Pengisian Data Surveilans Kematian Ibu

PENGISIAN DATA SURVEILANS KEMATIAN IBU
Kabupaten:
Periode Laporan:
Jumlah Kematian:
Bagian dalam formulir ini:

Formulir yang diisi:
Tempat tinggal:
Identitas:
Sosio-demografik:
Riwayat obstetrik:
Informasi waktu dan tempat meninggal:
Antenatal care:
Informasi persalinan:
Rujukan:
Masalah non-medis:
Diagnosa:
Penyebab kematian:
Hasil pengkajian AMP:
ID KASUS
Formulir yang diisi:
OVM
RMM
RMMP
Pengkajian AMP
Tempat Tinggal:
Desa
Kecamatan
Status Kependudukan
Sosial - Domografik:
Usia Ibu
Pendidikan Ibu
Pendidikan Suami
Penyebab kematian
Penyebab obtetri primer
Penyebab akhir
Faktor penyumbang
EMATIAN IBU
Sudah jelas
Jumlah kematian ibu yang terjadi pada periode laporan
Sudah jelas
Isi berdasarkan OVM
Isi berdasarkan OVM
Isi berdasarkan OVM
Isi berdasarkan OVM
Isi berdasarkan RMM
Isi berdasarkan OVM
Isi berdasarkan RMM/RMMP/OVM
Isi berdasarkan OVM/RMMP/RMM
Isi berdasarkan OVM
Isi berdasarkan RMM dan OVM
Isi berdasarkan RMM
Isi berdasarkan RMP
Terdiri dari 10 kolom

Pengisian dilakukan dari kolom paling kiri ke kanan
Kolom 1-2: diisi dengan 2 digit tahun kejadian kematian ibu (2018 ditulis 18)
Kolom 3-4: diisi dengan 2 digit kode provinsi sesuai BPS
Kolom 5-6: diisi dengan 2 digit kode kab/kota sesuai BPS
Kolom 7-10: diisi dengan 4 digit nomor urut kasus kematian ibu di kabupaten pada tahun
tersebut (Kasus 1 ditulis 0001)
ID Kasus pada setiap kasus berlaku pada semua formulir AMP milik kasus
Pada bagian ini, hanya ingin mengetahui formulir yang dimiliki (artinya terisi) kasus, tanpa
melihat kelengkapan pengisian
Diisi dengan kode "Dilakukan" atau "Tidak"
Diisi dengan kode "Dilakukan" atau "Tidak". Jika kasus tidak mendapatkan pelayanan kesehatan
dari fasilitas kesehatan lain, isi kolom denngan kode "Tidak Ada Fasilitas Perantara"
Diisi dengan xxx digit kode desa sesuai BPS

Diisi dengan 2 digit kode kecamatan sesuai BPS
Diisi dengan kode, berdasarkan domisili kasus sesuai dengan kartu identitas kependudukan (KTP)
`
cth:
Formulir yang diisi Tempat tinggal Sosio-d
1 2 3 4 5 6 7 8 9 10
Status
ID KASUS OVM RMM RMMP PM RPM Desa Kecamatan Penduduk Usia ibu
1=Penduduk
dalam wilayah
1=Dilakukan
1=Dilakukan kabupaten
2=Tidak
1=Dilakukan 2=Tidak 1=Dilakukan 1=Dilakukan ditulis nama Diisi berdasarkan 2=Penduduk luar (tahun)
7=Tidak ada
2=Tidak 7=Kematian 2=Tidak 2=Tidak desa Kode BPS wilayah
fasilitas
bukan di fasilitas kabupaten
perantara 3=Penduduk luar
wilayah provinsi
1931750001 1 1 1 11 masa depan 1 1 35

Sosio-demografik Riwayat obstetrik Informasi waktu dan tempat
11 12 13 14 15 16 17 18 19
Pendidikan ibu Pendidikan suami Usia

