Surveypoint

Q01

NAME OF FACILITY

Q02

CODE

Q03

NAME OF THE PREGNANT WOMAN

Q04

HOSPITAL REGISTRATION

Q05

PREGNANT WOMAN ARRIVAL DATE

Q06

PREGNANT WOMAN ARRIVAL TIME

Q07

Patient arrival at the facility

Q07A

INCLUSION CRITERIA – Patient arrival at the facility

Q07A_1

Stage I (Latent phase) and conscious

Yes

No

Q07A_2

Stage II (Active phase) and conscious

Yes

No

Q07A_3

Unconscious but in Stage I or Stage II

Yes

No

Q07B

EXCLUSION CRITERIA - Patient arrival at the facility

Q07B_1

Stage III and conscious

Yes

No

Q07B_2

Stage IV and conscious

Yes

No

Q07B_3

Unconscious but in Stage III or Stage IV

Yes

No

Q07B_4

Taken directly to Operation Theatre

Yes

No

Q08

Status of observation

Q08A

INCLUSION CRITERIA – Patient arrival at the facility

Q08A_1

Stage I (Latent phase) and conscious

Observation started

Consent refused

Could not initiate direct observation as Nurse – Investigator is engaged in other delivery observation

Q08A_2

Stage II (Active phase) and conscious

Observation started

Consent refused

Could not initiate direct observation as Nurse – Investigator is engaged in other delivery observation

Q08A_3

Unconscious but in Stage I or Stage II

Observation started

Consent refused

Could not initiate direct observation as Nurse – Investigator is engaged in other delivery observation

Q08B

EXCLUSION CRITERIA - Patient arrival at the facility

Q08B_1

Stage III and conscious

Observation started

Consent refused

Could not initiate direct observation as Nurse – Investigator is engaged in other delivery observation

Q08B_2

Stage IV and conscious

Observation started

Consent refused

Could not initiate direct observation as Nurse – Investigator is engaged in other delivery observation

Q08B_3

Unconscious but in Stage III or Stage IV

Observation started

Consent refused

Could not initiate direct observation as Nurse – Investigator is engaged in other delivery observation

Q08B_4

Taken directly to Operation Theatre

Observation started

Consent refused

Could not initiate direct observation as Nurse – Investigator is engaged in other delivery observation

Q09

Location of the observation initiated

Q09A

INCLUSION CRITERIA – Patient arrival at the facility

Q09A_1

Stage I (Latent phase) and conscious

Observation area

Post-partum ward

Female ward

OPD

Labor room

Other (specify…..)

Q09A_2

Stage II (Active phase) and conscious

Observation area

Post-partum ward

Female ward

OPD

Labor room

Other (specify…..)

Q09A_3

Unconscious but in Stage I or Stage II

Observation area

Post-partum ward

Female ward

OPD

Labor room

Other (specify…..)

Q09B

EXCLUSION CRITERIA - Patient arrival at the facility

Q09B_1

Stage III and conscious

Observation area

Post-partum ward

Female ward

OPD

Labor room

Other (specify…..)

Q09B_2

Stage IV and conscious

Observation area

Post-partum ward

Female ward

OPD

Labor room

Other (specify…..)

Q09B_3

Unconscious but in Stage III or Stage IV

Observation area

Post-partum ward

Female ward

OPD

Labor room

Other (specify…..)

Q09B_4

Taken directly to Operation Theatre

Observation area

Post-partum ward

Female ward

OPD

Labor room

Other (specify…..)

