Prenatal Record - National Archives and Records Administration

PRENATAL RECORD (Con't)
REPRODUCTIVE HISTORY (Con't)
PAGE 2
Item #11. "Immature" (Con 't)
more infants (alive or dead) at 21 to 28 weeks gestation.
Item #12, "Premature"
List the number of pregnancies terminating in the delivery of one
or more infants (alive or dead) at 29 to .36 weeks gestation.
Item #13. "Full Term"
List the number of pregnancies terminating in the delivery of one or
more infants (alive or dead) at .37 weeks gestation or more.
Item #14. "Stillbirths"
List the total number of babies which were born dead at 29 weeks
gestation or more.
Item #15, "Multiple Pregnancies"
Each multiple pregnancy shall be counted as one, regardless of the
number of infants produced. (6ne set of twins would be considered a
single multiple pregnancy.)
Item #16. "Number of Living Children"
List the number of living children at the time this information is
obtained.
The previous pregnancies should be recorded in chronological order
beginning with the first pregnancy. A second page 1 of this ·form OB-9
must be used if there are more than five previous pregnancies. For
instructions regarding Items #17 through #27, refer to instructions to
interviewers, Reproductive History, OB-2, in the manual.
Par. 1
Par. 2
In the space labeled ''Name," record the pati,ent 's full name.
Record both the hospital and NINDE numbers in the spaces provided.
Par • .3
Par. 4
Reproduced at the National Archives
In the space labeled "This History Taken By," record your own name.
This must always be done, even though an addressograph has been used
and pages 1 and 3 are fully identified.
The first four items entitled "Summary of Acute Illness During the Past
Twelve Months," usummary of Blood Transfusion and Reactions, if Any,"
"Summary of Previous Hospitalization Other than Pregnancy," and "Summary
of Previous X-Ray Examinations or Treatment," may all be summarized from
the interviewers' records of "Recent Medical History," OB-5, and "Past
Medical History," OB-6, in those institutions which have an interviewer
completing this portion of th~ protocol. In summarizing this information
ou should rna e ce tain b di cussion with the atient that it is
February 195
(For Forms in Use April 1961
II.A.l88
OB-9