(yang ditamatkan) (yang ditamatkan) G P A Tanggal meninggal Periode kematian kehamilan Tempat meninggal
1=Rumah sendiri/keluarga
(tgl/bln/thn jam:menit) 2=Rumah dukun
1=Tidak Sekolah 3=Polindes
1=Tidak Sekolah 2=SD/sederajat 1=Saat hamil 4=Pustu
2=SD/sederajat (minggu)
3=SMP/sederajat 2=Saat melahirkan 5=Rumah Bidan (termasuk
3=SMP/sederajat 4=SMA/sederajat ISI DENGAN 00:00 JIKA 3=Sesudah melahirkan Praktek Mandiri Bidan)
4=SMA/sederajat ISI '99' JIKA
5=Akademi/Universitas JAM TIDAK DIKETAHUI. 9=Tidak tahu 6=Puskesmas
5=Akademi/Universitas TIDAK TAHU.
8=Ibu tidak menikah/cerai TULIS TANDA (-) JIKA 7=RS
9=Tidak tahu 9=Tidak tahu TANGGAL TIDAK 8=Dalam perjalanan ke
DIKETAHUI fasilitas
9=Lainnya
1 1 2 1 0 3/1/2018 16:00 1 34 7
formasi waktu dan tempat meninggal Antenatal care (ANC)
20 21 22 23 24
Jika meninggal di faskes, isi: Jumlah ANC
Apakah Apakah
meninggal mendapat
Tanggal dan jam masuk faskes Tanggal dan jam keluar faskes Lama rawat pelayanan
dalam 24 jam Trimester 1 Trimester 2 Trimester 3
terakhir terakhir (dalam JAM) antenatal?
masuk faskes?
(tgl/bln/thn jam:menit)
(tgl/bln/thn jam:menit)
SAMA DENGAN TANGGAL KEMATIAN
JIKA PASIEN MENINGGAL DI FASKES 1=Ya
TERAKHIR. 2=Tidak
PERHITUNGAN 7=Tidak dirujuk 1=Ya
ISI DENGAN 00:00 JIKA JAM TIDAK 2=Tidak
ISI DENGAN 00:00 JIKA JAM TIDAK OTOMATIS ke faskes
DIKETAHUI. 9=Tidak tahu
DIKETAHUI. 9=Tidak bisa
TULIS TANDA (-) JIKA TANGGAL TIDAK TULIS TANDA (-) JIKA TANGGAL TIDAK ditentukan
DIKETAHUI. DIKETAHUI.
ISI BERDASARKAN FORM RMM. ISI BERDASARKAN FORM RMM.
28/02/2018 3/1/2018 16:00 22.92 1 1 1 1 2

Informasi Persalinan
24 25 26 27 28
Tanggal persalinan Cara persalinan Tempat persalinan Penolong persalinan Kondisi bayi saat dilahirkan?
bayi 1 bayi 2 bayi 1 bayi 2 bayi 1 bayi 2 bayi 1 bayi 2 Bayi 1
1=Rumah sendiri/keluarga
1=Spontan/Normal 2=Rumah dukun 1=Dukun 1=Lahir hidup
2=Vakum/forsep 3=Polindes 2=Keluarga 2=Lahir mati (still birth)
3=Ekstraksi Bokong 4=Pustu 3=Bidan 7=Meninggal dalam kandungan (IUFD)
(tgl/bln/thn) (tgl/bln/thn) 4=Versi ekstraksi 5=Rumah Bidan 4=Dokter
5=Embriotomi/dekapitasi/eviserasi 6=RS 5=SpOG
ISI BERDASARKAN OVM DAN RMM.
6=Seksio sesarea/per abdominam 7=Dalam perjalanan ke fasilitas 6=Lainnya
7=Meninggal saat hamil 8=Lainnya 7=Meninggal saat hamil
77=Meninggal saat hamil
0 0 7 7 0 0 0 0
Rujukan Masalah no
28 29 30 31 32 33
ondisi bayi saat dilahirkan?
Total faskes (atau HITUNG:
Total orang/
tempat yang nakes) yang Kapan mencari pertolongan pertama? Waktu sejak mencari pertolongan Terlambat
ditemui/memberi dikunjungi/ (tanggal dan jam) pertama hingga meninggal mencari
Bayi 2 memberi bantuan
pertolongan pertolongan (dalam HARI)
HITUNG SEMUA (tgl/bln/thn jam:menit)

ORANG/TEMPAT,
hir hidup BAIK ITU HITUNG HANYA BAGIAN RUJUKAN POIN C PADA
hir mati (still birth)
eninggal dalam kandungan (IUFD) FASKES/NAKES FASKES/NAKES. TEMPAT/ORANG PERTAMA YANG DIKUNJUNGI 1=Ya
MAUPUN BUKAN ATAU DICARI. BUKAN JAM KEMATIAN. OTOMATIS TERISI. 2=Tidak
FASKES/NAKES. ISI '99' JIKA TIDAK 9=Tidak tahu
ERDASARKAN OVM DAN RMM. TAHU. ISI DENGAN 00:00 JIKA JAM TIDAK DIKETAHUI.
ISI '99' JIKA TIDAK TULIS TANDA (-) JIKA TANGGAL TIDAK
TAHU. DIKETAHUI.
2/27/2018 13:32 2.10

