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Obstetrics Maternal Fetal Medicine Note

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TYPE OF PROCEDURE

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AMNIOCENTESIS

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Date

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Time Start

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Time End

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Indication

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Instruments Used (Needle)

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No Of Attempts

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Sample

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Transplacental

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Volume Obtained (Ml)

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Problems

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Investigations

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Comments

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Postoperative Evaluation

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Fetal Heart Activity

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AMNIOINFUSION

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Date

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Time Start

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Indication

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Instrument

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Insertion Site

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Method

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No Of Attempts

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Volume Infused (mls)

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Solution Infused

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Comments

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Postoperative Evaluation

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Fetal Heart Activity

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Findings

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AMNIOREDUCTION

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Date

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Time Start

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Time End

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Indication

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No Of Attempts

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Sample Quality

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Volume Drained (mls)

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Fetal Laboratory Test

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Comments

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Postoperative Evaluation

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Fetal Heart Activity

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CHORIONIC VILLOUS SAMPLING

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Date

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Time Start

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Indication

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Route

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Sample Obtained (mls)

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No Of Attempts

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Comments

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Postoperative Evaluation

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Fetal Heart Activity

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FETOSCOPIC LASER COAGULATION

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Date

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Time Start

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Time End

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Indication

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Anaesthesia

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Instruments Used

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Power Used

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Port Used

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Placenta

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Total number of Vascular Anastomosis

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Total number of Vascular Anastomosis

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Solomon Technique

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Difficulties Encountered

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Diagram Of Anastomosis

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Amnioinfusion Done

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Amnioreduction Post Procedure

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Other Procedures Done

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Postoperative Evaluation

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Fetal Heart Activity

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DVP

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Donor

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Recipient

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Comments

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FETAL BLOOD SAMPLING

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Date

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Time Start

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Time End

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Indication

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Instruments Used (Needle)

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Method

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Sampling Site

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Intrauterine Transfusion

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No Of Attempts

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Postoperative Evaluation

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Fetal Heart Activity

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Comments

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INTRAUTERINE TRANSFUSION

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Date

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Time Start

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Time End

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Indication

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No Of Attempts

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Findings

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OTHERS

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Date

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Time Start

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Time End

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Indication

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No Of Attempts

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Findings

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PERFORMING STAFF

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SIGNATURES

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