data collection tools
TRANSCRIPT
Clinical and Community Act ion to Address Postpartum Hemorrhage TOOL KIT
Data Collection Tools
Facility Supervisory Checklist
Patient Referral Sheet
Non-Pneumatic Anti-Shock Garment (NASG) Case Study Form
Primary-Level Facility Patient Logbook
Secondary-Level Facility Patient Logbook
Tertiary-Level Facility Patient Logbook
Clinical and Community Action to Address Postpartum Hemorrhage
Page 1 of 3 CCA-PPH Project – Facility Supervisory Checklist
Facility Supervisory Checklist
Instructions: The Facility Supervisory Checklist is used to assess facility-based services for the prevention and management of postpartum hemorrhage. The State Coordinator should complete this checklist once a month for each project facility. Together, facility staff and the State Coordinator should review the completed checklist and identify strengths and areas where corrective actions need to be made. One copy of the completed checklist should be left in a binder at the facility and one copy should be submitted to the M&E Officer at the central office by the first Friday of each month. During the next visit to the facility, the State Coordinator should review the checklist and progress toward agreed-upon corrective actions with staff. The Facility Supervisory Checklist is in two parts “Facility Review” and “Observation of Delivery Practices”. Observation of deliveries, when possible, is part of the routine supervisory visit. PART I. FACILITY REVIEW (To be completed once for each facility visit)
A. BLOOD LOSS ESTIMATION 1. Does the facility have a method for measuring blood loss? Y__ N__ 2. What method is being used to measure blood loss (check all that apply)
a. Calibrated measuring jug Y__ N__ b. Blood drape Y__ N__ c. Observation Y__ N__ d. Other (explain)_____________________________________________________________________
3. Observe: Is the device for measuring blood loss available at the time of visit? Y__ N__ 4. How is the blood drape disposed of (if applicable)? ______________________________________________
A. DISINFECTION 1. Observe: Is Chlorine available for disinfection? Y__ N__ 2. Is attendant able to correctly describe the chlorine/water mixture for disinfection? Y__ N__ 3. Is attendant able to describe the correct steps for disinfecting the NASG and blood
collection device (if applicable), including processing time? Y__ N__ 4. Observe (if possible): NASG cleaned & disinfected properly1 for each cleaning observed? Y__ N__
B. AVAILABILITY OF NASG 1. Observe: Number of NASG in good condition that are available at the facility _________________ 2. Observe: Is the NASG accessible (e.g. not locked-up)? Y__ N__ 3. Does the facility have a plan in place for disposing of NASG that are in poor condition? Y__ N__ 4. Does the facility have a plan in place to return NASG with referral facilities? Y__ N__ IDENTIFY WEAKNESSES AND NOTE CORRECTIVE ACTION ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
1 Proper cleaning steps: gloved hands, .05% bleach solution prepared, NASG completely submerged for 10 minutes max, scrub NASG, rinse in clean water, ring out access water, hang in sun to dry
Name of Person Completing Form: __ ________________________________________________________ Name of Facility: _________________________________________________________________________ Facility level: ____________________________________________________________________________ State: ______________________ Date: ______________________________
Clinical and Community Action to Address Postpartum Hemorrhage
Page 2 of 3 CCA-PPH Project – Facility Supervisory Checklist
C. MANAGEMENT TOOLS AND JOB AIDES
1. Did the facility receive job aides from Pathfinder? Y__ N__ 2. Observe: Check which of the following are displayed in labor room:
a. AMTSL flow chart Y__ N__ b. Management of Shock flow chart Y__ N__ c. Applying the NASG flowchart Y__ N__ d. Removing the NASG flowchart Y__ N__ e. Care and cleaning of the NASG flow chart Y__ N__ f. Visual estimation of blood loss job aide Y__ N__ g. Using the blood collection drape flow chart Y__ N__ h. Mixing bleach solution Y__ N__
3. Observe: Is there a sufficient supply (minimum one month) of referral forms available? Y__ N__ 4. Total number of referral forms completed during the past calendar month2 _________________ 5. Total number of forms with every item completed3 _________________ 6. Observe: Has the log book been completely filled and is up-to-date? Y__ N__ 7. Observe: Is there a sufficient supply of logbooks (at least 2 months) available? Y__ N__
D. AVAILABILITY AND STORAGE OF UTEROTONICS (Observe: Check both labor ward and pharmacy) Labor Ward Pharmacy
1. Is Ergometrine available? Y__ N__ Y__ N__ 2. Is Ergometrine stored in closed containers? Y__ N__ Y__ N__ 3. Is Oxytocin available? Y__ N__ Y__ N__ 4. Is Oxytocin stored in a refrigerator? Y__ N__ Y__ N__ 5. Is Misoprostol available? Y__ N__ Y__ N__ 6. Did you observe any expired uterotonics? Y__ N__ Y__ N__
E. TRAINING 1. Number of PPH-trained staff needed at this facility4 _________________ 2. Number of current providers who have completed the CC-PPH training _________________ 3. Number of PPH-trained providers who have left this facility since last visit _________________ IDENTIFY WEAKNESSES AND NOTE CORRECTIVE ACTION _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
2 Calendar month should be the first date to the last date of the last completed month
3 A referral form is only considered complete if every line item has been filled in with the requested information
4 Insert staffing level based on facility assessment and other factors.
Clin
ical
and
Com
mun
ity A
ctio
n to
Add
ress
Pos
tpar
tum
Hem
orrh
age
Page
3 o
f 3
CCA
-PPH
Pro
ject
– F
acili
ty S
uper
viso
ry C
heck
list
PART
II.
OBS
ERV
ATI
ON
OF
DEL
IVER
Y PR
ACT
ICES
(To
be fi
lled
in fo
r eac
h de
liver
y ob
serv
ed)
D
ELIV
ERY
1N
OTE
S D
ELIV
ERY
2N
OTE
S D
ELIV
ERY
3N
OTE
S D
ELIV
ERY
STEP
O
bser
ved
Obs
erve
d O
bser
ved
Y N
Y
N
Y N
1.
G
iven
cor
rect
dos
e of
an
appr
opri
ate
uter
oton
ic
w
ithin
1 m
inut
e of
del
iver
y of
bab
y (n
ote
type
)
2.
Plac
enta
del
iver
ed th
roug
h co
ntro
lled
cord
tr
actio
n
3.
Rece
ived
ute
rine
mas
sage
aft
er d
eliv
ery
of
pl
acen
ta
4.
Patie
nt r
ecor
d fil
led
in c
orre
ctly
and
com
plet
ely
follo
win
g de
liver
y.
5. B
lood
loss
est
imat
ed a
nd r
ecor
ded
in p
atie
nt
reco
rd.
IDEN
TIFY
WEA
KNES
SES
AN
D N
OTE
CO
RREC
TIV
E A
CTIO
N
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
___
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
___
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
___
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
___
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
___
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
___
CLINICAL AND COMMUNITY ACTION TO ADDRESS POSTPARTUM HEMORRHAGE
Patient Referral Sheet
The Patient Referral Sheet should be completed by the referring provider for each patient who is experiencing hemorrhage and is referred to another facility where providers have been trained on the continuum of care, including the NASG. The referral form should be sent with the patient to provide a brief report of the patient’s condition prior to referral, which will assist the facility accepting the referral to act quickly and appropriately. Keep this form with the patient’s clinical records for a complete record of treatment.
Date: …………………… Referred to: ……………………………………………..
Referring Health Facility Information: Name of Doctor/Midwife/CHEW ……………………………………….............................................. Name/Location of Health Facility ………………………………………..............................................
Patient’s Information:
Name: …………………………………….. Age: ……………………
Number of previous pregnancies…………. Number of previous miscarriage: ………………
Number of children alive: ……………….. Mobile Phone Number: ……………………………..
Index pregnancy: Delivered/undelivered (please tick):
If delivered, what was the outcome? (Please tick): Alive ….Fresh still birth …. Macerated birth …..
Brief History/Complaint: (Please continue on reverse side of this sheet for complete history.)
Findings on Examination: Vital signs at time of referral: Blood pressure: ………. Pulse Rate: ……………. Respiratory Rate: ……….. Temperature: …………. Estimate of blood loss (mls) Visual: ……………. Use of blood drape: ……………..
Diagnosis: Reason for Referral:
Test Results: Hb: …………….. PCV: ………………… Blood Group: …………. Urinalysis: ……………………..
Treatment Given: IVF given: Number: …………… Type: ……………………………………………… Blood Transfusion: Number: …………………………………. Uterotonic Given: Oxytocin (units) …… Ergometrine (dose) ……... Misoprostol (dose) .................. Other treatment given:
Antibiotics: Surgical procedures:
If NASG is applied on the patient before referral, please provide the NASG number in the box below
Clinical and Community Action to Address Postpartum Hemorrhage
NASG CASE STUDY FORM State: …………… Name of facility: ……………………………… Date: ……………..
Brief History/Complaint: (Please continue on reverse side of this sheet for complete history.)
Findings on Examination Vital signs: Blood pressure: ………….Pulse Rate: ……………. Respiratory Rate: ……….. Temperature: …………. Estimated blood loss (mls): …………………………………….. How was the estimate done? (please tick) Visual ……. Use of blood drape ……. Another measuring device (specify)…………………. Level of consciousness (LOC): Normal (N) …….. Agitated/confused ……… Unconscious (UC) ………
Cause of Hemorrhage (please tick): uterine atony …… genital tract tear …… retained placenta ……. retained
product of conception ……. others (please specify)………………………………………………………………………….
Test Results: Hb: …………….. Urinalysis: ……………………….
Blood Group: ………………………………………..
Urine output after 24 hours: …………………………
PCV on admission: ………………………………….
Treatment Given: IVF: Volume (mls): ……… Type: ……… Start time of first IVF administration (military time): ………
Blood Transfusion: Start time of first blood transfusion (military time)……………….# units…………………………
Uterotonic Given: Oxytocin (mg)……. Ergometrine/methergine (mg) ……... Misoprostol (µg)............ Other ………………..
Other treatment given: Antibiotics (name): ………… Other (please specify ………………………………
Abdominal surgical procedures (Please tick, more than one may apply): Salpingostomy/Salpingectomy ……
C/Section …… Uterine compression sutures …… Uterine artery ligation/devascularization ……
Emergency hysterectomy ……. Other (please specify) …………………………………………………………
Vaginal surgical procedures (may be more than one): Repair cervix …… Repair vagina …… Repair perineum ……..
Evacuation …… Manual removal of placenta …….. Other ……..
(continue on reverse side)
Date/time of onset of shock: ……………………………………….
Date/time of NASG application: …………………………………...
Date/time of NASG removal: ……………………………………....
