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العربية
Antenatal Pregnancy Record
IVF / Assisted Conception — Comprehensive monitoring record generator
Patient Demographics
Patient Name
Date of Birth
Civil ID
Blood Group
—
A+
A-
B+
B-
AB+
AB-
O+
O-
Rhesus Status
—
Positive
Negative
Height (cm)
Booking Weight (kg)
BMI
Allergies
Contact Number
Emergency Contact
⚠ Alerts & Key Information
Plurality
Singleton
Twin
Higher order
Chorionicity (if twins)
N/A
MCDA
MCMA
DCDA
Pre-eclampsia Prophylaxis
Aspirin 150 mg nocte from 12 wks
Calcium 1 g/day
Confirm started
Luteal — Progesterone
Luteal — Oestradiol
Wean Date
Other Medications
VTE Prophylaxis
Risk assessed
LMWH required
Dose
Key Risk Factors
Conception Details (IVF)
Transfer Date
Transfer Type
Fresh
FET
No. Embryos Transferred
Embryo Stage
Day 3
Day 5
Blast
EDD (from transfer)
GA at Booking
Donor Gametes
None
Oocyte
Sperm
Both
Consultant
PGT Performed
No
Yes
PGT Type
No. Embryos Frozen
Obstetric History
Gravida
Para
Miscarriage
Ectopic
TOP
Living
Previous Deliveries
Year
GA
Mode
Birth Wt
Sex
Complications
Outcome
—
SVD
CS elective
CS emergency
Instrumental
—
M
F
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Medical, Surgical & Mental Health History
Medical History
Surgical History
Family History (DM, HTN, PE, VTE, genetic)
PHQ-2 at Booking
GAD-2 at Booking
Mental Health Concerns
Generate Record
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