOTAL
FIGO ANATOMIC STAGE/SURGICAL PROCEDURE
FIGO ANATOMIC STAGE

Stage I
Stage II
Stage III
Stage IV
No data
TOTAL
FIGO ANATOMIC STAGE/WHO PROGNOSTIC SCORE
FIGO ANATOMIC STAGE

Stage I
Stage II
Stage III
Stage IV
No data
TOTAL
WHO PROGNOSTIC SCORE/SURGICAL PROCEDURE

Low risk
High risk
No data
TOTAL
WHO PROGNOSTIC SCORE/CONDITION ON DISCHARGE

Low risk
High risk
No data
TOTAL
WHO PROGNOSTIC SCORE/CHEMOTHERAPY

Low risk
High risk
No data
TOTAL
DIAGNOSIS/CONDITION ON DISCHARGE
DIAGNOSIS
Invasive mole
Choriocarcinoma
Unspecified
No data
TOTAL
SECTION SIX: CROSS TABULATION OF VARIOUS CLINICAL CHARACTERISTICS OF PSTT

FIGO ANATOMIC STAGE/CONDITION ON DISCHARGE
FIGO ANATOMIC STAGE

Stage I
Stage II
Stage III
Stage IV
No data
TOTAL
FIGO ANATOMIC STAGE/SURGICAL PROCEDURE
FIGO ANATOMIC STAGE

Stage I
Stage II
Stage III
Stage IV
No data
TOTAL
FIGO ANATOMIC STAGE/WHO PROGNOSTIC SCORE
FIGO ANATOMIC STAGE

Stage I
Stage II
Stage III
Stage IV
No data
TOTAL
WHO PROGNOSTIC SCORE/SURGICAL PROCEDURE

Low risk
High risk
No data
TOTAL
WHO PROGNOSTIC SCORE/CONDITION ON DISCHARGE

Low risk
High risk
No data
TOTAL
WHO PROGNOSTIC SCORE/CHEMOTHERAPY

Low risk
High risk
No data
TOTAL
DIAGNOSIS/CONDITION ON DISCHARGE
DIAGNOSIS
Invasive mole
Choriocarcinoma
Unspecified
No data
TOTAL
GICAL SOCIETY
FREQUENCY
PERCENT
-
Partial response
0
0
0
0
0
0
Progressive
0
0
0
0
0
0
Dead
0
0
0
0
0
0
No data
0
0
0
0
0
0
TOTAL
0
0
0
0
0
0
SURGICAL PROCEDURE
Curettage
TAH
0
0
0
0
0
0
Others
0
0
0
0
0
0
No data
0
0
0
0
0
0
TOTAL
0
0
0
0
0
0
0
0
0
0
0
0

Low risk
High risk
0
0
0
0
0
0
No data
0
0
0
0
0
0
TOTAL
0
0
0
0
0
0
0
0
0
0
0
0
SURGICAL PROCEDURE
Curettage
TAH
Others
No data
TOTAL
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Partial response
0
0
0
0
Progressive
0
0
0
0
Dead
0
0
0
0
No data
0
0
0
0
TOTAL
0
0
0
0
0
0
0
0
CHEMOTHERAPY
Single
Triple
0
0
0
0
EMACO
0
0
0
0
Others
0
0
0
0
No data
0
0
0
0
TOTAL
0
0
0
0
0
0
0
0
Partial response
0
0
0
0
0
Progressive
0
0
0
0
0
Dead
0
0
0
0
0
No data
0
0
0
0
0
TOTAL
0
0
0
0
0
0
0
0
0
0
Partial response
0
0
0
0
0
0
Progressive
0
0
0
0
0
0
Dead
0
0
0
0
0
0
No data
0
0
0
0
0
0
TOTAL
0
0
0
0
0
0
SURGICAL PROCEDURE
Curettage
TAH
0
0
0
0
0
0
Others
0
0
0
0
0
0
No data
0
0
0
0
0
0
TOTAL
0
0
0
0
0
0

