Prenatal Record - National Archives and Records Administration

C.JL.. •1.•10'JJ.. 9
1•59
EXAMINED I!Y
!DATE (Mo.O•·Y•J
1. TEMP. :2. PULSE 13. I!LOOO PRESSURE
"F I /MIN i I
~. NON-PREGNANT wEIGHT :s. PRES. weIGHT I'· HEIGHT
I"ILVIC EXAMINATION
7. EXTERNAL GENITALIA II. BLEEDING
_: .....__, Nor-1
:.None
-Present
=Vulvar Var~c••t•e•
C From Utetua
= Othe. =p,..,. Cervix w Vagi no.
-Not Eva luoted
=Other (Rectal, etc.)
8. INTROITUS -Nat Evaluatecl
~Normal
12. CERVIX
Abnormal
=N--1
= Urethrocele, Cystocele
Abnormal
,..._Rectocele
=Chronic Cyatic C.rvicitia
=Old Perineal Lae~ration
I:Eraaion
=other
._ - Not Evajuated
CE..nion
=Polyp
9. V"GIN" :J Old Loc:erati on
- Normal =Ott...
"bnornool
-:Nat Evol.,.tecl
=Abnormality present other than voginitia
13 • UTERUS
..._,Not Evaluated
:.Nar....l
10. VAGINITIS -Abnormal
=None =,..,­
Preaent
:-" Contenitol Anomaly
..- Trtchomonaa ::Other
.....,Nat Evoluatod
=Monilia
1 •• ADNEXA
=Non.Spectfic
....... N....-1
=Other
-Abn•-•
=Not e ...........
IVAI.UATION OP PI!LVIS
.......,,__..
~Excessive Tenderneaa
-Other
-.-Not e ...........
15. DIAGONAL CONJUGATE 16. SACRUM 17. SPINES 18. ARCH
=Not R..ched ~Nar-•c- =Not Pr anti rwnt
1""1Normal
=:Reached at--- CMS. :Flat C P"omineftt A Wide
i=A...........
?1 Norrow
19. Si·lachiol 120. Posterior So9ittol 21. ..._criatol 22. SIDEWALLS SACROSCIATIC NOTCH
23. "SYMMETRY r~· OTHER PELVIC ABNORMAUTY =c-..90"'
=None
.....,N_
- PreHnt ;:::::; Pre..nt
SUMMATION
-- ....~-
~Di..rgent
=Average
C:Wide
::Narrow
26. X·RAY PELVIMETRY !If Dort•)
25. INLET !28. MIDPELVIS 29. OUTLI!T Marpheloty fTyp•)
=:Adequate =Adequate OB c.,ju90,.: CMS.
!
::c--.."·
lm.tapinoua: CMS.
=Contractod =Controctecl Tr--roe Inlet: CMS.
27. LIST BY BOX NUMBER AND DESCRIBE ANY ABNORMAL FINDINGS NOTED PRESENT ABOVE.
COL..L.A80AAT1VIt AIISEA .. CH (08-9) P"GE 3 OF ~
_.II: lit IN A TAL. AlES IE AflltCH ... ANCH, NINO •• NIM
SIE THilSDA 14, ~Oa
II.A.l56
OB-9
Reproduced at the National Archives