Q10

Status of obsevation completion

Q10A

INCLUSION CRITERIA – Patient arrival at the facility

Q10A_1

Stage I (Latent phase) and conscious

Observation completed

Discontinued in between as referred out to other facility

Discontinued in between as sent back home after initial assessment

Discontinued in between (Specify other reason)

Q10A_2

Stage II (Active phase) and conscious

Observation completed

Discontinued in between as referred out to other facility

Discontinued in between as sent back home after initial assessment

Discontinued in between (Specify other reason)

Q10A_3

Unconscious but in Stage I or Stage II

Observation completed

Discontinued in between as referred out to other facility

Discontinued in between as sent back home after initial assessment

Discontinued in between (Specify other reason)

Q10B

EXCLUSION CRITERIA - Patient arrival at the facility

Q10B_1

Stage III and conscious

Observation completed

Discontinued in between as referred out to other facility

Discontinued in between as sent back home after initial assessment

Discontinued in between (Specify other reason)

Q10B_2

Stage IV and conscious

Observation completed

Discontinued in between as referred out to other facility

Discontinued in between as sent back home after initial assessment

Discontinued in between (Specify other reason)

Q10B_3

Unconscious but in Stage III or Stage IV

Observation completed

Discontinued in between as referred out to other facility

Discontinued in between as sent back home after initial assessment

Discontinued in between (Specify other reason)

Q10B_4

Taken directly to Operation Theatre

Observation completed

Discontinued in between as referred out to other facility

Discontinued in between as sent back home after initial assessment

Discontinued in between (Specify other reason)

Delivery Observation Template -Form Fill

NAME OF FACILITY

CODE

NAME OF THE PREGNANT WOMAN

HOSPITAL REGISTRATION

PREGNANT WOMAN ARRIVAL DATE

PREGNANT WOMAN ARRIVAL TIME

Patient arrival at the facility var statement=document.write(localStorage.getItem('total'));

INCLUSION CRITERIA – Patient arrival at the facility var statement=document.write(localStorage.getItem('total'));

Stage I (Latent phase) and conscious

Stage II (Active phase) and conscious

Unconscious but in Stage I or Stage II

EXCLUSION CRITERIA - Patient arrival at the facility var statement=document.write(localStorage.getItem('total'));

Stage III and conscious

Stage IV and conscious

Unconscious but in Stage III or Stage IV

Taken directly to Operation Theatre

Status of observation var statement=document.write(localStorage.getItem('total'));

INCLUSION CRITERIA – Patient arrival at the facility var statement=document.write(localStorage.getItem('total'));

Stage I (Latent phase) and conscious

Stage II (Active phase) and conscious

Unconscious but in Stage I or Stage II

EXCLUSION CRITERIA - Patient arrival at the facility var statement=document.write(localStorage.getItem('total'));

Stage III and conscious

Stage IV and conscious

Unconscious but in Stage III or Stage IV

Taken directly to Operation Theatre

Location of the observation initiated var statement=document.write(localStorage.getItem('total'));

INCLUSION CRITERIA – Patient arrival at the facility var statement=document.write(localStorage.getItem('total'));

Stage I (Latent phase) and conscious

Stage II (Active phase) and conscious

Unconscious but in Stage I or Stage II

EXCLUSION CRITERIA - Patient arrival at the facility var statement=document.write(localStorage.getItem('total'));

Stage III and conscious

Stage IV and conscious

Unconscious but in Stage III or Stage IV

Taken directly to Operation Theatre

Status of obsevation completion var statement=document.write(localStorage.getItem('total'));

INCLUSION CRITERIA – Patient arrival at the facility var statement=document.write(localStorage.getItem('total'));

Stage I (Latent phase) and conscious

Stage II (Active phase) and conscious

Unconscious but in Stage I or Stage II

EXCLUSION CRITERIA - Patient arrival at the facility var statement=document.write(localStorage.getItem('total'));

Stage III and conscious

Stage IV and conscious

Unconscious but in Stage III or Stage IV

Taken directly to Operation Theatre

Patient arrival at the facility

INCLUSION CRITERIA – Patient arrival at the facility

EXCLUSION CRITERIA - Patient arrival at the facility

Status of observation

INCLUSION CRITERIA – Patient arrival at the facility

EXCLUSION CRITERIA - Patient arrival at the facility

Location of the observation initiated

INCLUSION CRITERIA – Patient arrival at the facility

EXCLUSION CRITERIA - Patient arrival at the facility

Status of obsevation completion

INCLUSION CRITERIA – Patient arrival at the facility

EXCLUSION CRITERIA - Patient arrival at the facility