Prenatal Health History Checklist
Checklists
Obie Editorial Team
During the first prenatal visit, a prenatal health history is taken to give the doctor insight into any potential problems that may be faced during the pregnancy. The prenatal health history includes mother, father, siblings, children, and grandparents. Health problems facing other blood relatives may also be pertinent. When visiting the doctor for the first time, gather all available information to complete detailed prenatal health history. Even the smallest details of birth-related problems, difficulty with pregnancy, multiple births, and illnesses are important.
Print out this checklist to take to your doctor or midwife!
Allergies
Illnesses suffered as a child
Previous medical conditions
Chronic illnesses
Hospital stays
Minor surgical operations
Major surgical operations
Anesthesia history
Accidents requiring hospitalization
Current prescription medications
Current over the counter medications
Previous prescription medications
Medication based creams and lotions both prescription and non-prescription
Smoking
Drinking
Eating habits
Weight loss
Weight gain
Previous full-term pregnancies
Previous aborted pregnancies
Miscarriages
Multiple pregnancies
Cycle- normal or abnormal
Blood flow – normal or abnormal
Endometriosis
Pelvic inflammatory disease
Other gynecological problems
History of all infectious diseases both cures and ongoing
Date of last period
Date of positive pregnancy test
Cramping
Bleeding
Vaginal discharge
Chronic illnesses
Pregnancy complications
Multiple births
Ethnic background
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