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Original site: www.cdc.gov/nchs/nvss/facility-worksheets-guide/15.htm | RestoredCDC.org is an independent project, not affiliated with CDC or any federal entity. Visit CDC.gov for free official information. Due to archival on January 6, 2025, recent outbreak data is unavailable. Videos are not restored. Access data.restoredcdc.org for restored data. Use of this site implies acceptance of this disclaimer.
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Facility Information
+ Facility name
+ Facility ID
+ City, town, or location of birth
+ County of birth
+ Place where birth occurred (Birthplace)
+ National Center for Health Statistics Home
* Prenatal Care and Pregnancy History
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Prenatal Care and Pregnancy History
+ Date of the first prenatal care visit
+ Total number of prenatal care visits for this pregnancy
+ Date last normal menses began
+ Number of previous live births now living
+ Number of previous live births now dead
+ Date of last live birth
+ Number of other pregnancy outcomes
+ Date of last other pregnancy outcome
+ Risk factors in this pregnancy
+ Infections present and/or treated during this pregnancy
+ Obstetric procedures
+ National Center for Health Statistics Home
* Labor and Delivery
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Labor and Delivery
+ Date of birth
+ Time of birth
+ Certifier’s name and title
+ Date certified
+ Principle source of payment
+ Infant’s medical record number
+ Was the mother transferred to this facility for maternal medical or fetal indications for delivery?
+ Attendant’s name, title, and ID
+ Mother’s weight at delivery
+ Characteristics of labor and delivery
+ Method of delivery
+ Maternal morbidity (maternal transfusion)
+ National Center for Health Statistics Home
* Newborn Information
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Newborn Information
+ Birthweight or weight of fetus
+ Obstetric estimate of gestation at delivery
+ Sex of child
+ Apgar score
+ Plurality
+ If not a single birth, order born in the delivery
+ If not a single birth, number of infants in the delivery born alive
+ Abnormal conditions of the newborn
+ Congenital anomalies of the newborn
+ Was the infant transferred within 24 hours of delivery?
+ Is the infant living at the time of the report?
+ Is the infant being breastfed at discharge?
+ Method of disposition
+ National Center for Health Statistics Home
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15. Infections present and/or treated during this pregnancy
Infections present and/or treated during this pregnancy
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Category: Prenatal Care and Pregnancy History
BC # 42
15. Infections present …
Infections present at the time of the pregnancy diagnosis or a confirmed diagnosis during the pregnancy with or without documentation of treatment.
Definitions
Documentation of treatment during this pregnancy is adequate if a definitive diagnosis is not present in the available record.
Check all boxes that apply. The mother may have more than one infection.
Instructions
If the mother has none of the risk factors, check “none of the above.”
Sources See below
“+” indicates that the test for the infection was positive and the woman has the infection.
Keywords and Abbreviations “–” indicates that the test was negative, and the woman does not have the infection.
Look for: treatment or Rx for specific infection.
Gonorrhea
Definitions A positive test or culture for Neisseria gonorrhoeae.
Instructions
1st Prenatal record under –
* Infection history
* Sexually transmitted diseases
* Problem list
* Complications this pregnancy
* Factors this pregnancy
* Medical history
2nd Labor and delivery nursing admission triage form under – Comments
Sources
3rd Admission history and physical (H&P) under –
* Current pregnancy history
* Medical history
* Problem list/findings
4th Delivery record under –
* Maternal OB/labor summary
* Labor and delivery admission history
GC
Gonorrheal
Keywords and Abbreviations Gonoccocal
Treatment or Rx for Gonocchea
NAAT–Nucleic amplification tests
Syphilis (also called lues)
Definitions A positive test for Treponema pallidum.
Instructions
1st Prenatal record under –
* Infection history
* Sexually transmitted diseases
* Problem list
* Complications this pregnancy
* Factors this pregnancy
* Medical history
2nd Labor and delivery nursing admission triage form under – Comments
Sources
3rd Admission history and physical (H&P) under –
* Current pregnancy history
* Medical history
* Problem list/findings
4th Delivery record under –
* Maternal OB/labor summary
* Labor and delivery admission history
TP-PA–T. pallidum particle agglutination
STS–Serologic test for syphilis
RPR–Rapid plasma regain
Keywords and Abbreviations VDRL–Venereal disease research laboratories
FTA-AS–Fluorescent antibody test
Lues
Treatment or Rx for syphilis or lues
Chlamydia
Definitions A positive test for Chlamydia trachomatis.