Low risk
High risk
0
0
0
No data
0
0
0
TOTAL
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
SURGICAL PROCEDURE
Curettage
TAH
0
0
0
0
Others
0
0
0
0
No data
0
0
0
0
TOTAL
0
0
0
0
0
0
0
0
Partial response
0
0
0
0
Progressive
0
0
0
0
Dead
0
0
0
0
No data
0
0
0
0
TOTAL
0
0
0
0
0
0
0
0
CHEMOTHERAPY
Single
Triple
0
0
0
0
EMACO
0
0
0
0
Others
0
0
0
0
No data
0
0
0
0
TOTAL
0
0
0
0
0
0
0
0
0
0
0
0
0
Partial response
Progressive
0
0
0
0
0
Dead
0
0
0
0
0
No data
0
0
0
0
0
TOTAL
0
0
0
0
0
0
0
0
0
0

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PHILIPPINE OBSTETRICAL AND GYNECOLOGICAL SOCIET

ic Disease Form STILL HAVE TO BE SUBMITTED.

PHILIPPINE OBSTETRICAL AND GYNECOLOGICAL SOCIET

Last Year of Pregnancy

VAGINAL DELIVERY - Only for the CURRENT pregnancy.

INFANT FETAL DATA

Pediatric Age (weeks)

Fetal Neonatal Condition

PHILIPPINE OBSTETRICAL AND GYNECOLOGICAL SOCIET

1 Other Benign Conditions of the Follicular cyst of ovar

For Malignancy For Genital

Laparotomy Other Ope

Laparotomy Other Ope

With hysterectomy Alive

Subtotal hyste Left

Without hysterect Alive

Without hysterect Alive

Without hysterect Alive

With hysterectomy Alive

PHILIPPINE OBSTETRICAL AND GYNECOLOGICAL SOCIET

ANTECEDENT AND UNDERLYING CAUSE

COMPLICATIONS AND DEATH

PHILIPPINE OBSTETRICAL AND GYNECOLOGICAL SOCIET

Last Year of Pregnancy

High Risk Factor

Baseline hCG levels (mIU/mL)

FIGO Anatomic Stage

Modified WHO Score

Combined FIGO-WHO Score

Combined FIGO-WHO Score

Interval Months from Index Pregnancy

Pretreatment hCG (mIU/mL)

Largest Tumor Size (cm)

Number of Metastases Identified

Previous Failed Chemotherapy

PHILIPPINE OBSTETRICAL AND GYNECOLOGICAL SOCIET

SECTION ONE: ADMISSIONS DATA

AGE RANGE OF PATIENTS

SECTION TWO: OBSTETRIC AND MEDICAL COMPLICATION IN DELIVERED PATIENTS

Hemorhage in Early Pregnancy (< 22 weeks)

Hyperemesis gravidarum, severe

Genital Tract Infection

Diabetes mellitus Insulin dependent

Diabetes mellitus non-Insulin dependent

Malnutrition (BMI less than 19.8)

Multiple gestation with malpresentation for one or more fetus

Disproportion (known or suspected)

Previous Caesarian Section

Post Term >= 42 weeks

Gestational trophoblastic neoplasia

SECTION THREE: COMPLICATIONS OF LABOR AND DELIVERY

Failure of Cervical Dilatation (<1 cm/hr in active phase)

Hypertonic uterine contraction

( involving fourchette, labia, skin, vagina, vulva)

Retained placenta without hemorrhage

SECTION FOUR: DELIVERY AND OTHER PROCEDURES

Endocrine, nutritional and metabolic diseases

Mental Disorders and Diseases of the Nervous System

Diseases of the Respiratory System

Diseases of the Circulatory System

Diseases of the Digestive System

SECTION SEVEN: OTHER PROCEDURES

PHILIPPINE OBSTETRICAL AND GYNECOLOGICAL SOCIET