ANNEXURE-I Women Death First Information ... - Nrhmharyana.org

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If no, reason: Lack of awareness □ Lack of accessibility □ Lack of funds□Lack of attendee□ family problems □If Yes, Type of Care Provider (mark all):College/Tertiary Hosp□S/C ANM □ M/O PHC□ M/O CHC □ Specialist SDH □ Specialist D/H □ SpecialistPrivate Hosp □ (Please Specify Type of Doctor/Nurse)If yes, was she told she has risk factors? Yes□ No □ Don’t know □Type ofComplicationPrevious C/SectionAbnormalPresentation/lieAnaemiaGlycosuriaHypertension withProteinuriaHypertensionTwins etcAPHEctopic/pain inabdomenOther ( Pleasespecify)Yes No Don’t know Other
Comments on antenatal care - List any medication5. DELIVERY, PUERPERIUM AND NEONATAL INFORMATIONDid she have labor pains? Yes□ No □ Don’t know □If Yes, was a partograph used? Yes□ No □ Don’t know □In which phase of labor did she die?LatentphaseActivephaseSecondstageThirdstage> 24 hrsafterbirthDuration of labour: □□hrs □□mins
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Page 17 and 18: ANNEXURE IIIName of the BlockPHC/Di
Page 19: ADMISSION AT INSTITUTION WHERE DEAT
Page 24 and 25: Other Contributory (or antecedent)
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Page 32: ANNEXURE-VISr.No.(To be filled by t

ANNEXURE-I Women Death First Information ... - Nrhmharyana.org

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