Avon Longitudinal Study of Parents and Children
ALSPAC Pregnancy, Birth and Infancy (pregnancy to 12 months)
Data from Neonatal, Antenatal & Obstetric Records
alspac_95_dq
DELIVERY QUESTIONNAIRE
To be completed from medical records.
Is there any conflicting information in this questionnaire?
please describe:
Is this a multiple birth?
twin triplet quadruplet
Was the baby admitted to SCBU?
please state which baby or babies were admitted to SCBU, eg., twin 1 / triplet 2 etc.
Was any information: illegible
please describe
Was any information: missing
please describe:
SECTION A: IDENTIFICATION
ANTENATAL MEASUREMENTS
SECTION B : SUMMARY OF THE PREGNANCY
Date of first day of her last menstrual period:
Was mother certain of this?
What was the final clinical estimate of expected date of delivery?
Please give mother's blood group: ABO:
Please give mother's blood group: Rhesus:
Please give mother's blood group: Rubella immune
Use codes on preceding page where appropriate.
Was hypertension/pre-eclampsia diagnosed at any time during the pregnancy?
what was the exact diagnosis? (words used)
what was the date of diagnosis?
what treatments were given?
Were any of the following noted during pregnancy before the onset of labour. Abnormal AFP
Were any of the following noted during pregnancy before the onset of labour. Amniocentesis*
give reason
Were any of the following noted during pregnancy before the onset of labour. Anaemia
Were any of the following noted during pregnancy before the onset of labour. Anti D
Were any of the following noted during pregnancy before the onset of labour. Biophysical profile (BPP)
Were any of the following noted during pregnancy before the onset of labour. Breech presentation
Were any of the following noted during pregnancy before the onset of labour. Blood sugars
Were any of the following noted during pregnancy before the onset of labour. Cervical cerclage (eg. Shirodkar's suture)
Were any of the following noted during pregnancy before the onset of labour. Chorionic villus sampling *
give reason
Were any of the following noted during pregnancy before the onset of labour. Creatinine
Were any of the following noted during pregnancy before the onset of labour. Diabetes
Were any of the following noted during pregnancy before the onset of labour. Eclamptic convulsions
Were any of the following noted during pregnancy before the onset of labour. Excessive vomiting (hyperemesis)
Were any of the following noted during pregnancy before the onset of labour. E.C.V. (external cephalic version)
Were any of the following noted during pregnancy before the onset of labour. Failed E.C.V
Were any of the following noted during pregnancy before the onset of labour. Genital herpes
Were any of the following noted during pregnancy before the onset of labour. Gonorrhoea
Were any of the following noted during pregnancy before the onset of labour. Hepatitis B
Were any of the following noted during pregnancy before the onset of labour. In-vitro fertilisation (IVF)
Were any of the following noted during pregnancy before the onset of labour. Ketones
Were any of the following noted during pregnancy before the onset of labour. Oligohydramnios
Were any of the following noted during pregnancy before the onset of labour. Other antibodies (specify* ...)
Were any of the following noted during pregnancy before the onset of labour. Placental abruption (detachment of the placenta)
Were any of the following noted during pregnancy before the onset of labour. Placenta praevia (covering or adjoining the internal OS)
Were any of the following noted during pregnancy before the onset of labour. Polyhydramnios/hydramnios
Were any of the following noted during pregnancy before the onset of labour. Random blood sugar
Were any of the following noted during pregnancy before the onset of labour. Rh antibodies
Were any of the following noted during pregnancy before the onset of labour. Suspected fetal growth retardation (I.U.G.R.)
