Pregnancy registration Date cannot be in the past. Date cannot be more than one month from today. I don't know Enter date If has a specific upcoming ANC appointment date, enter it here. You will receive a task three days before to remind her to attend. is ** weeks** pregnant. Please refer to the health facility at the appropriate time. The WHO recommends ANC visits at 12, 20, 26, 30, 34, 36, 38, 40 weeks. ANC Visits at Health Facility (Scheduled) You entered that has attended ANC visits at the health facility. You entered that has attended 1 ANC visit at the health facility. I don't know Enter date Please enter the date if you know it. Enter the correct date. Date must be within this pregnancy and cannot be in the future. Date Enter the correct date. Date must be within this pregnancy and cannot be in the future. Date I don't know Enter date Visit Please enter the dates if you have them. Each "Visit" section below asks about one individual visit. Please complete all sections. Enter 0 if she has not been yet. Must be an integer between 0 and 9. How many times has been to the health facility for ANC? ANC Visits at Health Facility (Past) No Yes Breaking of water No Yes Breathlessness Great news! Please closely monitor her until her next scheduled pregnancy visit. Ask to monitor these danger signs throughout the pregnancy. Does currently have any of these danger signs? No Yes Getting tired easily No Yes Swelling of face and hands No Yes Fever No Yes Fits No Yes Reduced or no fetal movements Please refer to the health facility immediately. Accompany her if possible. Please complete the follow-up task within 3 days. No Yes Severe abdominal pain No Yes Severe headache No Yes Vaginal bleeding No Yes Very pale Danger Sign Check Months Weeks Select one. Would you like to report the pregnancy in weeks or months? Must be between 1 and 9. Months Must be between 4 and 40. Weeks Date cannot be in the past. Date cannot be more than 9 months in the future. Please enter the expected date of delivery. Start date cannot be less than 1 month ago. Start date cannot be more than 9 months in the future. Please enter the start date of the LMP. If this seems incorrect, click "< Prev" and update the pregnancy information. The estimated date of delivery is: **** You entered ** months** pregnant. You entered ** weeks** pregnant. You entered an LMP of: **** is currently weeks pregnant. You entered the EDD: **** You selected "No information is known." The woman is not on any family planning methods and has missed her periods. You performed a pregnancy test and it is positive but the woman does not know the age of the pregnancy or LMP. The woman is visibly pregnant but does not know for how long. Select one. Why do you want to register ? Refer to the health facility to confirm. You will receive tasks every two weeks to check in on the pregnancy. Schedule will follow WHO recommendations once LMP or EDD is entered. Current weeks or months pregnant Expected date of delivery (EDD) Last menstrual period (LMP) No information is known Select one. How would you like to report the pregnancy? Registering a pregnancy will help you to provide timely guidance and support to the pregnant woman. Gestational Age What is the patient's name? Date of Birth Name CHW name CHW phone Contact Parent Parent Patient ID Sex Short Name Contact Source Source ID Patient No Yes Is this 's first pregnancy? No Yes Has had any miscarriages or stillbirths? max characters = 100 If yes, please describe. No Yes Are there additional factors that could make this pregnancy high-risk? Asthma Diabetes Heart condition High blood pressure None of the above Select all that apply. If "None of the above" selected, cannot select any other option. Does have any of these risk factors? Asthma Diabetes Heart condition High blood pressure Last baby born less than one year ago Has delivered four or more children None of the above Previous difficulties in childbirth Select all that apply. If "None of the above" selected, cannot select any other option. Does have any of these risk factors? Risk Factors No Yes Has received deworming medication? Worms can affect the nutritional status of and baby. Frequent testing ensures that receives medicine to prevent transmission of HIV to the baby. No Yes Has been tested for HIV in the past 3 months? No Yes Is taking iron folate daily? Iron folate aids in the development of child's brain and spinal cord. It also prevents premature birth, sepsis, anemia and low birth weight. Sleeping under a LLIN **EVERY night** prevents malaria. No Yes Does use a long-lasting insecticidal net (LLIN)? Get malaria prophylaxis in second trimester if living in malaria endemic area. It's safest to deliver in a health facility. Discuss a birth plan with . Eat more often than usual and a balanced diet to give you strength and help the baby grow. Respond to the baby's movements-kicks by gentle touching or massaging your tummy. Talk softly to the unborn baby. The baby can hear you and will be able to recognize voices. No Yes Has received any Tetanus Toxoid (TT) immunizations during this pregnancy? Immunizing with at least two doses of tetanus toxoid before or during pregnancy protects the newborn for the first few weeks of life and protects the mother. Women can receive up to two TT vaccines per pregnancy. After five TT vaccines, they are vaccinated for life. Safe Pregnancy Practices Follow-up Tasks the woman The woman Breaking of water Breathlessness Getting tired easily Swelling of face and hands Fever Fits Reduced or no fetal movements Severe abdominal pain Severe headache Vaginal bleeding Very pale Danger Signs The following tasks will appear: Please conduct a danger sign follow-up in 3 days. Make sure attends her clinic visit on . Please remind her three days before. Please conduct the next pregnancy home visit in week(s). Please conduct the next pregnancy home visit in 2 weeks. <h2 style="text-align:center;margin-bottom:0px;"></h2> years old weeks pregnant. EDD: Unknown weeks pregnant. Refer to clinic immediately for: Danger Sign Please refer to the health facility at the appropriate time. Please refer to the health facility immediately to receive the EDD and appropriate care. Referrals Deworming HIV test Iron folate TT Request the following services: Asthma Diabetes Risk Factors First pregnancy Heart condition High blood pressure Last baby born less than one year ago Has delivered four or more children Previous difficulties in childbirth Previous miscarriages or stillbirths Please attend ANC on: <h4 style="text-align:center;">Click the Submit button at the bottom of the form.</h4> Summary Patient The WHO recommends routine ANC visits at 12, 20, 26, 30, 34, 36, 38, 40 weeks. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - yes - yes - yes - - yes - - yes - - - - - - - - - - - - - - - - - - - - - - yes - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ../active_pregnancy = 'false' - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - user <_id/> 0

method_lmp method_approx method_edd method_none approx_weeks approx_months visibly_pregnant test_positive missed_periods no yes no yes no yes yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no woman woman-start