Response to NASG: Date/time systolic BP = or >90 ……………...
Date/time pulse < 100 ……………………………………………..
Date/time LOC changed from UC to N ……………………………
Patient’s Information:
Initials: ………… Age: …… Mobile Phone Number: ………………………… File number: ……………………
Date of admission: ………………………. Date/Time of delivery: …………………………………………….
Where delivery took place (please tick): Home …………. Health Facility …………
Place of onset of PPH (please tick): Home ………. Health facility ……… Time of onset of PPH……………………...
Number of previous pregnancies………. Number of previous miscarriage: ………… Number of children alive: ...........
Index pregnancy: Delivered/undelivered (please circle one)
If delivered, what was the outcome? (please tick): Alive ……Fresh still birth …… Macerated birth …….
Treatment outcome (please tick): Alive …… Died ……
Alive with complications (Please state the complications) ……………………………………………………………………
If died, obstetrical cause of death and name of organ failure (please tick):
Single organ failure (heart, lung, kidney, brain) (please specify)………………………………………………………..
Multi-organ Dysfunction Syndrome (MODS) (please specify)………………………………………………………….
Please provide as much detail as possible describing the woman’s condition and response to treatment, delays in treatment, lack of blood, fluid supply etc.
Clinical and Community Action to Address Postpartum Hemorrhage
Page 1 of 2 CCA-PPH Project - Primary Facility Logbook Guidance and Definitions
Guidance and Definitions for Filling out Primary Health Center Logbook
Every patient coming to this facility for the following should be recorded in the logbook: 1. Childbirth delivery 2. With complications after childbirth (up to 42 days post-partum) 3. With complications after having a non-live birth outcome {miscarriage, stillbirth or unsafe abortion
(performed elsewhere)} up to 42 days post-partum
The following information corresponds to the column number in the logbook.
1. Reference #: Number assigned to the patient by the facility. Use whatever number has been assigned to the patient according to the facility’s recording system.
Codes are assigned to columns 2 through 15. Use the corresponding codes to enter information in the logbook
2. Admission Type D- if direct admission (i.e. woman came on her own) R-I-F- if referred in by a private or public facility/private skilled provider/CHEW due to PPH, PAH, ECL and OOH R-I-C- if referred in by community (chief, ASHA, TBA, other) due to PPH, PAH, ECL and OOH 3. Delivery took place outside of a skilled facility OF-if patient delivered outside of a primary, secondary or tertiary facility N-if delivery took place in a primary, secondary or tertiary facility 4. Arrived in Shock SHK- if patient was already in hypovolemic shock secondary to hemorrhage when she was admitted to this institution either from home of from another facility N- if patient was not admitted with shock 5. Blood Drape
BD- if the blood drape is placed under this woman immediately after the delivery of the placenta N- if no blood drape was used
6. PPH (postpartum hemorrhage) N- if no PPH or if blood loss is <350 mL PPH-A- alert to PPH if blood loss after delivery is 350-499 mL and/or is diagnosed by provider with PPH-A PPH- if blood loss after delivery is 500-999 mL and/or is diagnosed by provider with PPH PPHS- severe PPH if blood loss after delivery is >1000 mL and/or diagnosed by provider with PPHS PAH- post-abortion with hemorrhage (determined by clinical sign) OOH- if other obstetric hemorrhage (e.g. placenta previa or any other anomaly of placenta implantation)
7. Uterotonic received for management of PPH OXY- if Oxytocin received to manage bleeding due to PPH EGT- if Ergometrine received to manage bleeding due to PPH MISO- if Misoprostol received to manage bleeding due to PPH N- if no uterotonic was given to manage a woman who is experiencing PPH
8. Crystalloid (IV fluids) in first hour for management of PPH IVC-PPH- if Ringers Lactate, Hartmann’s Solution or Normal Saline is used for the management of PPH
N- if no IV crystalloid is used
Clinical and Community Action to Address Postpartum Hemorrhage
Page 2 of 2 CCA-PPH Project - Primary Facility Logbook Guidance and Definitions
9. Hypovolemic Shock (developed after admission) HYP-SHK- if clinical signs of decompensation of circulatory system due to excessive blood loss. Blood loss may be revealed (as in PPH from uterine atony) or partially concealed (as in abruption or ruptured uterus). Vital signs change so that the pulse is > 120 BPM, systolic blood pressure < 90 mmHG, the patient may become diaphoretic, confused, agitated or unconscious. N- if no signs of hypovolemic shock 10. NASG (Non-Pneumatic Anti-shock Garment) received
NASG- if received NASG before transfer N- if did not receive NASG before transfer 11. Crystalloid (IV fluids) for the management of shock
IVC-SHK- if Ringers Lactate, Hartmann’s Solution or Normal Saline is used for the management of shock
N- if no IV crystalloid is used 12. ECL (pre-eclampsia/eclampsia) ECL-R- if pre-eclampsia (or eclampsia) and referred out to another facility ECL-T- if pre-eclampsia (or eclampsia) and treated at the facility ECL-T-R- if pre-eclampsia (or eclampsia) and treated at the facility and referred to higher level N- if no pre-eclampsia (or eclampsia) 13. Refer-Out REF-O- if referred out to other hospital for PPH, PPHS, PAH or OOH N- if no referral 14. Death (deaths that only occur at facility) Died- if the woman died N- if the woman survived 15. Obstetrical cause of death (if died, write obstetrical cause of death as one of the following
categories) PPH/PPHS- if blood loss after delivery is >500 mL or provider diagnosis PPH/PPHS as cause of death PAH- if post-abortion hemorrhage ECL- if eclampsia OOH- if other obstetric hemorrhage (e.g. placenta previa or any other anomaly of placenta implantation) OTHER- if other causes
Mon
th: _
____
____
____
___
Yea
r: 20
____
____
____
____
City
:___
____
____
____
___
Sta
te: _
____
____
____
____
Ref
eren
ce #
Adm
issi
on ty
peD
eliv
ery
outs
ide
of a
sk
illed
faci
lity
Arr
ived
in s
hock
Blo
od d
rape
Hem
orrh
age
*see
de
finiti
on fo
r gui
danc
eU
tero
toni
c re
ceiv
ed fo
r m
anag
emen
t of P
PH
Cry
stal
loid
(IV
fluid
s) in
fir
st h
our f
or
man
agem
ent o
f PPH
12
34
56
78
DO
FS
HK
BD
N (<
350)
OX
YIV
C-P
PH
R-I-
FN
NN
PP
H-A
(350
-499
)E
GT
NR
-I-C
PP
H (5
00-9
99)
MIS
OP
PH
S (>
1000
)N
PA
HO
OH
Nam
e of
Fac
ility
: ___
____
____
____
____
____
____
____
____
____
____
____
____
____
Clin
ical
and
Com
mun
ity A
ctio
n to
Add
ress
Pos
tpar
tum
Hem
orrh
age
Prim
ary-
leve
l Fac
ility
Pat
ient
Log
book
Hyp
ovol
emic
sho
ck
(dev
elop
ed a
fter
adm
issi
on)
NA
SG re
ceiv
edC
ryst
allo
id (I
V flu
ids)
for
man
agem
ent o
f sho
ckEC
L (p
re-e
clam
psia
/ ec
lam
psia
)R
efer
-Out
for P
PH, P
PHS,
PA
H, O
OH
Dea
th a
t thi
s fa
cilit
yO
bste
tric
al c
ause
of
deat
h9
1011
1213
1415
HY
P-S
HK
NA
SG
IVC
-SH
KE
CL-
RR
EF-
OD
IED
PP
H/P
PH
SN
N
NE
CL-
TN
NP
AH
EC
L-T-
RE
CL
NO
OH
OTH
ER
Clin
ical
and
Com
mun
ity A
ctio
n to
Add
ress
Pos
tpar
tum
Hem
orrh
age
Pri
mar
y-L
evel
Fac
ilit
y M
onth
ly D
eliv
ery
Sta
tist
ics
M
onth
: ___
____
____
_ Y
ear:
20_
__ N
ame
of F
acil
ity:
___
____
____
____
___
Sub
-dis
tric
t___
____
____
___
Dis
tric
t: _
____
____
___S
tate
: ___
____
____
__
Inst
ruct
ions
: Thi
s fo
rm is
for
rep
ortin
g m
onth
ly (
1) to
tal n
umbe
r of
wom
en w
ho c
ame
to th
e ho
spita
l for
del
iver
y se
rvic
es, (
2) ty
pe o
f se
rvic
es r
ecei
ved
by w
omen
, and
(3)
con
diti
ons
obse
rved
am
ong
the
wom
en. T
he f
orm
wil
l be
fill
ed in
wit
h in
form
atio
n fr
om th
e P
atie
nt L
ogbo
ok in
whi
ch a
bri
ef d
escr
ipti
on o
f ea
ch it
em is
giv
en. A
list
of
defi
nitio
ns o
f th
e ite
ms
is
give
n in
a s
epar
ate
page
. The
sha
ded
sect
ion
of th
e ta
ble
is f
or w
omen
who
wer
e re
ferr
ed f
rom
ano
ther
fac
ility
(re
cord
ed a
s R
IF)
or f
rom
the
com
mun
ity (
reco
rded
as
RIC
). W
rite
the
tota
l nu
mbe
r of
wom
en w
ho w
ere
refe
rred
to T
HIS
fac
ilit
y fr
om a
noth
er f
acili
ty o
r co
mm
unity
in th
e bo
x at
the
top
of th
e se
ctio
n. T
he o
ther
sec
tion
(to
the
left
of
the
shad
ed s
ectio
n) o
f th
e ta
ble
is f
or th
ose
wom
en w
ho c
ame
dire
ctly
to th
e fa
cilit
y (n
ot r
efer
red)
or
cam
e on
thei
r ow
n. W
rite
the
tota
l num
ber
of w
omen
who
cam
e di
rect
ly to
TH
IS f
acili
ty in
the
box
at th
e to
p of
th
e se
ctio
n. T
he P
atie
nt L
ogbo
ok is
to r
ecor
d da
ta f
or E
AC
H P
AT
IEN
T A
DM
ITT
ED
to th
e fa
cili
ty o
n w
hich
SE
RV
ICE
S S
HE
RE
CE
IVE
D a
nd/o
r an
y co
nditi
ons
SH
E H
AD
. Tra
nsfe
r th
e da
ta f
rom
the
Fac
ility
Pat
ient
Log
book
ont
o th
e ta
lly s
heet
s by
mak
ing
a ta
lly m
ark
(/)
in th
e C
OL
UM
N n
ext t
o th
e co
rres
pond
ing
NA
ME
of
serv
ice
or c
ondi
tion
. Mak
e a
tall
y fo
r E
VE
RY
SE
RV
ICE
AN
D C
ON
DIT
ION
rec
eive
d by
EV
ER
Y P
AT
IEN
T a
s re
cord
ed in
the
mon
thly
logb
ook.
