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Comprehensive Delivery Note Template

This delivery note documents essential information regarding a newborn's birth, including date and time of birth, sex, body weight, mode of delivery, and APGAR scores. It also includes maternal history, admission diagnosis, and antenatal conditions. The note serves as a comprehensive record for medical professionals involved in the care of both mother and child.

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criptomzack
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78 views3 pages

Comprehensive Delivery Note Template

This delivery note documents essential information regarding a newborn's birth, including date and time of birth, sex, body weight, mode of delivery, and APGAR scores. It also includes maternal history, admission diagnosis, and antenatal conditions. The note serves as a comprehensive record for medical professionals involved in the care of both mother and child.

Uploaded by

criptomzack
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

Delivery note

Date and Time of Birth - _____________________________________________

Sex - _____________________________________________

Body weight - _____________________________________________

Maturity by Date - _____________________________________________

Maturity by Scan - _____________________________________________

Mode of Delivery - _____________________________________________

Indication for MOD APGAR ( ) at 1 min, ( ) at 5 min & ( ) at 10 min.

Liquor-

Resuscitation Simple

Advanced - Bag & Mask resuscitation

- Chest compression
- ET tube intubation
- Medication

Birth Trauma - _____________________________________________

Heart rate - /min

Respiratory rate - /min

Respiratory distress -

Capillary Refill time -

Can suck well or not -

Heart - Lungs –

Abdomen - Umblicus & cord -

Genitalia/hernia/Anus -

Spine - Limbs –

Neurological examination - Moro’s reflex- Urine Output-

Final Diagnosis - _____________________________________________


Maternal History
Mother - ___________ RN -___________

Age - ___________ Gravida - ___________ Parity - ___________

Admission Diagnosis - _______________________________________________________

Infection status (BCR & VDRL) - ______________________

Mother Blood Group - ______________________

Past Obstetric history - ________________________________________________

Medical History - ______________________

Surgical History - ______________________

Drug History - ______________________

History of Present Illness

Antenatal condition PE ( ),PIH ( ),Placenta Previa ( ),Abruptio Placenta ( )

Maternal pyrexia ( ), Fetal distress ( )

Antenatal USG - ______________________

Antenatal Steroid - ______________________

Natal condition PROM>18hrs ( )

Meconium-stained liquor ( )

Foul smelling liquor ( )

Fetal Distress ( )

Post-natal condition PPH ( ), Retained placenta ( )

Antenatal treatment - ______________________


Delivery note
Accoucheur - ______________________

Assistant - ______________________

Diagnosis - ______________________

Type of Delivery - ______________________

Findings

,(Alive,Death), BWt - , Height - ,was delivered at

APGAR – ( ) , Liquor - , Placenta –

Episiotomy - , PPH - ,Tears-

Treatment

Name - Age - RN -

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