Making Every Baby Count
9789241511223-eng
9789241511223-eng
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. antepartum complications<br />
Annex 2: Births and Deaths<br />
Summary Form<br />
(and guidance for completion)<br />
Annex 2a: Births and Deaths Summary Form<br />
Annex 2A<br />
Section 1: Identification<br />
1.1 Data collected at (facility name):<br />
1.2 Data for the month of:<br />
1.3 District name:<br />
1.4 Births Total births<br />
(incl deaths)<br />
< 1000 g<br />
1000–1499 g<br />
1500–1999 g<br />
2000–2499 g<br />
2500 g+<br />
Stillbirths (SB)<br />
Neonatal deaths<br />
Antepartum SB Intrapartum SB Unknown SB Early Late<br />
1.5 Multiple pregnancies babies from pregnancies<br />
1.6 Born before arrival total<br />
1.7 Mode of delivery<br />
CVD vacuum forceps caesarean unknown<br />
1.8 Gestational age<br />
term post-term ext preterm very preterm mod preterm unknown<br />
1.9 HIV status<br />
negative positive unknown<br />
1.10 Syphilis serology<br />
negative positive unknown<br />
1.11 Maternal age<br />
20–34 y > 34 y 18–19 y < 18y unknown<br />
Section 2: Cause of death<br />
2.1a Cause of death: antepartum stillbirths M1 M2 M3 M4 M5 other unknown<br />
82 MAKING EVERY BABY COUNT: a. AUDIT congenital AND REVIEW OF STILLBIRTHS AND NEONATAL DEATHS