Masalah non-medis Diagnosa Penyebab kematian
34 35 36 37 38 39 40 41 42
Tidak tersedia Penyebab

Menolak Kesulitan Lokasi fasilitas biaya Dx saat meninggal Dx saat meninggal obstetrik Penyebab Faktor
pengobatan mendapatkan yang sulit persalinan/ (OVM) (Rekam Medis) - RMM primer akhir penyumbang
transportasi dijangkau rujukan (ICD10MM)
1=Ya 1=Ya 1=Ya 1=Ya ISI BERDASARKAN FORM PM ATAU RPM (JIKA ADA) .
BISA DIAMBIL DARI
2=Tidak 2=Tidak 2=Tidak 2=Tidak JIKA TIDAK ADA FORM PM/RPM, ISI BERDASARKAN
BAGIAN INFORMASI
9=Tidak tahu 9=Tidak tahu 9=Tidak tahu 9=Tidak tahu FORM RMM.
KEMATIAN DI RMM .
Penyebab kematian
43 44 45 46 47 48
Keterlambatan
Apakah kematian pada
Penyebab non obstetrik (penyakit yang
diderita sebelumnya atau infeksi yang kasus ini dapat
tidak terkait dengan kehamilan) dihindarkan? Masalah
(sesuai standar pelayanan Terlambat 1 Terlambat 2 Terlambat 3 pribadi
di RPM)
1=Ya 1=Ya, hanya 1 faktor 1=Ya, hanya 1 faktor 1=Ya, hanya 1 faktor 1=Ya
LIHAT TABEL MASALAH OBSETRIK PRIMER 2=Tidak 2=Ya, lebih dari 1 faktor 2=Ya, lebih dari 1 faktor 2=Ya, lebih dari 1 faktor 2=Tidak
PADA FORM PM. 9=Tidak tahu 0=tidak ada 0=tidak ada 0=tidak ada 9=Tidak tahu
Hasil pengkajian Audit Maternal Perinatal (AMP)
49 50 51 52 53 54 55 56 57
Faktor yang dapat dihindarkan
Hambatan untuk Kurangnya Kurangnya fasilitas Kurangnya petugas/staf

asuhan kesehatan Masalah untuk
Masalah Masalah Masalah rawat-inap di akses atau yang mendapat pelatihan Masalah
(termasuk asuhan
keluarga masyarakat transportasi rumah sakit atau keterjangkau yang diperlukan (termasuk komunikasi
berfungsinya antenatal
klinik an berfungsinya petugas)
fasilitas)
1=Ya 1=Ya 1=Ya 1=Ya 1=Ya 1=Ya 1=Ya 1=Ya 1=Ya

2=Tidak 2=Tidak 2=Tidak 2=Tidak 2=Tidak 2=Tidak 2=Tidak 2=Tidak 2=Tidak
9=Tidak tahu 9=Tidak tahu 9=Tidak tahu 9=Tidak tahu 9=Tidak tahu 9=Tidak tahu 9=Tidak tahu 9=Tidak tahu 9=Tidak tahu
58 59 60 61
target rekomendasi
Masalah untuk Masalah untuk asuhan Tindakan tidak profesional

asuhan individu fasyankes dinkes pemda masyara lainnya
postpartum tenaga kesehatan kat
intrapartum
1=Ya 1=Ya 1=Ya 1=Ya 1=Ya 1=Ya 1=Ya 1=Ya 1=Ya

2=Tidak 2=Tidak 2=Tidak 2=Tidak 2=Tidak 2=Tidak 2=Tidak 2=Tidak 2=Tidak
9=Tidak tahu 9=Tidak tahu 9=Tidak tahu
62
Rekomendasi singkat
RINGKASAN POIN PENTING DARI

REKOMENDASI YANG DIBUAT TIM PENGKAJI
(SESUAI TARGET REKOMENDASI)
1 2 3 4 5 6 7 8
9 10 11 12 13
READ ME
The WHO Application of ICD-10 to deaths during pregnancy, childbirth and the
puerperium: ICD-MM
Listing of ICD 10 codes for chapter 15

