Obstetric History

This form captures information about the patient’s obstetric history. Please add a new row for each pregnancy that a patient has had. Include information about the pregnancy date, duration, outcome, medications taken during pregnancy, and other relevant comments.

If the exact pregnancy date is unavailable, use July 1 with the approximate year of diagnosis. If an exact year is not available, an approximation is acceptable. If any approximations are used, please make a note in the comments section of the corresponding row.

Once the date is entered, please click on the calculator to calculate the days from the INDEX diagnosis date.