Cou
nt th
e M
AR
KS
and
wri
te th
e T
OT
AL
num
bers
in th
e bo
xes
in th
e “T
otal
” co
lum
n on
this
she
et. R
ecor
d se
para
tely
tota
ls f
or r
efer
red
from
ano
ther
fac
ilit
y (R
IF)
and
refe
rred
fro
m c
omm
unit
y (R
IC).
Num
ber
of d
eath
s ca
n be
talli
ed a
s de
scri
bed
abov
e.
Tot
al n
umbe
r of
wom
en c
omin
g D
IRE
CT
LY
to th
e fa
cili
ty f
or d
eliv
ery
or
rela
ted
serv
ices
(no
t ref
erre
d):
T
otal
num
ber
of P
PH
, PA
H, E
CL
, OO
H c
ases
ref
erre
d to
this
fac
ilit
y fr
om
AN
OT
HE
R F
AC
ILIT
Y o
r fr
om th
e C
OM
MU
NIT
Y:
Serv
ices
/con
ditio
ns
Tot
al
Serv
ices
/con
ditio
ns
RIF
(To
tal)
R
IC (
Tot
al)
Del
iver
ed o
utsi
de o
f a
skill
ed f
acili
ty (
OF
) (3
) 1
D
eliv
ered
out
side
of
a sk
illed
fac
ility
(O
F)
(3)
Arr
ived
in s
hock
(S
HK
) (4
)
Arr
ived
in s
hock
(S
HK
) (4
)
U
se o
f bl
ood
drap
e (B
D)
(5)
U
se o
f bl
ood
drap
e (B
D)
(5)
Pos
tpar
tum
hem
orrh
age
aler
t (P
PH-A
) (3
50-4
99)
(6)
P
ostp
artu
m h
emor
rhag
e al
ert (
PPH
-A)
(350
-499
) (6
)
P
ostp
artu
m h
emor
rhag
e (P
PH)
(500
-999
) (6
)
Pos
tpar
tum
hem
orrh
age
(PPH
) (5
00-9
99)
(6)
Pos
tpar
tum
hem
orrh
age
seve
re (
PPH
S)
(>10
00)
(6)
P
ostp
artu
m h
emor
rhag
e se
vere
(P
PHS
) (>
1000
) (6
)
P
ost-
abor
tion
hem
orrh
age
(PA
H)
(6)
P
ost-
abor
tion
hem
orrh
age
(PA
H)
(6)
Oth
er o
bste
tric
hem
orrh
age
(OO
H)
(6)
O
ther
obs
tetr
ic h
emor
rhag
e (O
OH
) (6
)
R
ecei
ved
uter
oton
ic f
or m
anag
emen
t of
PP
H (
OX
Y)
(7)
R
ecei
ved
uter
oton
ic f
or m
anag
emen
t of
PP
H (
OX
Y)
(7)
Rec
eive
d ut
erot
onic
for
man
agem
ent o
f P
PH
(E
GT
) (7
)
Rec
eive
d ut
erot
onic
for
man
agem
ent o
f P
PH
(E
GT
) (7
)
R
ecei
ved
uter
oton
ic f
or m
anag
emen
t of
PP
H (
MIS
O)
(7)
R
ecei
ved
uter
oton
ic f
or m
anag
emen
t of
PP
H (
MIS
O)
(7)
Rec
eive
d IV
cry
stal
loid
in f
irst
hou
r fo
r m
anag
emen
t of
PP
H (
IVC
-PP
H)
(8)
R
ecei
ved
IV c
ryst
allo
id in
fir
st h
our
for
man
agem
ent o
f P
PH
(I
VC
-PP
H)
(8)
Hyp
ovol
emic
sho
ck d
evel
oped
aft
er a
dmis
sion
(H
YP-
SHK
) (9
)
Hyp
ovol
emic
sho
ck d
evel
oped
aft
er a
dmis
sion
(H
YP-
SHK
) (9
)
Rec
eive
d N
AS
G (
NA
SG
) (1
0)
R
ecei
ved
NA
SG
(N
AS
G)
(10)
R
ecei
ved
IV c
ryst
allo
id f
or m
anag
emen
t of
shoc
k (I
VC
-SH
K)
(11)
Rec
eive
d IV
cry
stal
loid
for
man
agem
ent o
f sh
ock
(IV
C-S
HK
) (1
1)
Pre
-ecl
amps
ia/e
clam
psia
ref
erre
d ou
t (E
CL
-R)
(12)
Pre
-ecl
amps
ia/e
clam
psia
ref
erre
d ou
t (E
CL
-R)
(12)
P
re-e
clam
psia
/ecl
amps
ia a
nd tr
eate
d (E
CL
-T )
(12
)
Pre
-ecl
amps
ia/e
clam
psia
and
trea
ted
(EC
L-T
) (
12)
Pre
-ecl
amps
ia/e
clam
psia
trea
ted
and
refe
rred
(E
CL
-T-R
) (1
2)
P
re-e
clam
psia
/ecl
amps
ia tr
eate
d an
d re
ferr
ed (
EC
L-T
-R)
(12)
R
efer
ral o
ut to
oth
er f
acil
itie
s of
cas
es w
ith
PP
H, P
PH
S, P
AH
or
OO
H
(RE
F-O
) (1
3)
R
efer
ral o
ut to
oth
er f
acil
itie
s of
cas
es w
ith
PP
H, P
PH
S, P
AH
or
OO
H (
RE
F-O
) (1
3)
Dea
th a
t thi
s fa
cili
ty (
DIE
D)
(14)
Dea
th a
t thi
s fa
cili
ty (
DIE
D)
(14)
N
um
ber
of
dea
ths
in t
his
rep
orti
ng
mon
th (
15)
T
otal
# o
f de
aths
:
D
eath
s fr
om
PP
H/P
PH
S:
Dea
ths
from
PA
H:
Dea
ths
from
EC
L:
Dea
ths
from
OO
H:
Dea
ths
from
OT
HE
R:
1 N
umbe
r in
Bol
d r
epre
sent
s th
e co
lum
n in
the
logb
ook
the
indi
cato
r is
ass
ocia
ted
wit
h
Tot
al#:
T
otal
#:
CC
A-P
PH
Pro
ject
, Pat
hfi
nd
er I
nte
rnat
ion
al
Tal
ly S
hee
ts
Tal
ly f
or w
omen
com
ing
dir
ectl
y to
th
e fa
cili
ty f
or r
elat
ed s
ervi
ces
Se
rvic
es/c
ondi
tions
T
ally
T
OT
AL
D
eliv
ered
out
side
of
a sk
illed
fac
ility
(O
F)
(3) 2
Arr
ived
in s
hock
(S
HK
) (4
)
U
se o
f bl
ood
drap
e (B
D)
(5)
Pos
tpar
tum
hem
orrh
age
aler
t (P
PH-A
) (3
50-4
99)
(6)
Pos
tpar
tum
hem
orrh
age
(PPH
) (5
00-9
99)
(6)
Pos
tpar
tum
hem
orrh
age
seve
re (
PPH
S)
(>10
00)
(6)
Pos
t-ab
orti
on h
emor
rhag
e (P
AH
) (6
)
O
ther
obs
tetr
ic h
emor
rhag
e (O
OH
) (6
)
R
ecei
ved
uter
oton
ic f
or m
anag
emen
t of
PP
H (
OX
Y)
(7)
Rec
eive
d ut
erot
onic
for
man
agem
ent o
f P
PH
(E
GT
) (7
)
R
ecei
ved
uter
oton
ic f
or m
anag
emen
t of
PP
H (
MIS
O)
(7)
Rec
eive
d IV
cry
stal
loid
in f
irst
hou
r fo
r m
anag
emen
t of
PP
H (
IVC
-PP
H)
(8)
Hyp
ovol
emic
sho
ck d
evel
oped
aft
er a
dmis
sion
(H
YP-
SHK
) (9
)
Rec
eive
d N
AS
G (
NA
SG
) (1
0)
Rec
eive
d IV
cry
stal
loid
for
man
agem
ent o
f sh
ock
(IV
C-S
HK
) (1
1)
Pre
-ecl
amps
ia/e
clam
psia
ref
erre
d ou
t (E
CL
-R)
(12)
P
re-e
clam
psia
/ecl
amps
ia a
nd tr
eate
d (E
CL
-T )
(12
)
P
re-e
clam
psia
/ecl
amps
ia tr
eate
d an
d re
ferr
ed (
EC
L-T
-R)
(12)
R
efer
ral o
ut to
oth
er f
acil
itie
s of
cas
es w
ith
PP
H, P
PH
S, P
AH
or
OO
H
(RE
F-O
) (1
3)
Dea
th a
t thi
s fa
cili
ty (
DIE
D)
(14)
Tal
ly f
or P
PH
, PA
H, E
CL
, OO
H c
ases
ref
erre
d t
o th
is f
acil
ity
from
an
oth
er f
acil
ity
2 N
umbe
r in
Bol
d r
epre
sent
s th
e co
lum
n in
the
logb
ook
the
indi
cato
r is
ass
ocia
ted
wit
h
Serv
ices
/con
ditio
ns
RIF
TA
LL
Y
TO
TA
L
Del
iver
ed o
utsi
de o
f a
skill
ed f
acili
ty (
OF
) (3
)
A
rriv
ed in
sho
ck (
SH
K)
(4)
Use
of
bloo
d dr
ape
(BD
) (5
)
P
ostp
artu
m h
emor
rhag
e al
ert (
PPH
-A)
(350
-499
) (6
)
P
ostp
artu
m h
emor
rhag
e (P
PH)
(500
-999
) (6
)
P
ostp
artu
m h
emor
rhag
e se
vere
(P
PHS
) (>
1000
) (6
)
P
ost-
abor
tion
hem
orrh
age
(PA
H)
(6)
Oth
er o
bste
tric
hem
orrh
age
(OO
H)
(6)
Rec
eive
d ut
erot
onic
for
man
agem
ent o
f P
PH
(O
XY
) (7
)
R
ecei
ved
uter
oton
ic f
or m
anag
emen
t of
PP
H (
EG
T)
(7)
Rec
eive
d ut
erot
onic
for
man
agem
ent o
f P
PH
(M
ISO
) (7
)
R
ecei
ved
IV c
ryst
allo
id in
fir
st h
our
for
man
agem
ent o
f P
PH
(IV
C-P
PH
) (8
)
H
ypov
olem
ic s
hock
dev
elop
ed a
fter
adm
issi
on (
HY
P-S
HK
) (9
)
R
ecei
ved
NA
SG
(N
AS
G)
(10)
R
ecei
ved
IV c
ryst
allo
id f
or m
anag
emen
t of
shoc
k (I
VC
-SH
K)
(11)
P
re-e
clam
psia
/ecl
amps
ia r
efer
red
out (
EC
L-R
) (1
2)
Pre
-ecl
amps
ia/e
clam
psia
and
trea
ted
(EC
L-T
) (
12)
Pre
-ecl
amps
ia/e
clam
psia
trea
ted
and
refe
rred
(E
CL
-T-R
) (1
2)
Ref
erra
l out
to o
ther
fac
ilit
ies
of c
ases
wit
h P
PH
, PP
HS
, PA
H o
r O
OH
(R
EF
-O)
(13)
Dea
th a
t thi
s fa
cili
ty (
DIE
D)
(14)
Tal
ly f
or P
PH
, PA
H, E
CL
, OO
H c
ases
ref
erre
d t
o th
is f
acil
ity
from
com
mu
nit
y Se
rvic
es/c
ondi
tions
R
IC T
AL
LY
T
OT
AL
D
eliv
ered
out
side
of
a sk
illed
fac
ility
(O
F)
(3)
Arr
ived
in s
hock
(S
HK
) (4
)
U
se o
f bl
ood
drap
e (B
D)
(5)
Pos
tpar
tum
hem
orrh
age
aler
t (P
PH-A
) (3
50-4
99)
(6)
Pos
tpar
tum
hem
orrh
age
(PPH
) (5
00-9
99)
(6)
Pos
tpar
tum
hem
orrh
age
seve
re (
PPH
S)
(>10
00)
(6)
Pos
t-ab
orti
on h
emor
rhag
e (P
AH
) (6
)
O
ther
obs
tetr
ic h
emor
rhag
e (O
OH
) (6
)
R
ecei
ved
uter
oton
ic f
or m
anag
emen
t of
PP
H (
OX
Y)
(7)
Rec
eive
d ut
erot
onic
for
man
agem
ent o
f P
PH
(E
GT
) (7
)
R
ecei
ved
uter
oton
ic f
or m
anag
emen
t of
PP
H (
MIS
O)
(7)
Rec
eive
d IV
cry
stal
loid
in f
irst
hou
r fo
r m
anag
emen
t of
PP
H (
IVC
-PP
H)
(8)
Hyp
ovol
emic
sho
ck d
evel
oped
aft
er a
dmis
sion
(H
YP-
SHK
) (9
)
Rec
eive
d N
AS
G (
NA
SG
) (1
0)
Rec
eive
d IV
cry
stal
loid
for
man
agem
ent o
f sh
ock
(IV
C-S
HK
) (1
1)
Pre
-ecl
amps
ia/e
clam
psia
ref
erre
d ou
t (E
CL
-R)
(12)
P
re-e
clam
psia
/ecl
amps
ia a
nd tr
eate
d (E
CL
-T )
(12
)
P
re-e
clam
psia
/ecl
amps
ia tr
eate
d an
d re
ferr
ed (
EC
L-T
-R)
(12)
R
efer
ral o
ut to
oth
er f
acil
itie
s of
cas
es w
ith
PP
H, P
PH
S, P