ICD 10 codes in Chapter 15 have been assigned to classification groups according to ICD MM
It is possible to search by ICD code or by classifcation group
group 9 is not represented here because these are "coincidental" deaths
the group "morbidity" denotes codes for contributory conditions
the annex contains codes for late maternal deaths
Please note:
1. for purpose of classification obstructed labour codes (O 62 to O 66) should be considered contributory causes
if no other information is given then these deaths will be considered direct maternal deaths
2. suicide is considered a direct maternal death but coded under X60-X84
ICD-10 Code, Title Classification title of group
2010 edition group number
O00 Ectopic pregnancy 1 pregnancy with abortive outcome
O00.0 Abdominal pregnancy 1 pregnancy with abortive outcome
O00.1 Tubal pregnancy 1 pregnancy with abortive outcome
O00.2 Ovarian pregnancy 1 pregnancy with abortive outcome
O00.8 Other ectopic pregnancy 1 pregnancy with abortive outcome
O00.9 Ectopic pregnancy, unspecified 1 pregnancy with abortive outcome
O01 Hydatidiform mole 1 pregnancy with abortive outcome
O01.0 Complete hydatidiform mole 1 pregnancy with abortive outcome
O01.1 Incomplete and partial hydatidiform 1 pregnancy with abortive outcome
mole
O01.9 Hydatidiform mole, unspecified 1 pregnancy with abortive outcome
O02 Other abnormal products of 1 pregnancy with abortive outcome
conception
O02.0 Blighted ovum and nonhydatidiform 1 pregnancy with abortive outcome
mole
O02.1 Missed abortion 1 pregnancy with abortive outcome
O02.8 Other specified abnormal products of 1 pregnancy with abortive outcome
conception
O02.9 Abnormal product of conception, 1 pregnancy with abortive outcome
unspecified
O03 Spontaneous abortion 1 pregnancy with abortive outcome
O03.0 Spontaneous abortion : incomplete, 1 pregnancy with abortive outcome
complicated by genital tract and
pelvic infection
complicated by delayed or excessive
haemorrhage
complicated by embolism
with other and unspecified
complications
without complication
O03.5 Spontaneous abortion : complete or 1 pregnancy with abortive outcome
unspecified, complicated by genital
tract and pelvic infection
unspecified, complicated by delayed
or excessive haemorrhage
unspecified, complicated by
embolism
unspecified, with other and
unspecified complications
unspecified, without complication
O04 Induced abortion 1 pregnancy with abortive outcome
O04.0 Medical abortion : incomplete, 1 pregnancy with abortive outcome
pelvic infection
haemorrhage
O04.3 Medical abortion : incomplete, with 1 pregnancy with abortive outcome
other and unspecified complications
O04.5 Medical abortion : complete or 1 pregnancy with abortive outcome
embolism
O05 Complications following abortion and 1 pregnancy with abortive outcome
ectopic and molar pregnancy
O05.0 Other abortion : incomplete, 1 pregnancy with abortive outcome
pelvic infection
haemorrhage
O05.3 Other abortion : incomplete, with 1 pregnancy with abortive outcome
other and unspecified complications
O05.4 Other abortion : incomplete, without 1 pregnancy with abortive outcome
complication
O05.5 Other abortion : complete or 1 pregnancy with abortive outcome
embolism
O06 Unspecified abortion 1 pregnancy with abortive outcome
O06.0 Unspecified abortion : incomplete, 1 pregnancy with abortive outcome
pelvic infection
haemorrhage
with other and unspecified
complications
O06.5 Unspecified abortion : complete or 1 pregnancy with abortive outcome
embolism
O07 Failed attempted abortion 1 pregnancy with abortive outcome
O07.0 Failed medical abortion, complicated 1 pregnancy with abortive outcome
by genital tract and pelvic infection
by delayed or excessive
haemorrhage
by embolism
O07.3 Failed medical abortion, with other 1 pregnancy with abortive outcome
and unspecified complications
O07.4 Failed medical abortion, without 1 pregnancy with abortive outcome
complication
O07.5 Other and unspecified failed 1 pregnancy with abortive outcome
attempted abortion, complicated by
genital tract and pelvic infection
delayed or excessive haemorrhage
embolism
attempted abortion, with other and
attempted abortion, without
complication
O11-O16 Oedema, proteinuria and 2 hypertensive disorders in pregnnacy, childbirth, and
hypertensive disorders in pregnancy, the puerperium
childbirth and the puerperium
O11 Pre-eclampsia superimposed on 2 hypertensive disorders in pregnnacy, childbirth, and