Were any of the following noted during pregnancy before the onset of labour. Syphilis
Were any of the following noted during pregnancy before the onset of labour. Threatened abortion
Were any of the following noted during pregnancy before the onset of labour. Threatened pre-term labour
Were any of the following noted during pregnancy before the onset of labour. Transverse lie
Were any of the following noted during pregnancy before the onset of labour. Unstable lie
Were any of the following noted during pregnancy before the onset of labour. Urinary Tract Infection
Were any of the following noted during pregnancy before the onset of labour. Urea & electrolytes
Were any of the following noted during pregnancy before the onset of labour. Vaginal bleeding in 1st trimester (up to 13 weeks and 6 days)
Were any of the following noted during pregnancy before the onset of labour. Vaginal bleeding in 2nd trimester (14 weeks to 27 weeks and 6 days)
Were any of the following noted during the pregnancy before the onset of labour. Vaginal bleeding in 3rd trimester. (28 weeks to term)
Were any of the following noted during the pregnancy before the onset of labour. Vaginal discharge/infection
Were any of the following noted during the pregnancy before the onset of labour.
Please list all other complications arising during the pregnancy: (eg. influenza, migraines, cramps etc)
Please list all current chronic diseases/disorders noted in the clinical records. (eg. epilepsy, mental illness, alcoholism, diabetes etc)
List all treatments, drugs and investigations not otherwise noted:
Was this a multiple pregnancy?
give date when this was first diagnosed:
During this pregnancy was the mother ever made to rest in bed for more than a week?
for what reason(s)
During this pregnancy was the mother ever made to rest in bed for less than a week?
for what reason(s)
During pregnancy was the mother ever adviced to rest (not in bed)?
for what reason(s):
Was her salt intake restricted at any time during this pregnancy?
for what reason(s)
Was she put onto any special diet?
please describe:
Was the mother admitted to hospital during this pregnancy?
_admission < 7 &&
_admission < 7 &&
Date of admission
Days stayed
Hospital
Reasons for admission and brief details of any treatment
SECTION C: LABOUR AND DELIVERY
If this is a multiple pregnancy please fill in the labour and delivery details for the first born on this Section C and complete a separate CX section for each subsequent birth.
When was mother admitted?
Was mother:
How did the membranes rupture?
How long was the interval between rupture and delivery?
Did membranes rupture before or after onset of regular contractions?
How did labour start?
If labour induced, please indicate methods:
If labour induced, please indicate methods: prostaglandin gel (vaginal)
If labour induced, please indicate methods: prostaglandin pessaries
If labour induced, please indicate methods: extra-amniotic prostaglandins
If labour induced, please indicate methods: oral prostaglandins
If labour induced, please indicate methods: artificial rupture of membranes (ARM)
If labour induced, please indicate methods: syntocinon infusion
If labour induced, please indicate methods: 'other' please specify
If labour was induced, please list reasons:
Was labour augmented?
please indicate methods: artificial rupture of membranes (ARM)
please indicate methods: mobilisation of mother
please indicate methods: Syntocinan infusion
please indicate methods: other, please specify
If labour was augmented, please list reasons
What was the presentation at onset of labour?
What was the presentation at delivery or at caesarean section?
What was the method of delivery?
If forceps used, please indicate which type:
Was the delivery by caesarean section?
Indicate which of the following analgesics/anaesthetics used during the first or second stages of labour or at caesarean section? Birthing pool
Indicate which of the following analgesics/anaesthetics used durng the first or second stages of labour or at caesarean section? Caudal epidural (needle through caudal hiatus)
Indicate which of the following analgesics/anaesthetics used durng the first or second stages of labour or at caesarean section? Diamorphine
Indicate which of the following analgesics/anaesthetics used durng the first or second stages of labour or at caesarean section? Epidural n.o.s
Indicate which of the following analgesics/anaesthetics used durng the first or second stages of labour or at caesarean section? Fentanyl
Indicate which of the following analgesics/anaesthetics used durng the first or second stages of labour or at caesarean section? Gas and air
Indicate which of the following analgesics/anaesthetics used durng the first or second stages of labour or at caesarean section? General anaesthetic
Indicate which of the following analgesics/anaesthetics used durng the first or second stages of labour or at caesarean section? Hot bath
Indicate which of the following analgesics/anaesthetics used durng the first or second stages of labour or at caesarean section? Lumbar epidural (needle in lumbar region)
Indicate which of the following analgesics/anaesthetics used durng the first or second stages of labour or at caesarean section? Perineal infiltration
Indicate which of the following analgesics/anaesthetics used durng the first or second stages of labour or at caesarean section? Pethidine
Indicate which of the following analgesics/anaesthetics used durng the first or second stages of labour or at caesarean section? Pethilorfan
Indicate which of the following analgesics/anaesthetics used durng the first or second stages of labour or at caesarean section? Pudendal block
Indicate which of the following analgesics/anaesthetics used durng the first or second stages of labour or at caesarean section? Spinal anaesthetic
Indicate which of the following analgesics/anaesthetics used durng the first or second stages of labour or at caesarean section? T.E.N.S.