AH
or
OO
H (
RE
F-O
) (1
3)
Dea
th a
t thi
s fa
cili
ty (
DIE
D)
(14)
Clinical and Community Action to Address Postpartum Hemorrhage
Page 1 of 2 CCA-PPH Project, Pathfinder International - Secondary Facility Logbook Guidance and Definitions
Guidance and Definitions for Filling out Secondary Facility Logbook
Every patient coming to this facility for the following should be recorded in the logbook: 1. Childbirth delivery 2. With complications after childbirth (up to 42 days post-partum) 3. With complications after having a non-live birth outcome {miscarriage, stillbirth or unsafe abortion
(performed elsewhere)} up to 42 days post-partum
The following information corresponds to the column number in the log book.
1. Reference #: Number assigned to the patient by the facility. Use whatever number has been assigned to the patient according to the facility’s recording system.
Codes are assigned to columns 2 through 16. Use the corresponding codes to enter information in the logbook
2. Admission Type D- if direct admission (i.e. woman came on her own) R-I-F- if referred in by a private or public facility/private skilled provider/CHEW due to PPH, PPHS, PAH, ECL or OOH R-I-C- if referred in by community (chief, ASHA, TBA, other) due to PPH, PPHS, PAH, ECL or OOH 3. Delivery took place outside of a skilled facility OF- if patient delivered outside of a primary, secondary or tertiary facility N- if delivery took place in a primary, secondary or tertiary facility 4. Arrived in Shock SHK- if patient was already in hypovolemic shock secondary to hemorrhage when she was admitted to this institution either from home of from another facility N- if patient was not admitted with shock 5. PPH (postpartum hemorrhage)
N- if no clinical signs of PPH or if blood loss is <500 mL PPH- if blood loss after delivery is 500-999 mL and/or diagnosed by provider with PPH PPHS - severe PPH if blood loss after delivery is >1000 mL and/or diagnosed by provider with PPHS
PAH- post-abortion with hemorrhage (determined by clinical sign) OOH- if other obstetric hemorrhage (e.g. placenta previa or any other anomaly of placenta implantation)
6. Uterotonic received for management of PPH OXY- if Oxytocin received to manage bleeding due to PPH EGT- if Ergometrine received to manage bleeding due to PPH MISO- if Misoprostol received to manage bleeding due to PPH N- if no uterotonic was given to manage a woman who is experiencing PPH
7. Crystalloid (IV fluid) in first hour for management of PPH IVC-PPH- if Ringers Lactate, Hartmann’s Solution or Normal Saline is used for management of PPH
N- if no IV Crystalloid is used 8. Hypovolemic Shock (developed after admission) HYP-SHK- if clinical signs of decompensation of circulatory system due to excessive blood loss. Blood loss may be revealed (as in PPH from uterine atony) or partially concealed (as in abruption or ruptured uterus). Vital signs change so that the pulse is > 120 BPM, systolic blood pressure < 90 mmHG; the patient may become diaphoretic, confused, agitated or unconscious. N-if no signs of hypovolemic shock
Clinical and Community Action to Address Postpartum Hemorrhage
Page 2 of 2 CCA-PPH Project, Pathfinder International - Secondary Facility Logbook Guidance and Definitions
9. NASG (Non-Pneumatic Anti-shock Garment) Applied
NASG- if NASG applied before transfer N- if NASG not applied before transfer 10. Crystalloid (IV fluid) for the management of shock IVC- SHK if received Ringers Lactate, Hartmann’s Solution or Normal Saline for management of SHK N- if no IV Crystalloid is used 11. Blood Transfusion BL-TRNFS- if received a blood transfusion N- if no blood transfusion was recieved 12. Operations/Procedures HYST- if surgical removal of the uterus to stop intractable obstetrical hemorrhage C-Sec- if had C-section MRP- if placenta was manually removed to manage hemorrhage in the third stage of labor LAP- if intractable PPH was managed by open abdominal surgery to ligate uterine/internal iliac arteries or to repair a possible ueterine rupture N- if no procedure was preformed 13. ECL (pre-eclampsia/eclampsia) ECL-R- if pre-eclampsia (or eclampsia) and referred out to another facility ECL-T- if pre-eclampsia (or eclampsia) and treated at the facility ECL-T-R- if pre-eclampsia (or eclampsia) and treated at the facility and referred to higher level N– if no pre-eclampsia (or eclampsia) 14. Refer-Out for PPH, PPHS, PAH and OOH Ref-O- if referred out to other hospital for PPH, PPHS, PAH or OOH N- if no referral 15. Death (deaths that only occur at facility) Died- if the woman died N- if the woman survived 16. Obstetrical cause of death (if died, write obstetrical cause of death as one of the following categories) PPH/PPHS- if bleeding after delivery is > 500 mL PAH- if post-abortion hemorrhage ECL- if eclampsia OOH- if other obstetric hemorrhage (e.g. placenta previa or any other anomaly of placenta implantation) Other- if other causes
Ref
eren
ce #
Adm
issi
on ty
peD
eliv
ery
outs
ide
of a
sk
illed
faci
lity
Arr
ived
in s
hock
Hem
orrh
age
*see
def
initi
on fo
r gu
idan
ce
Ute
roto
nic
rece
ived
fo
r man
agem
ent o
f PP
H
Cry
stal
loid
(IV
fluid
s)
in fi
rst h
our f
or
man
agem
ent o
f PPH
Hyp
ovol
emic
sho
ck
(dev
elop
ed a
fter
adm
issi
on)
12
34
56
78
DO
FS
HK
N (<
500)
OX
YIV
C-P
PH
HY
P-S
HK
R-I-
FN
NP
PH
(500
-999
)E
GT
NN
R-I-
CP
PH
S (>
1000
)M
ISO
PA
HN
OO
H
Clin
ical
and
Com
mun
ity A
ctio
n to
Add
ress
Pos
tpar
tum
Hem
orrh
age
Sec
onda
ry-le
vel F
acili
ty P
atie
nt L
ogbo
okM
onth
:___
____
____
Yea
r: 20
____
__ N
ame
of F
acili
ty: _
____
____
____
____
____
____
____
___
City
: ___
____
____
____
_ S
tate
: ___
____
____
____
__
NA
SG a
pplie
d
Cry
stal
loid
(IV
fluid
s)
for m
anag
emen
t of
shoc
kB
lood
Tra
nsfu
sion
Ope
ratio
ns /
proc
edur
esEC
L (p
re-e
clam
psia
/ ec
lam
psia
)R
efer
-Out
for P
PH,
PPH
S, P
AH
, OO
HD
eath
at t
his
faci
lity
Obs
tetr
ical
cau
se o
f de
ath
910
1112
1314
1516
NA
SG
IVC
-SH
KB
L-TR
NFS
HY
ST
EC
L-R
RE
F-O
DIE
DP
PH
/PP
HS
N
NN
C-S
EC
EC
L-T
NN
PA
HM
RP
EC
L-T-
RE
CL
LAP
NO
OH
NO
THE
R
Clin
ical
and
Com
mun
ity A
ctio
n to
Add
ress
Pos
tpar
tum
Hem
orrh
age
Sec
onda
ry-l
evel
Fac
ilit
y M
onth
ly D
eliv
ery
Sta
tist
ics
M
onth
: ___
____
____
_ Y
ear:
20_
__ N
ame
of F
acili
ty: _
____
____
____
____
____
____
_ C
ity: _
____
____
____
___
Stat
e: _
____
____
___
Inst
ruct
ions
: Thi
s fo
rm is
for
rep
ortin
g m
onth
ly (
1) to
tal n
umbe
r of
wom
en w
ho c
ame
to th
e ho
spita
l for
del
iver
y or
oth
er r
elat
ed s
ervi
ces,
(2)
type
of
serv
ices
rec
eive
d by
wom
en, a
nd (
3)
cond
ition
s ob
serv
ed a
mon
g th
e w
omen
. The
for
m w
ill b
e fi
lled
in w
ith in
form
atio
n fr
om th
e F
acili
ty P
atie
nt L
ogbo
ok in
whi
ch a
bri
ef d
escr
ipti
on o
f ea
ch it
em is
giv
en. A
list
of
defi
nitio
ns o
f th
e ite
ms
is g
iven
in a
sep
arat
e pa
ge. T
he s
hade
d se
ctio
n of
the
tabl
e is
for
wom
en w
ho w
ere
refe
rred
by
PH
Cs,
ano
ther
SC
s, o
r fr
om c
omm
uniti
es. W
rite
the
tota
l num
ber
of
wom
en w
ho w
ere
refe
rred
to T
HIS
fac
ilit
y fr
om a
noth
er f
acili
ty o
r co
mm
unity
in th
e bo
x at
the
top
of th
e se
ctio
n. T
he o
ther
sec
tion
(to
the
left
of
the
shad
ed s
ectio
n) o
f th
e ta
ble
is f
or
thos
e w
omen
who
cam
e di
rect
ly to
the
faci
lity
(not
ref
erre
d) o
r ca
me
on th
eir
own.