chronic hypertension the puerperium
O12 Gestational [pregnancy-induced] 2 hypertensive disorders in pregnnacy, childbirth, and
oedema and proteinuria without the puerperium
hypertension
O12.0 Gestational oedema 2 hypertensive disorders in pregnnacy, childbirth, and
the puerperium
O12.1 Gestational proteinuria 2 hypertensive disorders in pregnnacy, childbirth, and
the puerperium
O12.2 Gestational oedema with proteinuria 2 hypertensive disorders in pregnnacy, childbirth, and
the puerperium
O13 Gestational [pregnancy-induced] 2 hypertensive disorders in pregnnacy, childbirth, and
hypertension the puerperium
O14 Pre-eclampsia 2 hypertensive disorders in pregnnacy, childbirth, and
the puerperium
O14.0 Mild pre-eclampsia 2 hypertensive disorders in pregnnacy, childbirth, and
the puerperium
O14.1 Severe pre-eclampsia 2 hypertensive disorders in pregnnacy, childbirth, and
the puerperium
HELLP syndrome 2 hypertensive disorders in pregnnacy, childbirth, and
O14.2 the puerperium
O14.9 Pre-eclampsia, unspecified 2 hypertensive disorders in pregnnacy, childbirth, and
the puerperium
O15 Eclampsia 2 hypertensive disorders in pregnnacy, childbirth, and
the puerperium
O15.0 Eclampsia in pregnancy 2 hypertensive disorders in pregnnacy, childbirth, and
the puerperium
O15.1 Eclampsia in labour 2 hypertensive disorders in pregnnacy, childbirth, and
the puerperium
O15.2 Eclampsia in the puerperium 2 hypertensive disorders in pregnnacy, childbirth, and
the puerperium
O15.9 Eclampsia, unspecified as to time 2 hypertensive disorders in pregnnacy, childbirth, and
period the puerperium
O16 Unspecified maternal hypertension 2 hypertensive disorders in pregnnacy, childbirth, and
the puerperium
O20 Haemorrhage in early pregnancy 3 obstetric haemorrhage
O20.0 Threatened abortion 3 obstetric haemorrhage
O20.8 Other haemorrhage in early 3 obstetric haemorrhage
pregnancy
O20.9 Haemorrhage in early pregnancy, 3 obstetric haemorrhage
unspecified
O43 Placental disorders 3 obstetric haemorrhage
O43.2 Morbidly adherent placenta 3 obstetric haemorrhage
O44 Placenta praevia 3 obstetric haemorrhage
O44.1 Placenta praevia with haemorrhage 3 obstetric haemorrhage
O45 Premature separation of placenta 3 obstetric haemorrhage
[abruptio placentae]
O45.0 Premature separation of placenta 3 obstetric haemorrhage
with coagulation defect
O45.8 Other premature separation of 3 obstetric haemorrhage
placenta
O45.9 Premature separation of placenta, 3 obstetric haemorrhage
unspecified
O46 Antepartum haemorrhage, not 3 obstetric haemorrhage
elsewhere classified
O46.0 Antepartum haemorrhage with 3 obstetric haemorrhage
coagulation defect
O46.8 Other antepartum haemorrhage 3 obstetric haemorrhage
O46.9 Antepartum haemorrhage, 3 obstetric haemorrhage
unspecified
O67 Labour and delivery complicated by 3 obstetric haemorrhage
intrapartum haemorrhage, not
O67.0 Intrapartum haemorrhage with 3 obstetric haemorrhage
coagulation defect
O67.8 Other intrapartum haemorrhage 3 obstetric haemorrhage
O67.9 Intrapartum haemorrhage, 3 obstetric haemorrhage
unspecified
O71.0 Rupture of uterus before onset of 3 obstetric haemorrhage
labour
O71.1 Rupture of uterus during labour 3 obstetric haemorrhage
O71.3 Obstetric laceration of cervix 3 obstetric haemorrhage
O71.4 Obstetric high vaginal laceration 3 obstetric haemorrhage
alone
O71.7 Obstetric haematoma of pelvis 3 obstetric haemorrhage
O72 Postpartum haemorrhage 3 obstetric haemorrhage
O72.0 Third-stage haemorrhage 3 obstetric haemorrhage
O72.1 Other immediate postpartum 3 obstetric haemorrhage
haemorrhage
O72.2 Delayed and secondary postpartum 3 obstetric haemorrhage
haemorrhage
O72.3 Postpartum coagulation defects 3 obstetric haemorrhage
O23 Infections of genitourinary tract in 4 pregnancy related infection
pregnancy
O23.0 Infections of kidney in pregnancy 4 pregnancy related infection
O23.1 Infections of bladder in pregnancy 4 pregnancy related infection
O23.2 Infections of urethra in pregnancy 4 pregnancy related infection
