Prenatal Health History Checklist

During the first prenatal visit, a prenatal health history will be taken to give the obstetrician an insight into potential problems that could be faced during the pregnancy. The prenatal health history will include mother, father, siblings, children and grandparents. Any other health problems facing other blood relatives may also be pertinent to the healthy birth of the fetus and should be reported. When visiting the doctor for the first time, the expecting woman should have information available to complete a detailed prenatal health history. Even the smallest details of birth related problems, difficulty with pregnancy, multiple births and illnesses are important to the obstetrician.

 

Personal History

         Allergies
         Illnesses suffered as a child
         Previous medical conditions
         Chronic illnesses
         Hospital stays

Surgery History

         Minor surgical operations
         Major surgical operations
         Anesthesia history
         Accidents requiring hospitalization

Medication History

         Current prescription medications
         Current over the counter medications
         Previous prescription medications
         Medication based creams and lotions both prescription and non-prescription

Lifestyle History

         Smoking
         Drinking
         Eating habits
         Weight loss
         Weight gain

Previous Pregnancy History

         Previous full term pregnancies
         Previous aborted pregnancies
         Miscarriages
         Multiple pregnancies

Gynecology History

<        Cycle- normal or abnormal
         Blood flow – normal or abnormal
         Endometriosis
         Pelvic inflammatory disease
         Other gynecological problems

Infectious Diseases

         History of all infectious diseases both cures and ongoing

Current Pregnancy History

         Date of last period
         Date of positive pregnancy test
         Cramping
         Bleeding
         Vaginal discharge

Complete Parental and Father Medical History

         Chronic illnesses
         Pregnancy complications
         Multiple births
         Ethnic background