Indicate which of the following analgesics/anaesthetics used durng the first or second stages of labour or at caesarean section? Other, please describe
Indicate which of the following analgesics/anaesthetics used durng the first or second stages of labour or at caesarean section?
Were any other drugs given during the first or second stages of labour or at caesarean section? Antibiotics Please specify:
Were any other drugs given during the first or second stages of labour or at caesarean section? Dexamethasone
Were any other drugs given during the first or second stages of labour or at caesarean section? Diazepam (Valium)
Were any other drugs given during the first or second stages of labour or at caesarean section? Dichloralphenazone (Welldorm)
Were any other drugs given during the first or second stages of labour or at caesarean section? Ephidrine
Were any other drugs given during the first or second stages of labour or at caesarean section? Nitrazepam (Mogadon)
Were any other drugs given during the first or second stages of labour or at caesarean section? Oxygen
Were any other drugs given during the first or second stages of labour or at caesarean section? Phenergan
Were any other drugs given during the first or second stages of labour or at caesarean section? Phenobarbitone
Were any other drugs given during the first or second stages of labour or at caesarean section? Phenytoin
Were any other drugs given during the first or second stages of labour or at caesarean section? Ranitidine
Were any other drugs given during the first or second stages of labour or at caesarean section? Ritodrine (Yutopar)
Were any other drugs given during the first or second stages of labour or at caesarean section? Salbutamol
Were any other drugs given during the first or second stages of labour or at caesarean section? Sodium citrate
Were any other drugs given during the first or second stages of labour or at caesarean section? Stemetil
Were any other drugs given during the first or second stages of labour or at caesarean section? Temazepam
Were any other drugs given during the first or second stages of labour or at caesarean section? Other please specify:
Were any other drugs given during the first or second stages of labour or at caesarean section?
During Labour, prior to actual delivery did the mother haemorrhage?
Was the mother's blood pressure taken in labour?
what was the reading with the highest diastolic?
Was the mother's urine tested for protein in labour?
give result:
Was the mothers urine tested for ketones in labour?
give result:
Was any oedema present in labour?
what sites were involved?
Were any of the following noted as occurring in labour or at caesarean section? Pyrexia
Were any of the following noted as occurring in labour or at caesarean section? Pyrexia give temperature
Were any of the following noted as occurring in labour or at caesarean section? Right lateral postion
Were any of the following noted as occurring in labour or at caesarean section? Water birth
Were any of the following noted as occurring in labour or at caesarean section? Other complications (please describe, eg. shoulder dystocia, cephalopelvic disproportion etc)
Were any of the following noted as occurring in labour or at caesarean section?
Monitoring. Were any of the following noted:
Monitoring. Were any of the following noted: CTG - intermittent
Monitoring. Were any of the following noted: CTG - continuous
Monitoring. Were any of the following noted: FSE
Monitoring. Were any of the following noted: Auscultatian
Monitoring. Were any of the following noted: Sonicaid
Monitoring. Were any of the following noted: Fetal heart heard not known with what
Monitoring. Were any of the following noted: Other (please specify)
Were there any abnormalities noted in fetal heart rate in labour?
please indicate which abnormalities were noted Other, please specify
Were fetal blood samples taken?
were there abnormalities in fetal blood ph?