O23.3 Infections of other parts of urinary 4 pregnancy related infection
tract in pregnancy
O23.4 Unspecified infection of urinary tract 4 pregnancy related infection
in pregnancy
O23.5 Infections of the genital tract in 4 pregnancy related infection
pregnancy
O23.9 Other and unspecified genitourinary 4 pregnancy related infection
tract infection in pregnancy
O41.1 Infection of amniotic sac and 4 pregnancy related infection
membranes
O75.3 Other infection during labour 4 pregnancy related infection
O85 Puerperal sepsis 4 pregnancy related infection
O86 Other puerperal infections 4 pregnancy related infection
O86.0 Infection of obstetric surgical wound 4 pregnancy related infection
O86.1 Other infection of genital tract 4 pregnancy related infection
following delivery
O86.2 Urinary tract infection following 4 pregnancy related infection
delivery
O86.3 Other genitourinary tract infections 4 pregnancy related infection
following delivery
O86.4 Pyrexia of unknown origin following 4 pregnancy related infection
delivery
O86.8 Other specified puerperal infections 4 pregnancy related infection
O91 Infections of breast associated with 4 pregnancy related infection
childbirth
O91.0 Infection of nipple associated with 4 pregnancy related infection
childbirth
O91.1 Abscess of breast associated with 4 pregnancy related infection
childbirth
O91.2 Nonpurulent mastitis associated with 4 pregnancy related infection
childbirth
A34 Obstetrical tetanus 4 pregnancy related infection
O21.1 Hyperemesis gravidarum with 5 other obstetric complications
metabolic disturbance
O21.2 Late vomiting of pregnancy 5 other obstetric complications
O22 Venous complications in pregnancy 5 other obstetric complications
O22.3 Deep phlebothrombosis in 5 other obstetric complications
pregnancy
O22.5 Cerebral venous thrombosis in 5 other obstetric complications
pregnancy
O22.8 Other venous complications in 5 other obstetric complications
pregnancy
O22.9 Venous complication in pregnancy, 5 other obstetric complications
unspecified
O24.4 Diabetes mellitus arising in 5 other obstetric complications
pregnancy
O26.6 Liver disorders in pregnancy, 5 other obstetric complications
O44.0 Placenta praevia specified as without 5 other obstetric complications
haemorrhage
O71.2 Postpartum inversion of uterus 5 other obstetric complications
O71.5 Other obstetric injury to pelvic 5 other obstetric complications
organs
O71.6 Obstetric damage to pelvic joints and 5 other obstetric complications
ligaments
O71.8 Other specified obstetric trauma 5 other obstetric complications
O71.9 Obstetric trauma, unspecified 5 other obstetric complications
O73 Retained placenta and membranes, 5 other obstetric complications
without haemorrhage
O73.0 Retained placenta without 5 other obstetric complications
haemorrhage
O73.1 Retained portions of placenta and 5 other obstetric complications
membranes, without haemorrhage
O75.4 Other complications of obstetric 5 other obstetric complications
surgery and procedures
O75.8 Other specified complications of 5 other obstetric complications
labour and delivery
O75.9 Complication of labour and delivery, 5 other obstetric complications
unspecified
O87 Venous complications in the 5 other obstetric complications
puerperium
O87.1 Deep phlebothrombosis in the 5 other obstetric complications
puerperium
O87.3 Cerebral venous thrombosis in the 5 other obstetric complications
puerperium
O87.9 Venous complication in the 5 other obstetric complications
puerperium, unspecified
O88 Obstetric embolism 5 other obstetric complications
O88.0 Obstetric air embolism 5 other obstetric complications
O88.1 Amniotic fluid embolism 5 other obstetric complications
O88.2 Obstetric blood-clot embolism 5 other obstetric complications
O88.3 Obstetric pyaemic and septic 5 other obstetric complications
embolism
O88.8 Other obstetric embolism 5 other obstetric complications
O90 Complications of the puerperium, not 5 other obstetric complications
