CONDUCTED CASE No.

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Hospital: LR: Ward No: Reg.No.Mother :

Unit: BedNo: Reg.No. Baby

Name: W/O Age: Religion:

Address:

Date and Time of Admission: Date and Time of Discharge:

I. ADMISSION NOTES
 Previous Labour History: G P A L

Nature of Nature of Sex of the

S.No Year Nature of Labour Remarks
Pregnancy Puerperium Child

a. Has been ……………………………………..hours in labour.

b. Membrane: Entire/ Ruptured …………………………. hours ago.
 Condition on Admission:
a. General condition:

Temp……………Pulse…………Respiration…………B.P…………………….Hydration……………
Anaemia………………Oedema……………… Heart…………………..Lung……………………….
b. By Palpation:

Height of Uterus in cms. ……………………………Height of Uterus in Weeks……………………….

Abdominal Girth …………………..………………..Condition of Uterus ……………………………...
Position of Foetus…………………………………..Presentation of Foetus ……………………………
Relative Position of Head to Pelvis ………………Foetal Heart Sound…………………………………
c. First Vaginal Examination:

Date Time Finding Advices

 d. Investigation or Special Observation:

Blood
Urine
Hb Grouping Blood Sugar Bowel Bladder Any other
Albumin Sugar
& Rh Type

II. ADMISSION HISTORY:

Date & Time Admission complaints:

Personal History:

Medical History:

Surgical History:

Family History:

Obstetrical History:

Menstrual History:

L.M.P. …………………………… EDD ……………………………………

 III. PROGRESS NOTES DURING FIRST AND SECOND STAGE OF LABOUR:

Interval & Dilatation & Station of

Date & Any drugs/
Duration of Membrane F.H.S. Effacement of Presenting Pelvis
Time Treatment
Pains Cervix Part

 Advices during 1st Stage of

labour: …………………………………………...................................................................
...............……………………………………………………………………………………
………..……………………………………………………………………………………
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 Advices during 2nd Stage of
labour: ……………………………………………………………………………………
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 Date & Time of Onset of Labour Pains: …...…………………………………………………..

 Date & Time of full Dilaiation of OS: .………………………………………………………….
 Date & Time of Birth of the Child: .……………………………………………………………..
 Date & Time of Placental Expulsion: ……………………………………………………………

 Total Hours:

1st Stage ……………………………

2nd Stage …………………………..

3rd Stage …………………………. Total hrs…………………………

 IV. DELIVERY
NOTES: …………………………………………………………………………………………......
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V. POST DELIVERY ASSESSMENT & CARE OF MOTHER & NEW BORN:

Day & MOTHER BABY

Date
Nursing Assessment & Care: Nursing Assessment & Care:

Advices: Advices:

Treatment:
Treatment:

 Condition of Mother on Transfer: ………..……………………………………………

…………………………………………………………………………………………….
 Condition of Baby on Transfer: …………………………………………………………
………………………………………………………………………………………………

Signature of the Teacher