Wri
te th
e to
tal n
umbe
r of
wom
en w
ho c
ame
dire
ctly
to T
HIS
fac
ility
in th
e bo
x at
the
top
of th
e se
ctio
n. T
he F
acili
ty P
atie
nt L
ogbo
ok is
to r
ecor
d da
ta f
or E
AC
H P
AT
IEN
T A
DM
ITT
ED
to th
e fa
cilit
y on
whi
ch S
ER
VIC
ES
SH
E R
EC
EIV
ED
and
/or
any
cond
ition
s SH
E H
AD
. T
rans
fer
the
data
fro
m th
e F
acili
ty P
atie
nt L
ogbo
ok o
nto
the
tally
she
ets
by m
akin
g a
tall
y m
ark
(/)
in th
e C
OL
UM
N n
ext t
o th
e co
rres
pond
ing
NA
ME
of
serv
ice
or c
ondi
tion.
Mak
e a
tall
y fo
r E
VE
RY
SE
RV
ICE
AN
D C
ON
DIT
ION
rec
eive
d by
EV
ER
Y P
AT
IEN
T a
s re
cord
ed in
the
mon
thly
logb
ook.
C
ount
the
MA
RK
S a
nd w
rite
the
TO
TA
L n
umbe
rs in
the
boxe
s in
th
e “T
otal
” co
lum
n on
this
she
et. N
ote
tota
ls f
or r
efer
red
from
ano
ther
fac
ility
(R
IF)
and
refe
rred
fro
m c
omm
unit
y (R
IC)
are
reco
rded
sep
arat
ely.
Num
ber
and
caus
es o
f de
aths
can
be
talli
ed a
s de
scri
bed
abov
e.
Tot
al n
umbe
r of
wom
en c
omin
g D
IRE
CT
LY
to th
e
Fac
ilit
y fo
r de
liver
y or
rel
ated
ser
vice
s:
Tot
al n
umbe
r of
PP
H, P
PH
S, P
AH
, EC
L o
r O
OH
cas
es r
efer
red
to
this
fac
ilit
y fr
om A
NO
TH
ER
FA
CIL
ITY
or
from
the
CO
MM
UN
ITY
: Se
rvic
es/c
ondi
tions
Tota
l Se
rvic
es/c
ondi
tions
RIF
(tot
al)
RIC
(tot
al)
Del
iver
ed o
utsi
de o
f a
skill
ed f
acili
ty (
OF
) (3
) 1
D
eliv
ered
out
side
of
a sk
illed
fac
ility
(O
F)
(3)
Arr
ived
in s
hock
(S
HK
) (4
)
Arr
ived
in s
hock
(S
HK
) (4
)
P
ostp
artu
m h
emor
rhag
e (P
PH)
(500
-999
) (5
)
Pos
tpar
tum
hem
orrh
age
(PPH
) (5
00-9
99)
(5)
Sev
ere
post
part
um h
emor
rhag
e (P
PHS)
( >
100
0) (
5)
S
ever
e po
stpa
rtum
hem
orrh
age
(PPH
S) (
> 1
000)
(5)
P
ost-
abor
tion
hem
orrh
age
(PA
H)
(5)
P
ost-
abor
tion
hem
orrh
age
(PA
H)
(5)
Oth
er o
bste
tric
hem
orrh
age
(OO
H)
(5)
O
ther
obs
tetr
ic h
emor
rhag
e (O
OH
) (5
)
U
tero
toni
c fo
r m
anag
emen
t of
PPH
(O
XY
) (6
)
Ute
roto
nic
for
man
agem
ent o
f P
PH (
OX
Y)
(6)
Ute
roto
nic
for
man
agem
ent o
f P
PH (
EG
T)
(6)
U
tero
toni
c fo
r m
anag
emen
t of
PPH
(E
GT
) (6
)
U
tero
toni
c fo
r m
anag
emen
t of
PPH
(M
ISO
) (6
)
Ute
roto
nic
for
man
agem
ent o
f P
PH (
MIS
O)
(6)
Rec
eive
d IV
cry
stal
loid
for
the
man
agem
ent o
f P
PH
(IV
C-P
PH
) (7
)
Rec
eive
d IV
cry
stal
loid
for
the
man
agem
ent o
f P
PH
(IV
C-P
PH
) (7
)
H
ypov
olem
ic s
hock
dev
elop
ed a
fter
adm
issi
on (
HY
P-S
HK
) (8
)
Hyp
ovol
emic
sho
ck d
evel
oped
aft
er a
dmis
sion
(H
YP
-SH
K)
(8)
NA
SG
App
lied
(N
ASG
) (9
)
NA
SG
App
lied
(N
ASG
) (9
)
R
ecei
ved
IV c
ryst
allo
id f
or th
e m
anag
emen
t of
shoc
k (I
VC
-SH
K)
(10)
R
ecei
ved
IV c
ryst
allo
id f
or th
e m
anag
emen
t of
shoc
k (I
VC
-SH
K)
(10)
Rec
eive
d bl
ood
tran
sfus
ion
(BL
-TR
NS
F)
(11)
Rec
eive
d bl
ood
tran
sfus
ion
(BL
-TR
NS
F)
(11)
H
ad o
pera
tion/
proc
edur
e do
ne (
HY
ST)
(12)
Had
ope
ratio
n/pr
oced
ure
done
(H
YST
) (1
2)
Had
ope
ratio
n/pr
oced
ure
done
(C
-Sec
) (1
2)
H
ad o
pera
tion/
proc
edur
e do
ne (
C-S
ec)
(12)
H
ad o
pera
tion/
proc
edur
e do
ne (
MR
P) (
12)
H
ad o
pera
tion/
proc
edur
e do
ne (
MR
P) (
12)
Had
ope
ratio
n/pr
oced
ure
done
(L
AP)
(12
)
Had
ope
ratio
n/pr
oced
ure
done
(L
AP)
(12
)
P
re-e
clam
psia
/ecl
amps
ia a
nd r
efer
red
out (
EC
L-R
) (1
3)
P
re-e
clam
psia
/ecl
amps
ia a
nd r
efer
red
out (
EC
L-R
) (1
3)
Pre
-ecl
amps
ia/e
clam
psia
trea
ted
(EC
L-T
) (1
3)
P
re-e
clam
psia
/ecl
amps
ia tr
eate
d (E
CL
-T)
(13)
P
re-e
clam
psia
/ecl
amps
ia tr
eate
d an
d re
ferr
ed o
ut (
EC
L-T
-R)
(13)
Pre
-ecl
amps
ia/e
clam
psia
trea
ted
and
refe
rred
out
(E
CL
-T-R
) (1
3)
Ref
erra
l to
othe
r fa
cili
ty o
f ca
ses
wit
h P
PH
, PP
HS
, PA
H o
r O
OH
(R
ef-
O)
(14)
Ref
erra
l to
othe
r fa
cili
ty o
f ca
ses
wit
h P
PH
, PP
HS
, PA
H o
r O
OH
(R
ef-O
) (1
4)
Dea
th a
t thi
s fa
cili
ty (
Die
d) (
15)
D
eath
at t
his
faci
lity
(D
ied)
(15
)
N
um
ber
of
dea
ths
in t
his
rep
orti
ng
mon
th (
16)
Tot
al #
of
deat
hs:
D
eath
s fr
om
PP
H/P
PH
S:
Dea
ths
from
P
AH
: D
eath
s fr
om
EC
L :
Dea
ths
from
O
OH
: D
eath
s fr
om
Oth
er:
1 T
he n
umbe
r in
Bol
d is
the
colu
mn
the
indi
cato
r is
ass
ocia
ted
with
in th
e lo
gboo
k
Tot
al#:
Tot
al#:
Clin
ical
and
Com
mun
ity A
ctio
n to
Add
ress
Pos
tpar
tum
Hem
orrh
age
T
ally
Sh
eets
T
ally
for
wom
en c
omin
g d
irec
tly
to t
he
faci
lity
for
rel
ated
ser
vice
s
Serv
ices
/con
ditio
ns
Ta
lly C
olum
n To
tal
Del
iver
ed o
utsi
de o
f a
skill
ed f
acili
ty (
OF
) (3
) 2
Arr
ived
in s
hock
(S
HK
) (4
)
P
ostp
artu
m h
emor
rhag
e (P
PH)
(500
-999
) (5
)
S
ever
e po
stpa
rtum
hem
orrh
age
(PPH
S) (
> 1
000)
(5)
P
ost-
abor
tion
hem
orrh
age
(PA
H)
(5)
Oth
er o
bste
tric
hem
orrh
age
(OO
H)
(5)
Ute
roto
nic
for
man
agem
ent o