O90.0 Disruption of caesarean section 5 other obstetric complications
wound
O90.1 Disruption of perineal obstetric 5 other obstetric complications
wound
O90.2 Haematoma of obstetric wound 5 other obstetric complications
O90.3 Cardiomyopathy in the puerperium 5 other obstetric complications
O90.4 Postpartum acute renal failure 5 other obstetric complications
O90.5 Postpartum thyroiditis 5 other obstetric complications
O90.8 Other complications of the 5 other obstetric complications
puerperium, not elsewhere classified
O90.9 Complication of the puerperium, 5 other obstetric complications
unspecified
O29 Complications of anaesthesia during 6 unanticipated complications of management
pregnancy
O29.0 Pulmonary complications of 6 unanticipated complications of management
anaesthesia during pregnancy
O29.1 Cardiac complications of 6 unanticipated complications of management
anaesthesia during pregnancy
O29.2 Central nervous system 6 unanticipated complications of management
complications of anaesthesia during
pregnancy
O29.3 Toxic reaction to local anaesthesia 6 unanticipated complications of management
during pregnancy
O29.5 Other complications of spinal and 6 unanticipated complications of management
epidural anaesthesia during
pregnancy
O29.6 Failed or difficult intubation during 6 unanticipated complications of management
pregnancy
O29.8 Other complications of anaesthesia 6 unanticipated complications of management
during pregnancy
O29.9 Complication of anaesthesia during 6 unanticipated complications of management
pregnancy, unspecified
O74 Complications of anaesthesia during 6 unanticipated complications of management
labour and delivery
O74.0 Aspiration pneumonitis due to 6 unanticipated complications of management
anaesthesia during labour and
delivery
O74.1 Other pulmonary complications of 6 unanticipated complications of management
delivery
delivery
labour and delivery
during labour and delivery
epidural anaesthesia during labour
and delivery
labour and delivery
during labour and delivery
labour and delivery, unspecified
O89 Complications of anaesthesia during 6
the puerperium unanticipated complications of management
O89.0 Pulmonary complications of 6 unanticipated complications of management
anaesthesia during the puerperium
anaesthesia during the puerperium
the puerperium
during the puerperium
epidural anaesthesia during the
puerperium
the puerperium
during the puerperium
the puerperium, unspecified
O10 Pre-existing hypertension 7 non-obstetric complications
complicating pregnancy, childbirth
and the puerperium
O10.0 Pre-existing essential hypertension 7 non-obstetric complications
and the puerperium
O10.1 Pre-existing hypertensive heart 7 non-obstetric complications
disease complicating pregnancy,
O10.2 Pre-existing hypertensive renal 7 non-obstetric complications
O10.3 Pre-existing hypertensive heart and 7 non-obstetric complications
renal disease complicating
pregnancy, childbirth and the
puerperium
O10.4 Pre-existing secondary hypertension 7 non-obstetric complications
and the puerperium
O10.9 Unspecified pre-existing 7 non-obstetric complications
hypertension complicating
puerperium
O24 Diabetes mellitus in pregnancy 7 non-obstetric complications
O24.0 Diabetes mellitus in pregnancy: Pre- 7 non-obstetric complications
existing diabetes mellitus, insulin-
dependent
existing diabetes mellitus, non-
insulin-dependent
existing malnutrition-related diabetes
mellitus
existing diabetes mellitus,
unspecified
O24.9 Diabetes mellitus in pregnancy, 7 non-obstetric complications
unspecified
O98 Maternal infectious and parasitic 7 non-obstetric complications
diseases classifiable elsewhere but
and the puerperium
O98.0 Tuberculosis complicating 7 non-obstetric complications
puerperium
O98.1 Syphilis complicating pregnancy, 7 non-obstetric complications
O98.2 Gonorrhoea complicating pregnancy, 7 non-obstetric complications
O98.3 Other infections with a predominantly 7 non-obstetric complications