Did the mother have an episiotomy?
Did the mother have a perineal tear?
SECTION D: POST PARTUM
Were any of the following noted as having occurred during the first 14 days postpartum? Anaemia
Were any of the following noted as having occurred during the first 14 days postpartum? Anaemia Result
Were any of the following noted as having occurred during the first 14 days postpartum? Blood transfusion
Were any of the following noted as having occurred during the first 14 days postpartum? Breast problems specify
Were any of the following noted as having occurred during the first 14 days postpartum? Catheterization
Were any of the following noted as having occurred during the first 14 days postpartum? Clots passed
Were any of the following noted as having occurred during the first 14 days postpartum? Depression
Were any of the following noted as having occurred during the first 14 days postpartum? D.V.T. (deep vein thrombosis)
Were any of the following noted as having occurred during the first 14 days postpartum? Eclamptic convulsions
Were any of the following noted as having occurred during the first 14 days postpartum? Genital infection
Were any of the following noted as having occurred during the first 14 days postpartum? Haemorrhoids
Were any of the following noted as having occurred during the first 14 days postpartum? Infection of caesarean wound
Were any of the following noted as having occurred during the first 14 days postpartum? Infection of episiotomy/tear
Were any of the following noted as having occurred during the first 14 days postpartum? Manual removal of placenta
Were any of the following noted as having occurred during the first 14 days postpartum? Mastitis
Were any of the following noted as having occurred during the first 14 days postpartum? Micturation problems
Were any of the following noted as having occurred during the first 14 days postpartum? Perineum problems. specify
Were any of the following noted as having occurred during the first 14 days postpartum? Psychosis
Were any of the following noted as having occurred during the first 14 days postpartum? Pulmonary embolism
Were any of the following noted as having occurred during the first 14 days postpartum? Pyrexia
Were any of the following noted as having occurred during the first 14 days postpartum? Pyrexia temperature
Were any of the following noted as having occurred during the first 14 days postpartum? Retained placenta
Were any of the following noted as having occurred during the first 14 days postpartum? Sterilisation
Were any of the following noted as having occurred during the first 14 days postpartum? Urinary infection
Were any of the following noted as having occurred during the first 14 days postpartum? Uterine infection
Were any of the following noted as having occurred during the first 14 days postpartum? Other (please describe)
Were any of the following notes as having occurred during the first 14 days postpartum?
Blood loss at or after Delivery
Did the mother have a post-partum haemorrhage?
was it 'primary' (loss of 500mls or more within 24hrs of delivery)? or 'secondary' (loss of 500mls or more after 1st 24hrs of delivery)
Please give amount in mls of haemorrhage
Drugs in postpartum during and following completion of 3rd stage. Did the mother have: antibiotics (please specify)
Drugs in postpartum during and following completion of 3rd stage. Did the mother have: other (please specify)
Drugs in postpartum during and following completion of 3rd stage. Did the mother have:
Date mother left maternity hospital:
Where did mother first go?
Did mother take her own discharge?
Was mother re-admitted at all (prior to 6 week postnatal check)?
Blood pressure of mother after delivery ... ... on
(give latest recorded)
SECTION E: OUTCOME OF PREGNANCY
Baby's Hospital No.
Questionnaire No.
(If twin, triplet or quad please fill in Sections E & F on a seperate questionnaire for all except the first born).
Weight of placenta .... g
Were there any abnormalities of the placenta or umbilical cord noted?
please describe:
What was the outcome of delivery?
when was the fetus thought to have died?
what condition was the fetus in?
What is the sex of the baby/fetus?
Is the baby a singleton, twin or triplet?
state whether this baby was 1st, 2nd, 3rd or 4th to be born.
Birthweight of this baby:.... gms
Crown heel length: ... cms
(please code as 88.8 if not stated)
Head circumference ... cms
SECTION F: THE LIVEBORN BABY - AT DELIVERY
Did the baby cry immediately after birth?