f P
PH (
OX
Y)
(6)
Ute
roto
nic
for
man
agem
ent o
f P
PH (
EG
T)
(6)
Ute
roto
nic
for
man
agem
ent o
f P
PH (
MIS
O)
(6)
Rec
eive
d IV
cry
stal
loid
for
the
man
agem
ent o
f P
PH
(IV
C-P
PH
) (7
)
H
ypov
olem
ic s
hock
dev
elop
ed a
fter
adm
issi
on (
HY
P-S
HK
) (8
)
N
AS
G A
ppli
ed (
NA
SG)
(9)
Rec
eive
d IV
cry
stal
loid
for
the
man
agem
ent o
f sh
ock
(IV
C-S
HK
) (1
0)
Rec
eive
d bl
ood
tran
sfus
ion
(BL
-TR
NS
F)
(11)
H
ad o
pera
tion/
proc
edur
e do
ne (
HY
ST)
(12)
H
ad o
pera
tion/
proc
edur
e do
ne (
C-S
ec)
(12)
H
ad o
pera
tion/
proc
edur
e do
ne (
MR
P) (
12)
Had
ope
ratio
n/pr
oced
ure
done
(L
AP)
(12
)
P
re-e
clam
psia
/ecl
amps
ia a
nd r
efer
red
out (
EC
L-R
) (1
3)
Pre
-ecl
amps
ia/e
clam
psia
trea
ted
(EC
L-T
) (1
3)
Pre
-ecl
amps
ia/e
clam
psia
trea
ted
and
refe
rred
out
(E
CL
-T-R
) (1
3)
Ref
erra
l to
othe
r fa
cili
ty o
f ca
ses
wit
h P
PH
, PP
HS
, PA
H o
r O
OH
(R
ef-O
) (1
4)
Dea
th a
t thi
s fa
cili
ty (
Die
d) (
15)
Tal
ly f
or P
PH
, PA
H, E
CL
, OO
H c
ases
ref
erre
d t
o th
is f
acil
ity
from
an
oth
er f
acil
ity
Serv
ices
/con
ditio
ns
R
IF T
AL
LY
T
OT
AL
D
eliv
ered
out
side
of
a sk
illed
fac
ility
(O
F)
(3)
Arr
ived
in s
hock
(S
HK
) (4
)
P
ostp
artu
m h
emor
rhag
e (P
PH)
(500
-999
) (5
)
S
ever
e po
stpa
rtum
hem
orrh
age
(PPH
S) (
> 1
000)
(5)
P
ost-
abor
tion
hem
orrh
age
(PA
H)
(5)
Oth
er o
bste
tric
hem
orrh
age
(OO
H)
(5)
Ute
roto
nic
for
man
agem
ent o
f P
PH (
OX
Y)
(6)
Ute
roto
nic
for
man
agem
ent o
f P
PH (
EG
T)
(6)
Ute
roto
nic
for
man
agem
ent o
f P
PH (
MIS
O)
(6)
Rec
eive
d IV
cry
stal
loid
for
the
man
agem
ent o
f P
PH
(IV
C-P
PH
) (7
)
H
ypov
olem
ic s
hock
dev
elop
ed a
fter
adm
issi
on (
HY
P-S
HK
) (8
)
N
AS
G A
ppli
ed (
NA
SG)
(9)
Rec
eive
d IV
cry
stal
loid
for
the
man
agem
ent o
f sh
ock
(IV
C-S
HK
) (1
0)
2 T
he n
umbe
r in
Bol
d is
the
colu
mn
the
indi
cato
r is
ass
ocia
ted
with
in th
e lo
gboo
k
Rec
eive
d bl
ood
tran
sfus
ion
(BL
-TR
NS
F)
(11)
H
ad o
pera
tion/
proc
edur
e do
ne (
HY
ST)
(12)
H
ad o
pera
tion/
proc
edur
e do
ne (
C-S
ec)
(12)
H
ad o
pera
tion/
proc
edur
e do
ne (
MR
P) (
12)
Had
ope
ratio
n/pr
oced
ure
done
(L
AP)
(12
)
P
re-e
clam
psia
/ecl
amps
ia a
nd r
efer
red
out (
EC
L-R
) (1
3)
Pre
-ecl
amps
ia/e
clam
psia
trea
ted
(EC
L-T
) (1
3)
Pre
-ecl
amps
ia/e
clam
psia
trea
ted
and
refe
rred
out
(E
CL
-T-R
) (1
3)
Ref
erra
l to
othe
r fa
cili
ty o
f ca
ses
wit
h P
PH
, PP
HS
, PA
H o
r O
OH
(R
ef-O
) (1
4)
Dea
th a
t thi
s fa
cili
ty (
Die
d) (
15)
Tal
ly f
or P
PH
, PA
H, E
CL
, OO
H c
ases
ref
erre
d t
o th
is f
acil
ity
from
com
mu
nit
y Se
rvic
es/c
ondi
tions
RIC
TA
LL
Y
TO
TA
L
Del
iver
ed o
utsi
de o
f a
skill
ed f
acili
ty (
OF
) (3
)
A
rriv
ed in
sho
ck (
SH
K)
(4)
Pos
tpar
tum
hem
orrh
age
(PPH
) (5
00-9
99)
(5)
Sev
ere
post
part
um h
emor
rhag
e (P
PHS)
( >
100
0) (
5)
Pos
t-ab
orti
on h
emor
rhag
e (P
AH
) (5
)
O
ther
obs
tetr
ic h
emor
rhag
e (O
OH
) (5
)
U
tero
toni
c fo
r m
anag
emen
t of
PPH
(O
XY
) (6
)
U
tero
toni
c fo
r m
anag
emen
t of
PPH
(E
GT
) (6
)
U
tero
toni
c fo
r m
anag
emen
t of
PPH
(M
ISO
) (6
)
R
ecei
ved
IV c
ryst
allo
id f
or th
e m
anag
emen
t of
PP
H (
IVC
-PP
H)
(7)
Hyp
ovol
emic
sho
ck d
evel
oped
aft
er a
dmis
sion
(H
YP
-SH
K)
(8)
NA
SG
App
lied
(N
ASG
) (9
)
R
ecei
ved
IV c
ryst
allo
id f
or th
e m
anag
emen
t of
shoc
k (I
VC
-SH
K)
(10)
R
ecei
ved
bloo
d tr
ansf
usio
n (B
L-T
RN
SF
) (1
1)
Had
ope
ratio
n/pr
oced
ure
done
(H
YST
) (1
2)
Had
ope
ratio
n/pr
oced
ure
done
(C
-Sec
) (1
2)
Had
ope
ratio
n/pr
oced
ure
done
(M
RP)
(12
)
H
ad o
pera
tion/
proc
edur
e do
ne (
LA
P) (
12)
Pre
-ecl
amps
ia/e
clam
psia
and
ref
erre
d ou
t (E
CL
-R)
(13)
P
re-e
clam
psia
/ecl
amps
ia tr
eate
d (E
CL
-T)
(13)
P
re-e
clam
psia
/ecl
amps
ia tr
eate
d an
d re
ferr
ed o
ut (
EC
L-T
-R)
(13)
R
efer
ral t
o ot
her
faci
lity
of
case
s w
ith
PP
H, P
PH
S, P
AH
or
OO
H (
Ref
-O)
(14)
D
eath
at t
his
faci
lity
(D
ied)
(15
)
Clinical and Community Action to Address Postpartum Hemorrhage
Page 1 of 2 CCA-PPH Project - Tertiary Facility Logbook Guidance and Definitions
Guidance and Definitions for Filling out Tertiary Facility Logbook
Every patient coming to this facility for the following should be recorded in the logbook 1. Childbirth delivery 2. With complications after childbirth (up to 42 days post-partum) 3. With complications after having a non-live birth outcome {miscarriage, stillbirth or unsafe abortion
(performed elsewhere)}up to 42 days post-partum
The following information corresponds to the column number in the log book.
1. Reference #: Number assigned to the patient by the facility. Use whatever number has been assigned to the patient according to the facility’s recording system.
