3rd trimester form(Singleton)
This form is developed as part of a national endeavor that aims to reduce perinatal mortality in India through a focus on PE and FGR. This form collects information on 3rd trimester pregnant women in India with a singleton fetus.
Mean Uterine Artery and CPR  (values and PI) are required entries for form submission.
Complete entries for umbilical artery, MCA, AEDV of umbilical artery, REDV of umbilical artery and DV if any of these two, mean uterine artery PI and/or CPR are abnormal.
Follow up scan recommended for FGR
Stage 1 : weekly
Stage 2: biweekly
Stage 3: alternate days
Stage 4: immediate delivery
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Email *
Scan ID 1st trimester (enter NA if not available) *
Scan ID 2nd trimester (Enter NA if not available) *
Scan ID 3rd trimester (use same ID for every 3rd trimester visit) *
3rd trimester Visit Number *
Month *
Year *
District *
State *
Date of Birth *
Enter as dd/mm/yyyy
Date of Exam *
Enter as dd/mm/yyyy
GA at exam (completed weeks) *
Type of conception *
Parity *
Pregnant Woman has PE *
Known High risk of PE *
GA at diagnosis of PE (completed weeks, enter 0 if no PE) *
Chronic HTN *
DM *
SLE *
APLS *
Mean Uterine artery PI *
Mean Uterine artery PI > 95th centile *
Umbilical artery PI
Umbilical artery PI > 95th centile
MCA PI
MCA PI<5th centile
CPR <5th centile *
CPR *
AEDV
REDV
DV >95th centile
Liquor *
EFW (grms) *
EFW Centiles *
Doppler Status (normal=no abnormality in any Doppler study)
Growth category *
Fetal breathing *
Fetal Heart Rate *
Decelerating Fetal Health *
FGR *
FGR stages *
Recommended Follow Up after (enter as days) *
Recommend Steroids for lung maturity *
Recommend CTG Monitoring *
Recommend Close Surveillance *
Recommend Immediate Delivery *
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