Version May 2024
| Past obstetric history (information for each pregnancy) |
| Date of delivery |
| Gestational age at delivery |
| Location of delivery |
| Sex of child |
| Birth weight and percentile for gestational age |
| Mode of delivery (vaginal, cesarean, assisted-vaginal) |
| Type of analgesia and anesthesia |
| Length of labor |
| Outcome (live birth, stillbirth) |
| Details (eg, type of hysterotomy incision, forceps, vacuum, etc) |
| Complications (eg, preterm birth, preeclampsia, gestational diabetes, previa, abruption, cholestasis) |
| Gynecologic history |
| Age at menarche |
| Date of last menstrual period |
| Date of previous menstrual period |
| Cycle length and duration |
| Type of contraception |
| Sexually transmitted infections |
| Gynecologic surgery or disorders (eg, cervical, uterine, or ovarian surgery; endometriosis, fibroids, uterine anomalies) |
| Miscarriage |
| Pregnancy termination |
| Ectopic pregnancy |
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