OBSTETRICS AUDIT FORM - HKCOG 2019 Ovarian cyst Abnormal and/or persistent ovarian cyst during with or without surgery in the antenatal EXPLANATORY NOTES ON DATA ENTRY period Patient Identification Fibroids Presence of uterine fibroids during pregnancy Name Anaemia Hb level <10g/dl at any time of gestation I.D. No (thalassaemia without anaemia is EXCLUDED) Date of Delivery dd/mm/yy Renal disease Disease of the urinary tract during pregnancy Age Number with 2 digits in completed years either Resident Status Resident / Non-Resident a. with symptoms or Chinese Ethnic Yes / No b. with impaired renal function or c. requiring treatment d. asymptomatic bacteriuria is EXCLUDED Antenatal, Medical / Surgical Complications Liver disease Liver diseases during pregnancy with impaired liver function Cardiac disease 1. No disease Respiratory Only those requiring treatment during pregnancy 2. Rheumatic valvular disease disease or with impaired respiratory function 3. Congenital heart disease Upper respiratory tract infection is EXCLUDED 4. Mitral valve prolapse Gastrointestinal Include only those requiring hospitalization and 5. Arrhythmia requiring treatment or regular biliary disease treatment cardiac treatment Epilepsy Only those requiring treatment during pregnancy 6. Others Psychiatric Only those requiring treatment during pregnancy Diabetes mellitus 1. No disease disease 2. Pre-existing DM – known DM before the Immunological Only those requiring treatment during pregnancy indexed pregnancy disregarding treatment disease was instituted or not Thyroid disease Only those requiring treatment during pregnancy 3. Gestational DM – DM diagnosed during Surgical disease Major surgical conditions / laparotomy or major pregnancy or postpartum by an OGTT operations that require general anaesthesia during pregnancy or puerperium (except PPS) Obstetric History & Complications Classification : 4. Gestational proteinuria (proteinuria >=300 mg/24 hours; Parity Including liveborns and stillbirths after 24 weeks or or 2 MSU / CSU collected >=4 over 500gm hours apart with 1 g/L; or 2+ or IVF Pregnancy Pregnancy from IVF procedure more on reagent strips Previous CS Including lower segment and classical Caesarean 5. Gestational proteinuric section hypertension Other Uterine Including open or laparoscopic myomectomy / 6. Chronic hypertension with scar hysterotomy / plastic operation / perforation of proteinuria uterus requiring repair 7. Chronic hypertension with Hypertension / Severity : 1. No superimposed preeclampsia – eclampsia 2. Mild-DBP < 110mmHg AND no proteinuria developing for the proteinuria first time during pregnancy 3. Severe-DBP >= 110 mmHg AND 8. Unclassified – BP unknown / OR proteinuria before 20 weeks Classification : 1. Irrelevant Antepartum Bleeding per vaginum from the 24th week to the 2. Eclampsia haemorrhage time of delivery 3. Gestational hypertension 1. No - BP normal before 20 weeks 2. APH of unknown origin – including those with and no previous history of “show” but not going into labour within 72 hours hypertension 3. Placenta praevia with bleeding - DBP >=110mmHg on any 1 4. Accidental haemorrhage – including those with occasion or >=90mmHg on 2 no revealed bleeding or more occasions at 4 hours 5. Other causes apart Placenta Including those with or without bleeding praevia ECV Performance of external cephalic version Threatened Diagnosed or suspected to have labour before 37 (I) DM / GDM preterm labour weeks of gestation which does not proceed to (II) Maternal medical / surgical condition delivery either spontaneously or after tocolytic 2. Bad obstetric history therapy 3. Antenatal / obstetric complications Use of Use of tocolytic agent(s) to suppress preterm labour (I) Prolonged pregnancy tocolytics (II) Hypertensive disease Use of steroid Use of antenatal steroid to enhance fetal (III) PROM / intrauterine infection maturity (IV) Antepartum haemorrhage Down's Down's screening in first timester (OSCAR) or (V) Multiple pregnancy screening second trimester (Biochemical) or combined 4. Fetal and cord conditions (I) Suspected IUGR / IUGR Fetal DNA Non-invasive fetal DNA testing for trisomy (II) Intrauterine death screening (III) Severe fetal abnormality Fetal reduction Fetal reduction for high multiple pregnancy (IV) Suboptimal antepartum 5. Others Augmentation of The use of synthetic oxytocin to accelerate labour Information About Labour labour process after it is already begun and that its quality Onset of labour Definition - a retrospective diagnosis of progress is unsatisfactory – use of amniotomy is - regular contractions with cervix at least NOT counted as augmentation 3cm dilated or there is progressive Duration of Summation of first stage and second stage (if any) cervical effacement or dilatation over 4 labour of labour to the closest number of hours. Enter 1 if hours duration <1 hour Induction of An obstetric procedure designed to pre-empt the labour natural process of labour by initiating its onset artificially before this occurs spontaneously Indications : 1. Maternal diseases / conditions Postnatal Complications 4. 