Pregnancy & Obstetric History Form

The Pregnancy and Obstetric History Form captures a comprehensive reproductive and obstetric timeline for patients of childbearing age. It documents gravidity, parity, term and preterm deliveries, abortions (spontaneous and elective), living children, and ectopic pregnancies using the standard GTPAL notation. Each prior pregnancy is recorded with gestational age at delivery, delivery method (vaginal, cesarean, vacuum-assisted, forceps), birth weight, and neonatal outcome.

This form is critical for prenatal risk stratification and delivery planning. A history of preeclampsia, gestational diabetes, placenta previa, preterm labor, cervical insufficiency, or postpartum hemorrhage significantly impacts management of subsequent pregnancies. The template includes dedicated sections for antepartum complications, intrapartum events, and postpartum complications for each prior pregnancy, enabling providers to identify recurrence risk patterns.

The template also captures menstrual history (LMP, cycle regularity), contraceptive history, fertility treatment history, and Rh factor status. It is used by OB/GYN practices, maternal-fetal medicine specialists, midwifery practices, fertility clinics, and family medicine providers managing prenatal care. The structured format ensures that no critical obstetric detail is overlooked during the initial prenatal visit.