How long before baby took first breath?
How long until regular respirations were established? ... mins ... secs
(If notes say less than 1 minute (<1) code as 66 mins 66 secs)
Apgar at 1 min:
Apgar at 5 mins:
Was the baby resuscitated
Method of resuscitation: bag and mask
Method of resuscitation: bag & mask & oxygen
Method of resuscitation: cardiac massage
Method of resuscitation: facial oxygen
Method of resuscitation: intubation
Method of resuscitation: IPPV with intubation
Method of resuscitation: mouth to mouth & nose
Method of resuscitation: ventilation nos
Method of resuscitation: Other, specify
Drugs given at delivery:
Treatment given at or shortly after delivery: suction
Treatment given at or shortly after delivery: chest compression
Treatment given at or shortly after delivery: none
Treatment given at or shortly after delivery: other (specify)
Treatment given at or shortly after delivery: cords visualised
was meconium seen?
UP UNTIL THE TIME OF DISCHARGE
Was the baby transferred?
Give reason(s) for transfer (if known)
For how long was baby there?
(If baby in SCBU throughout, leave rest of section F blank. When baby not in SCBU answer for postnatal notes only).
What type of feed was baby having at 24hrs?
Was the baby given Vitamin K?
Did the baby have convulsions?
What was the lowest temperature recorded: ... °C
(99.9 if not taken, 88.8 if not stated)
Was the baby ever examined by a paediatrician?
Were the hips examined?
were any abnormalities noted?
please describe
Please list all congenital malformations and other abnormalities (eg. cephalhaematoma)
Has a formal paediatric assessment of gestation been carried out?
give gestational assessment: ... wks (or 55 preterm, 56 term, 57 post-term)
Were any of the following noted on the postnatal ward or at home during first 14 postnatal days? Apnoeic attack(s) (baby stops breathing
Were any of the following noted on the postnatal ward or at home during first 14 postnatal days? Cyanotic attack(s) (baby turns blue)
Were any of the following noted on the postnatal ward or at home during first 14 postnatal days? Feeding problems
Were any of the following noted on the postnatal ward or at home during first 14 postnatal days? High pitched or abnormal cry
Were any of the following noted on the postnatal ward or at home during first 14 postnatal days? Moist eyes
Were any of the following noted on the postnatal ward or at home during first 14 postnatal days? Mucousy
Were any of the following noted on the postnatal ward or at home during first 14 postnatal days? Pyrexia
Were any of the following noted on the postnatal ward or at home during first 14 postnatal days? Pyrexia Result
Were any of the following noted on the postnatal ward or at home during first 14 postnatal days? Sticky eye(s)
Were any of the following noted on the postnatal ward or at home during first 14 postnatal days? Twitching
Were any of the following noted on the postnatal ward or at home during first 14 postnatal days? Umbilical infection
Were any of the following noted on the postnatal ward or at home during first 14 postnatal days? Unsettled
Were any of the following noted on the postnatal ward or at home during first 14 postnatal days? Other (specify)
Were any of the following noted on the postnatal ward or at home during first 14 postnatal days? None
Were any of the following noted on the postnatal ward or at home during first 14 postnatal days? Was jaundice present?
was SBR taken
Please list all drugs given to baby Antibiotics please specify:
Please list all drugs given to baby Dextrose
Please list all drugs given to baby Other please specify:
Please list all drugs given to baby None
Any other treatment or investigations Blood sugar assessments
Any other treatment or investigations Cot shield
Any other treatment or investigations Incubator
Any other treatment or investigations Light meter
Any other treatment or investigations Meconium observations
Any other treatment or investigations Phototherapy/Double Phototherapy
Any other treatment or investigations Other, please specify
Any other treatment or investigations None
Date of baby discharge/transfer from hospital:
Baby discharged to:
If to other hospital/unit
Has baby been readmitted since discharge up to time of 6 week post-natal check?
Were there any problems in the data collection you would like to add?