4th degree tear - where the anal canal is opened, and the tear may spread to the rectum PPH Blood loss of > 500 ml following Uterine rupture / Includes dehiscence of previous scar with no PPH (choose at or > 1000 ml following Caesarean delivery scar dehiscence most 3) Causes Include those performed up to 6 weeks postpartum 1. Uterine atony Puerperal Temperature >38 degree C within 14 days of 2. Retained POG pyrexia delivery 3. Injuries to genital tract Maternal An acute event involving the cardiorespiratory - ruptured uterus collapse systems and/or brain, resulting in a reduced or - cervical tear absent conscious level (and potentially death), at - vaginal tear any stage in pregnancy and up to six weeks after - perineal wound delivery. 4. Genital haematoma Maternal death The death of a woman while pregnant or within 42 5. Uterine inversion days of termination of pregnancy, irrespective of 6. DIC the duration and site of the pregnancy, from any 7. Placenta praevia/accreta/percreta cause related to or aggravated by the pregnancy or 8. Others its management but not from accidental or Amniotic fluid Status of the amniotic fluid during labour incidental causes. 1. Clear 2 Meconium stained 3. Blood stained Information About Delivery 4. No liquor seen Perineal tear 1. 1st degree tear - where the fourchette and Mode of delivery 1. Spontaneous vertex delivery vaginal mucosa are damaged and the 2. Ventouse extraction underlying muscles are exposed, but not torn 2. 2nd degree tear - the posterior vaginal walls 3. Forceps delivery and perineal muscles, but the anal sphincter is 4. Breech delivery intact. 5. Lower segment 3. 3rd degree tear - extend to the anal sphincter 6. Classical Caesarean section that is torn, but the rectal mucosa is intact 7. Unknown Second stage Caesarean section performed at second stage of section - maternal disorders CS labour (maximum 3 2. Past obstetrical history BBA Birth before arrival indications) - previous sections / uterine scar Presentation / 1. Vertex - bad obstetrical history lie at delivery 2. Breech 3. Antenatal / obstetric complications 3. Brow - antepartum haemorrhage 4. Face - hypertensive disorders 5. Oblique lie - multiple pregnancy 6. Transverse lie 4. Fetal and cord conditions 7. Compound presentation - fetal distress 8. Others - cord prolapse / presentation Indications for 2. Maternal diseases / conditions - suspected IUGR / IUGR instrumental - maternal disease complicating pregnancy - suspected macrosomia delivery - maternal distress 5. Labour and delivery problems (maximum 3 3. Past obstetrical history - abnormal lie / presentation indications) - previous Caesarean section - failure to progress 4. Antenatal / obstetric complications e.g. - cephalopelvic disproportion hypertension - contracted / unfavourable pelvis 5. Fetal and cord conditions - failed instrumental delivery - fetal distress (except cord prolapse) - tumour / congenital anomaly of genital - cord prolapse / presentation tract 6. Labour and delivery problems - failed induction – cervix fails to reach 3cm - prolonged second stage 6. Others - after-coming head of breech is - elderly mother / infertility EXCLUDED - social reason 7. Others - others Indications for 1. Maternal disease / conditions Caesarean - GDM / DM Information About the Baby 8. Unexplained 9. Uninvestigated Gestation In completed weeks according to best estimate Birth weight Weight in grams Contributory 1. Congenial anomaly Apgar score Range 0 – 10, or unknown factor to NND 2. Haemolytic disease of newborn Fetal outcome 1. Alive and no neonatal death 3. Intrauterine hypoxia / birth asphyxia 2. Stillbirth ( born without sign of life at or 4. Birth trauma after 24 weeks of gestation, or with birth weight 5. Respiratory distress / conditions over 500 gm when gestation is uncertain) 6. Intracranial haemorrhage - antepartum 7. Infection - intrapartum 8. Miscellaneous - undetermined – mother is already in labour 9. Unclassifiable on admission and fetal heart not detected Congenital Only include those significant ones detected before (evidence of fetal viability is accepted only if anomalies discharge obtained by a medical / midwifery staff) Birth trauma 1. Cephalhaematoma 3. Neonatal death (choose at most 2. Soft tissue trauma e.g. laceration - early (up to 6 days 23 hours 59 minutes) 3) 3. Subaponeurotic haemorrhage - later (form 7 days to 27 days 23 hours 59 4. Intracranial haemorrhage minutes) 5. Fractures 4. Abortion - for multiple pregnancy with IUD 6. Nerve injuries Cause of Choose only one of the following 7. Visceral injuries stillbirth / NND 1. Congenital anomaly Major infections 1. Meningitis 2. Isoimmunisation 2. Pneumonia 3. Pregnancy-induced hypertension 3. Septicaemia 4. Antepartum haemorrhage 4. Other major infections 5. Mechanical RDS Respiratory distress syndrome 6. Maternal disorder IVH Intraventricular haemorrhage 7. Others NEC Necrotising enterocolitis