Codes are assigned to columns 2 through 16. Use the corresponding codes to enter information in the logbook
2. Admission Type D- if direct admission (i.e. woman came on her own) R-I-F- if referred in by a private or public facility/private skilled provider/CHEW due to PPH, PPHS, PAH, ECL or OOH R-I-C- if referred in by community (chief, ASHA, TBA, other) due to PPH, PPHS, PAH, ECL or OOH 3. Delivery took place outside of a skilled facility OF- if patient delivered outside of a primary, secondary or tertiary facility N- if delivery took place in a primary, secondary or tertiary facility 4. Arrived in Shock SHK- if patient was already in hypovolemic shock secondary to hemorrhage when she was admitted to this institution either from home of from another facility N- if patient was not admitted with shock 5. PPH (postpartum hemorrhage)
N- if no clinical signs of PPH or if blood loss is <500 mL PPH- if blood loss after delivery is 500-999 mL and/or diagnosed by provider with PPH PPHS - severe PPH if blood loss after delivery is >1000 mL and/or diagnosed by provider with PPHS
PAH- post-abortion with hemorrhage (determined by clinical sign) OOH- if other obstetric hemorrhage (e.g. placenta previa or any other anomaly of placenta implantation)
6. Uterotonic received for management of PPH OXY- if Oxytocin received to manage bleeding due to PPH EGT- if Ergometrine received to manage bleeding due to PPH MISO- if Misoprostol received to manage bleeding due to PPH N- if no uterotonic was given to manage a woman who is experiencing PPH
7. Crystalloid (IV fluid) in first hour for management of PPH IVC-PPH- if Ringers Lactate, Hartmann’s Solution or Normal Saline is used for management of PPH
N- if no IV Crystalloid is used 8. Hypovolemic Shock (developed after admission) HYP-SHK- if clinical signs of decompensation of circulatory system due to excessive blood loss. Blood loss may be revealed (as in PPH from uterine atony) or partially concealed (as in abruption or ruptured uterus). Vital signs change so that the pulse is > 120 BPM, systolic blood pressure < 90 mmHG; the patient may become diaphoretic, confused, agitated or unconscious. N-if no signs of hypovolemic shock
Clinical and Community Action to Address Postpartum Hemorrhage
Page 2 of 2 CCA-PPH Project - Tertiary Facility Logbook Guidance and Definitions
9. NASG (Non-Pneumatic Anti-shock Garment) Applied NASG- if NASG applied before transfer
N- if NASG not applied before transfer 10. Crystalloid (IV fluid) for the management of shock IVC- SHK if received Ringers Lactate, Hartmann’s Solution or Normal Saline for management of SHK N- if no IV Crystalloid is used 11. Blood Transfusion BL-TRNFS- if received a blood transfusion N- if no blood transfusion was recieved 12. Operations/Procedures HYST- if surgical removal of the uterus to stop intractable obstetrical hemorrhage C-Sec- if had C-section MRP- if placenta was manually removed to manage hemorrhage in the third stage of labor LAP- if intractable PPH was managed by open abdominal surgery to ligate uterine/internal iliac arteries or to repair a possible ueterine rupture N- if no procedure was preformed 13. ECL (pre-eclampsia/eclampsia) ECL-R- if pre-eclampsia (or eclampsia) and referred out to another facility ECL-T- if pre-eclampsia (or eclampsia) and treated at the facility ECL-T-R- if pre-eclampsia (or eclampsia) and treated at the facility and referred to higher level N– if no pre-eclampsia (or eclampsia) 14. Refer-Out for PPH, PPHS, PAH and OOH Ref-O- if referred out to other hospital for PPH, PPHS, PAH or OOH N- if no referral 15. Death (deaths that only occur at facility) Died- if the woman died N- if the woman survived 16. Obstetrical cause of death (if died, write obstetrical cause of death as one of the following categories) PPH/PPHS- if bleeding after delivery is > 500 mL PAH- if post-abortion hemorrhage ECL- if eclampsia OOH- if other obstetric hemorrhage (e.g. placenta previa or any other anomaly of placenta implantation) Other- if other causes
Ref
eren
ce #
Adm
issi
on ty
peD
eliv
ery
outs
ide
a sk
illed
faci
lity
Arr
ived
in s
hock
Hem
orrh
age
*see
def
initi
on fo
r gu
idan
ce
Ute
roto
nic
rece
ived
fo
r man
agem
ent o
f PP
H
Cry
stal
loid
(IV
fluid
s) in
firs
t hou
r fo
r man
agem
ent o
f PP
H
Hyp
ovol
emic
sh
ock
(dev
elop
ed
afte
r adm
issi
on)
12
34
56
78
DO
FS
HK
N (<
500)
OX
YIV
C-P
PH
HY
P-S
HK
R-I-
FN
NP
PH
(500
-999
)E
GT
NN
R-I-
CP
PH
S (>
1000
)M
ISO
PA
HN
OO
H
Clin
ical
and
Com
mun
ity A
ctio
n to
Add
ress
Pos
tpar
tum
Hem
orrh
age
Terti
ary-
leve
l Fac
ility
Pat
ient
Log
book
Mon
th:_
____
____
__ Y
ear:
20__
____
Nam
e of
Fac
ility
: ___
____
____
____
____
____
____
____
_ C
ity: _
____
____
____
___
Sta
te: _
____
____
____
____
NA
SG a
pplie
d
Cry
stal
loid
(IV
fluid
s) fo
r m
anag
emen
t of
shoc
kB
lood
Tra
nsfu
sion
Ope
ratio
ns /
proc
edur
es
ECL
(pre
-ec
lam
psia
/ ec
lam
psia
)R
efer
-Out
for P
PH,
PPH
S, P
AH
, OO
HD
eath
at t
his
faci
lity
Obs
tetr
ical
cau
se
of d
eath
910
1112
1314
1516
NA
SG
IVC
-SH
KB
L-TR
NFS
HY
ST
EC
L-R
RE
F-O
DIE
DP
PH
/PP
HS
N
NN
C-S
EC
EC
L-T
NN
PA
H
MR
PE
CL-
T-R
EC
L
LAP
NO
OH
NO
THE
R
Clin
ical
and
Com
mun
ity A
ctio
n to
Add
ress
Pos
tpar
tum
Hem
orrh
age
Ter
tiary
-lev
el F
acili
ty M
onth
ly D
eliv
ery
Sta
tistic
s
Mon
th: _
____
____
___
Yea
r: 2
0___
Nam
e of
Fac
ility
: ___
____
____
____
____
____
___
City
: ___
____
____
____
_ St
ate:
___
____
____
_ In
stru
ctio
ns: T
his
form
is f
or r
epor
ting
(1)
tota
l num
ber
of w
omen
who
cam
e to
the
hosp
ital f
or d
eliv
ery
serv
ices
, (2)
type
of
serv
ices
rec
eive
d by
wom
en, a
nd (
3) c
ondi
tion
s ob
serv
ed
Inst
ruct
ions
: Thi
s fo
rm is
for
rep
ortin
g m
onth
ly (
1) to
tal n
umbe
r of
wom
en w
ho c
ame
to th
e ho
spita
l for
del
iver
y or
oth
er r
elat
ed s
ervi
ces,
(2)
type
of
serv
ices
rec
eive
d by
wom
en, a
nd (
3)
cond
ition
s ob
serv
ed a
mon
g th
e w
omen
. The
for
m w
ill b
e fi
lled
in w
ith in
form
atio
n fr
om th
e F
acili
ty P
atie
nt L
ogbo
ok in
whi
ch a
bri
ef d
escr
ipti
on o
f ea
ch it
em is
giv
en. A
list
of
defi
nitio
ns o
f th
e ite
ms
is g
iven
in a
sep
arat
e pa
ge. T
he s
hade
d se
ctio
n of
the
tabl
e is
for
wom
en w
ho w
ere
refe
rred
by
PH
Cs,
ano
ther
SC
, or
from
com
mun
ities
. Wri
te th
e to
tal n
umbe
r of
w
omen
who
wer
e re
ferr
ed to
TH
IS f
acil
ity
from
ano
ther
fac
ility
or
com
mun
ity in
the
box
at th
e to
p of
the
sect
ion.
The
oth
er s
ectio
n (t
o th
e le
ft o
f th
e sh
aded
sec
tion)
of
the
tabl
e is
for
th
ose
wom
en w
ho c
ame
dire
ctly
to th
e fa
cilit
y (n
ot r
efer
red)
or
cam
e on
thei
r ow
n. W
rite
the
tota
l num
ber
of w
omen
who
cam
e di
rect
ly to
TH
IS f
acili
ty in
the
box
at th
e to
p of
the
sect
ion.
The
Fac
ility
Pat
ient
Log
book
is to
rec
ord
data
for
EA
CH
PA
TIE
NT
AD
MIT
TE
D to
the
faci
lity
on w
hich
SE
RV
ICE
S S
HE
RE
CE
IVE
D a
nd/o
r an
y co
nditi
ons
SHE
HA
D.
Tra
nsfe
r th
e da
ta f
rom
the
Fac
ility
Pat
ient
Log
book
ont
o th
e ta
lly s
heet
s by
mak
ing
a ta
lly
mar
k (/
) in
the
CO
LU
MN
nex
t to
the
corr
espo
ndin
g N
AM
E o
f se
rvic
e or
con
ditio
n. M
ake
a ta
lly
for
EV
ER
Y S
ER
VIC
E A
ND
CO
ND
ITIO
N r
ecei
ved
by E
VE
RY
PA
TIE
NT
as
reco
rded
in th
e m
onth
ly lo
gboo
k.
Cou
nt th
e M
AR
KS
and
wri
te th
e T
OT
AL
num
bers
in th
e bo
xes
in
the
“Tot
al”
colu
mn
on th
is s
heet
. Not
e to
tals
for
ref
erre
d fr
om a
noth
er f
acili
ty (
RIF
) an
d re
ferr
ed f
rom
com
mun
ity
(RIC
) ar
e re
cord
ed s
epar
atel
y. N
umbe
r an
d ca
uses
of
deat
hs c
an b
e ta
llied
as
desc
ribe
d ab
ove.
T
otal
num
ber
of w
omen
com
ing