Instructions
1st Prenatal record under –
* Infection history
* Sexually transmitted diseases
* Problem list
* Complications this pregnancy
* Factors this pregnancy
* Medical history
2nd Labor and delivery nursing admission triage form under – Comments
Sources
3rd Admission history and physical (H&P) under –
* Current pregnancy history
* Medical history
* Problem list/findings
4th Delivery record under –
* Maternal OB/labor summary
* Labor and delivery admission history
Keywords and Abbreviations Treatment or Rx for chlamydia
Hepatitis B (HBV, serum hepatitis)
Definitions A positive test for the hepatitis B
Instructions
1st Prenatal record under –
* Infection history
* Sexually transmitted diseases
* Problem list
* Complications this pregnancy
* Factors this pregnancy
* Medical history
2nd Labor and delivery nursing admission triage form under – Comments
Sources
3rd Admission history and physical (H&P) under –
* Current pregnancy history
* Medical history
* Problem list/findings
4th Delivery record under –
* Maternal OB/labor summary
* Labor and delivery admission history
Hep B
Keywords and Abbreviations HBV
Treatment or Rx for hepatitis B
Hepatitis C (non A or non B hepatitis [HCV])
Definitions A positive test for the hepatitis C virus
Instructions
1st Prenatal record under –
* Infection history
* Sexually transmitted diseases
* Problem list
* Complications this pregnancy
* Factors this pregnancy
* Medical history
2nd Labor and delivery nursing admission triage form under – Comments
Sources
3rd Admission history and physical (H&P) under –
* Current pregnancy history
* Medical history
* Problem list/findings
4th Delivery record under –
* Maternal OB/labor summary
* Labor and delivery admission history
Hep C
Keywords and Abbreviations HCV
Treatment or Rx for hepatitis C
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Prenatal Care and Pregnancy History
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6. Date of the first prenatal care visit
The date a physician or other health care professional first examined or counseled the pregnancy woman for the pregnancy.
Categories: Prenatal Care and Pregnancy History
7. Total number of prenatal care visits for this pregnancy
The total number of visits recorded in the record.
Categories: Prenatal Care and Pregnancy History
8. Date last normal menses began
The date the mother’s last normal menstrual period began.
Categories: Prenatal Care and Pregnancy History
9. Number of previous live births now living
The total number of previous live-born infants now living.
Categories: Prenatal Care and Pregnancy History
10. Number of previous live births now dead
The total number of previous live-born infants now dead.
Categories: Prenatal Care and Pregnancy History
11. Date of last live birth
The date of birth of the last live-born infant.
Categories: Prenatal Care and Pregnancy History
12. Number of other pregnancy outcomes
Total number of other pregnancy outcomes that did not result in a live birth.
Categories: Prenatal Care and Pregnancy History
13. Date of last other pregnancy outcome
The date that the last pregnancy that did not result in a live birth ended.
Categories: Prenatal Care and Pregnancy History
14. Risk factors in this pregnancy
Risk factors of the mother during this pregnancy (e.g., diabetes, prepregnancy diabetes, gestational diabetes, hypertension, prepregnancy hypertension, gestational hypertension, eclampsia, previous preterm births, pregnancy resulted from infertility treatment, fertility-enhancing drugs, assisted reproductive technology, mother had a previous cesarean delivery).
Categories: Prenatal Care and Pregnancy History
15. Infections present and/or treated during this pregnancy
Infections present at the time of the pregnancy diagnosis or a confirmed diagnosis during the pregnancy with or without documentation of treatment (e.g., Gonorrhea, Syphilis, Chlamydia, Hepatitis B, Hepatitis C).
Categories: Prenatal Care and Pregnancy History
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Last Reviewed: August 5, 2019
Source: National Center for Health Statistics
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* Facility Information plus icon
+ Facility name
+ Facility ID
+ City, town, or location of birth
+ County of birth
+ Place where birth occurred (Birthplace)
* Prenatal Care and Pregnancy History plus icon
+ Date of the first prenatal care visit
+ Total number of prenatal care visits for this pregnancy
+ Date last normal menses began
+ Number of previous live births now living
+ Number of previous live births now dead
+ Date of last live birth
+ Number of other pregnancy outcomes
+ Date of last other pregnancy outcome
+ Risk factors in this pregnancy
+ Infections present and/or treated during this pregnancy
+ Obstetric procedures
* Labor and Delivery plus icon
+ Date of birth
+ Time of birth
+ Certifier’s name and title
+ Date certified
+ Principle source of payment
+ Infant’s medical record number
+ Was the mother transferred to this facility for maternal medical or fetal indications for delivery?
+ Attendant’s name, title, and ID
+ Mother’s weight at delivery
+ Characteristics of labor and delivery
+ Method of delivery
+ Maternal morbidity (maternal transfusion)
* Newborn Information plus icon
+ Birthweight or weight of fetus
+ Obstetric estimate of gestation at delivery
+ Sex of child
+ Apgar score
+ Plurality
+ If not a single birth, order born in the delivery
+ If not a single birth, number of infants in the delivery born alive
+ Abnormal conditions of the newborn
+ Congenital anomalies of the newborn
+ Was the infant transferred within 24 hours of delivery?
+ Is the infant living at the time of the report?
+ Is the infant being breastfed at discharge?
+ Method of disposition
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