DIR
EC
TL
Y to
the
faci
lity
for
del
iver
y
or r
elat
ed s
ervi
ces:
T
otal
num
ber
of P
PH
, PP
HS,
PA
H, E
CL
or
OO
H c
ases
ref
erre
d to
this
fac
ilit
y fr
om
AN
OT
HE
R F
AC
ILIT
Y o
r fr
om th
e C
OM
MU
NIT
Y :
Se
rvic
es/c
ondi
tions
Tota
l Se
rvic
es/c
ondi
tions
RIF
(tot
al)
RIC
(tot
al)
Del
iver
ed o
utsi
de o
f a
skill
ed f
acili
ty (
OF
) (3
) 1
D
eliv
ered
out
side
of
a sk
illed
fac
ility
(O
F)
(3)
Arr
ived
in s
hock
(S
HK
) (4
)
Arr
ived
in s
hock
(S
HK
) (4
)
P
ostp
artu
m h
emor
rhag
e (P
PH)
(500
-999
) (5
)
Pos
tpar
tum
hem
orrh
age
(PPH
) (5
00-9
99)
(5)
Sev
ere
post
part
um h
emor
rhag
e (P
PHS)
( >
100
0) (
5)
S
ever
e po
stpa
rtum
hem
orrh
age
(PPH
S) (
> 1
000)
(5)
P
ost-
abor
tion
hem
orrh
age
(PA
H)
(5)
P
ost-
abor
tion
hem
orrh
age
(PA
H)
(5)
Oth
er o
bste
tric
hem
orrh
age
(OO
H)
(5)
O
ther
obs
tetr
ic h
emor
rhag
e (O
OH
) (5
)
U
tero
toni
c fo
r m
anag
emen
t of
PPH
(O
XY
) (6
)
Ute
roto
nic
for
man
agem
ent o
f P
PH (
OX
Y)
(6)
Ute
roto
nic
for
man
agem
ent o
f P
PH (
EG
T)
(6)
U
tero
toni
c fo
r m
anag
emen
t of
PPH
(E
GT
) (6
)
U
tero
toni
c fo
r m
anag
emen
t of
PPH
(M
ISO
) (6
)
Ute
roto
nic
for
man
agem
ent o
f P
PH (
MIS
O)
(6)
Rec
eive
d IV
cry
stal
loid
for
the
man
agem
ent o
f P
PH
(IV
C-P
PH
) (7
)
Rec
eive
d IV
cry
stal
loid
for
the
man
agem
ent o
f P
PH
(IV
C-P
PH
) (7
)
H
ypov
olem
ic s
hock
dev
elop
ed a
fter
adm
issi
on (
HY
P-S
HK
) (8
)
Hyp
ovol
emic
sho
ck d
evel
oped
aft
er a
dmis
sion
(H
YP
-SH
K)
(8)
NA
SG
App
lied
(N
ASG
) (9
)
NA
SG
App
lied
(N
ASG
) (9
)
R
ecei
ved
IV c
ryst
allo
id f
or th
e m
anag
emen
t of
shoc
k (I
VC
-SH
K)
(10)
R
ecei
ved
IV c
ryst
allo
id f
or th
e m
anag
emen
t of
shoc
k (I
VC
-SH
K)
(10)
Rec
eive
d bl
ood
tran
sfus
ion
(BL
-TR
NS
F)
(11)
Rec
eive
d bl
ood
tran
sfus
ion
(BL
-TR
NS
F)
(11)
H
ad o
pera
tion/
proc
edur
e do
ne (
HY
ST)
(12)
Had
ope
ratio
n/pr
oced
ure
done
(H
YST
) (1
2)
Had
ope
ratio
n/pr
oced
ure
done
(C
-Sec
) (1
2)
H
ad o
pera
tion/
proc
edur
e do
ne (
C-S
ec)
(12)
H
ad o
pera
tion/
proc
edur
e do
ne (
MR
P) (
12)
H
ad o
pera
tion/
proc
edur
e do
ne (
MR
P) (
12)
Had
ope
ratio
n/pr
oced
ure
done
(L
AP)
(12
)
Had
ope
ratio
n/pr
oced
ure
done
(L
AP)
(12
)
P
re-e
clam
psia
/ecl
amps
ia a
nd r
efer
red
out (
EC
L-R
) (1
3)
P
re-e
clam
psia
/ecl
amps
ia a
nd r
efer
red
out (
EC
L-R
) (1
3)
Pre
-ecl
amps
ia/e
clam
psia
trea
ted
(EC
L-T
) (1
3)
P
re-e
clam
psia
/ecl
amps
ia tr
eate
d (E
CL
-T)
(13)
P
re-e
clam
psia
/ecl
amps
ia tr
eate
d an
d re
ferr
ed o
ut (
EC
L-T
-R)
(13)
Pre
-ecl
amps
ia/e
clam
psia
trea
ted
and
refe
rred
out
(E
CL
-T-R
) (1
3)
Ref
erra
l to
othe
r fa
cili
ty o
f ca
ses
wit
h P
PH
, PP
HS
, PA
H o
r O
OH
(R
ef-
O)
(14)
Ref
erra
l to
othe
r fa
cili
ty o
f ca
ses
wit
h P
PH
, PP
HS
, PA
H o
r O
OH
(R
ef-O
) (1
4)
Dea
th a
t thi
s fa
cili
ty (
Die
d) (
15)
D
eath
at t
his
faci
lity
(D
ied)
(15
)
N
um
ber
of
dea
ths
in t
his
rep
orti
ng
mon
th (
16)
Tot
al #
of
deat
hs:
D
eath
s fr
om
PP
H/P
PH
S:
Dea
ths
from
P
AH
: D
eath
s fr
om
EC
L :
Dea
ths
from
O
OH
: D
eath
s fr
om
Oth
er:
1 T
he n
umbe
r in
Bol
d is
the
colu
mn
the
indi
cato
r is
ass
ocia
ted
with
in th
e lo
gboo
k
CC
-PP
H P
roje
ct, P
ath
fin
der
In
tern
atio
nal
/Ind
ia/N
iger
ia
Tal
ly S
hee
ts
Tal
ly f
or w
omen
com
ing
dir
ectl
y to
th
e fa
cili
ty f
or r
elat
ed s
ervi
ces
Se
rvic
es/c
ondi
tions
Tally
Col
umn
TO
TA
L
Del
iver
ed o
utsi
de o
f a
skill
ed f
acili
ty (
OF
) (3
) 2
Arr
ived
in s
hock
(S
HK
) (4
)
P
ostp
artu
m h
emor
rhag
e (P
PH)
(500
-999
) (5
)
S
ever
e po
stpa
rtum
hem
orrh
age
(PPH
S) (
> 1
000)
(5)
P
ost-
abor
tion
hem
orrh
age
(PA
H)
(5)
Oth
er o
bste
tric
hem
orrh
age
(OO
H)
(5)
Ute
roto
nic
for
man
agem
ent o
f P
PH (
OX
Y)
(6)
Ute
roto
nic
for
man
agem
ent o
f P
PH (
EG
T)
(6)
Ute
roto
nic
for
man
agem
ent o
f P
PH (
MIS
O)
(6)
Rec
eive
d IV
cry
stal
loid
for
the
man
agem
ent o
f P
PH
(IV
C-P
PH
) (7
)
H
ypov
olem
ic s
hock
dev
elop
ed a
fter
adm
issi
on (
HY
P-S
HK
) (8
)
N
AS
G A
ppli
ed (
NA
SG)
(9)
Rec
eive
d IV
cry
stal
loid
for
the
man
agem
ent o
f sh
ock
(IV
C-S
HK
) (1
0)
Rec
eive
d bl
ood
tran
sfus
ion
(BL
-TR
NS
F)
(11)
H
ad o
pera
tion/
proc
edur
e do
ne (
HY
ST)
(12)
H
ad o
pera
tion/
proc
edur
e do
ne (
C-S
ec)
(12)
H
ad o
pera
tion/
proc
edur
e do
ne (
MR
P) (
12)
Had
ope
ratio
n/pr
oced
ure
done
(L
AP)
(12
)
P
re-e
clam
psia
/ecl
amps
ia a
nd r
efer
red
out (
EC
L-R
) (1
3)
Pre
-ecl
amps
ia/e
clam
psia
trea
ted
(EC
L-T
) (1
3)
Pre
-ecl
amps
ia/e
clam
psia
trea
ted
and
refe
rred
out
(E
CL
-T-R
) (1
3)
Ref
erra
l to
othe
r fa
cili
ty o
f ca
ses
wit
h P
PH
, PP
HS
, PA
H o
r O
OH
(R
ef-O
) (1
4)
Dea
th a
t thi
s fa
cili
ty (
Die
d) (
15)
Tal
ly f
or P
PH
, PA
H, E
CL
, OO
H c
ases
ref
erre
d t
o th
is f
acil
ity
from
an
oth
er f
acil
ity
Serv
ices
/con
ditio
ns
R
IF T
AL
LY
T
OT
AL
D
eliv
ered
out
side
of
a sk
illed
fac
ility
(O
F)
(3)
Arr
ived
in s
hock
(S
HK
) (4
)
P
ostp
artu
m h
emor
rhag
e (P
PH)
(500
-999
) (5
)
S
ever
e po
stpa
rtum
hem
orrh
age
(PPH
S) (
> 1
000)
(5)
P
ost-
abor
tion
hem
orrh
age
(PA
H)
(5)
Oth
er o
bste
tric
hem
orrh
age
(OO
H)
(5)
Ute
roto
nic
for
man
agem
ent o
f P
PH (
OX
Y)
(6)
Ute
roto
nic
for
man
agem
ent o
f P
PH (
EG
T)
(6)
Ute
roto
nic
for
man
agem
ent o
f P
PH (
MIS
O)
(6)
Rec
eive
d IV
cry
stal
loid
for
the
man
agem
ent o
f P
PH
(IV
C-P
PH
) (7
)
H
ypov
olem
ic s
hock
dev
elop
ed a
fter
adm
issi
on (
HY
P-S
HK
) (8
)
N
AS
G A
ppli
ed (
NA
SG)
(9)
Rec
eive
d IV
cry
stal
loid
for
the
man
agem
ent o
f sh
ock
(IV
C-S
HK
) (1
0)
2 T
he n
umbe
r in
Bol
d is
the
colu
mn
the
indi
cato
r is
ass
ocia
ted
with
in th
e lo
gboo
k
Rec
eive
d bl
ood
tran
sfus
ion
(BL
-TR
NS
F)
(11)
H
ad o
pera
tion/
proc
edur
e do
ne (
HY
ST)
(12)
H
ad o
pera
tion/
proc
edur
e do
ne (
C-S
ec)
(12)
H
ad o
pera
tion/
proc
edur
e do
ne (
MR
P) (
12)
Had
ope
ratio
n/pr
oced
ure
done
(L
AP)
(12
)
P
re-e
clam
psia
/ecl
amps
ia a
nd r
efer
red
out (
EC
L-R
) (1
3)
Pre
-ecl
amps
ia/e
clam
psia
trea
ted
(EC
L-T
) (1
3)
Pre
-ecl
amps
ia/e
clam
psia
trea
ted
and
refe
rred
out
(E
CL
-T-R
) (1
3)
Ref
erra
l to
othe
r fa
cili
ty o
f ca
ses
wit
h P
PH
, PP
HS
, PA
H o
r O
OH
(R
ef-O
) (1
4)
Dea
th a
t thi
s fa
cili
ty (
Die
d) (
15)
Tal
ly f
or P
PH
, PA
H, E
CL
, OO
H c
ases
ref
erre
d t
o th
is f
acil
ity
from
com
mu
nit
y Se
rvic
es/c
ondi
tions
RIC
TA
LL
Y
TO
TA
L
Del
iver
ed o
utsi
de o
f a
skill
ed f
acili
ty (
OF
) (3
)
A
rriv
ed in
sho
ck (
SH
K)
(4)
Pos
tpar
tum
hem
orrh
age
(PPH
) (5
00-9
99)
(5)
Sev
ere
post
part
um h
emor
rhag
e (P
PHS)
( >
100
0) (
5)
Pos
t-ab
orti
on h
emor
rhag
e (P
AH
) (5
)
O
ther
obs
tetr
ic h
emor
rhag
e (O
OH
) (5
)
U
tero
toni
c fo
r m
anag
emen
t of
PPH
(O
XY
) (6
)
U
tero
toni
c fo
r m
anag
emen
t of
PPH
(E
GT
) (6
)
U
tero
toni
c fo
r m
anag
emen
t of
PPH
(M
ISO
) (6
)
R
ecei
ved
IV c
ryst
allo
id f
or th
e m
anag
emen
t of
PP
H (
IVC
-PP
H)
(7)
Hyp
ovol
emic
sho
ck d
evel
oped
aft
er a
dmis
sion
(H
YP
-SH
K)
(8)
NA
SG
App
lied
(N
ASG
) (9
)
R
ecei
ved
IV c
ryst
allo
id f
or th
e m
anag
emen
t of
shoc
k (I
VC
-SH
K)
(10)
R
ecei
ved
bloo
d tr
ansf
usio
n (B
L-T
RN
SF
) (1
1)
Had
ope
ratio
n/pr
oced
ure
done
(H
YST
) (1
2)
Had
ope
ratio
n/pr
oced
ure
done
(C
-Sec
) (1
2)
Had
ope
ratio
n/pr
oced
ure
done
(M
RP)
(12
)
H
ad o
pera
tion/
proc
edur
e do
ne (
LA
P) (
12)
Pre
-ecl
amps
ia/e
clam
psia
and
ref
erre
d ou
t (E
CL
-R)
(13)
P
re-e
clam
psia
/ecl
amps
ia tr
eate
d (E
CL
-T)
(13)
P
re-e
clam
psia
/ecl
amps
ia tr
eate
d an
d re
ferr
ed o
ut (
EC
L-T
-R)
(13)
R
efer
ral t
o ot
her
faci
lity
of
case
s w
ith
PP
H, P
PH
S, P
AH
or
OO
H (
Ref
-O)
(14)
D
eath
at t
his
faci
lity
(D
ied)
(15
)