sexual mode of transmission
and the puerperium
O98.4 Viral hepatitis complicating 7 non-obstetric complications
puerperium
O98.5 Other viral diseases complicating 7 non-obstetric complications
puerperium
O98.6 Protozoal diseases complicating 7 non-obstetric complications
puerperium
O98.7 Human immunodeficiency [HIV] 7 non-obstetric complications
O98.8 Other maternal infectious and 7 non-obstetric complications
parasitic diseases complicating
puerperium
O98.9 Unspecified maternal infectious or 7 non-obstetric complications
parasitic disease complicating
puerperium
O99.0 Anaemia complicating pregnancy, 7 non-obstetric complications
O99.1 Other diseases of the blood and 7 non-obstetric complications
blood-forming organs and certain
disorders involving the immune
mechanism complicating pregnancy,
O99.2 Endocrine, nutritional and metabolic 7 non-obstetric complications
diseases complicating pregnancy,
O99.3 Mental disorders and diseases of the 7 non-obstetric complications
nervous system complicating
puerperium
O99.4 Diseases of the circulatory system 7 non-obstetric complications
and the puerperium
O99.5 Diseases of the respiratory system 7 non-obstetric complications
and the puerperium
O99.6 Diseases of the digestive system 7 non-obstetric complications
and the puerperium
O99.7 Diseases of the skin and 7 non-obstetric complications
subcutaneous tissue complicating
puerperium
O99.8 Other specified diseases and 7 non-obstetric complications
conditions complicating pregnancy,
O95 Obstetric death of unspecified cause 8 unknown/undetermined
O96 Death from any obstetric cause annex other codes of interest
occurring more than 42 days but less
than one year after delivery
O96.0 Death from direct obstetric cause annex other codes of interest
O96.1 Death from indirect obstetric cause annex other codes of interest
O96.9 Death from unspecified obstetric annex other codes of interest
cause
O97 Death from sequelae of direct annex other codes of interest
obstetric causes
O97.0 Death from sequelae of direct annex other codes of interest
obstetric cause
O97.1 Death from sequelae of indirect annex other codes of interest
obstetric cause
O97.9 Death from sequelae of obstetric annex other codes of interest
cause, unspecified
O08 Complications following abortion and morbidity contributory conditions
O08.0 Genital tract and pelvic infection morbidity contributory conditions
following abortion and ectopic and
molar pregnancy
O08.1 Delayed or excessive haemorrhage morbidity contributory conditions
molar pregnancy
O08.2 Embolism following abortion and morbidity contributory conditions
O08.3 Shock following abortion and ectopic morbidity contributory conditions
and molar pregnancy
O08.4 Renal failure following abortion and morbidity contributory conditions
O08.5 Metabolic disorders following morbidity contributory conditions
abortion and ectopic and molar
pregnancy
O08.6 Damage to pelvic organs and tissues morbidity contributory conditions
molar pregnancy
O08.7 Other venous complications morbidity contributory conditions
molar pregnancy
O08.8 Other complications following morbidity contributory conditions
abortion and ectopic and molar
pregnancy
O08.9 Complication following abortion and morbidity contributory conditions
ectopic and molar pregnancy,
unspecified
O21 Excessive vomiting in pregnancy morbidity contributory conditions
O21.0 Mild hyperemesis gravidarum morbidity contributory conditions
O21.8 Other vomiting complicating morbidity contributory conditions
pregnancy
O21.9 Vomiting of pregnancy, unspecified morbidity contributory conditions
O22.0 Varicose veins of lower extremity in morbidity contributory conditions
pregnancy
O22.1 Genital varices in pregnancy morbidity contributory conditions
O22.2 Superficial thrombophlebitis in morbidity contributory conditions
pregnancy
O22.4 Haemorrhoids in pregnancy morbidity other obstetric complications
O25 Malnutrition in pregnancy morbidity contributory conditions
O26 Maternal care for other conditions morbidity contributory conditions
predominantly related to pregnancy
O26.0 Excessive weight gain in pregnancy morbidity contributory conditions
O26.1 Low weight gain in pregnancy morbidity contributory conditions
O26.2 Pregnancy care of habitual aborter morbidity contributory conditions
O26.3 Retained intrauterine contraceptive morbidity contributory conditions
device in pregnancy
O26.4 Gestational pemphigoid morbidity contributory conditions
O26.5 Maternal hypotension syndrome morbidity contributory conditions
O26.7 Subluxation of symphysis (pubis) in morbidity contributory conditions
puerperium
O26.8 Other specified pregnancy-related morbidity contributory conditions
conditions
O26.9 Pregnancy-related condition, morbidity contributory conditions
unspecified
O28 Abnormal findings on antenatal morbidity contributory conditions
screening of mother
O28.0 Abnormal haematological finding on morbidity contributory conditions
antenatal screening of mother
O28.1 Abnormal biochemical finding on morbidity contributory conditions
O28.2 Abnormal cytological finding on morbidity contributory conditions
O28.3 Abnormal ultrasonic finding on morbidity contributory conditions
O28.4 Abnormal radiological finding on morbidity contributory conditions
O28.5 Abnormal chromosomal and genetic morbidity contributory conditions
finding on antenatal screening of
mother
O28.8 Other abnormal findings on morbidity contributory conditions
O28.9 Abnormal finding on antenatal morbidity contributory conditions
screening of mother, unspecified
O29.4 Spinal and epidural anaesthesia- morbidity contributory conditions
induced headache during pregnancy
O30 Multiple gestation morbidity contributory conditions
O30.0 Twin pregnancy morbidity contributory conditions
O30.1 Triplet pregnancy morbidity contributory conditions
O30.2 Quadruplet pregnancy morbidity contributory conditions
O30.8 Other multiple gestation morbidity contributory conditions
O30.9 Multiple gestation, unspecified morbidity contributory conditions
O30-O48 Maternal care related to the fetus morbidity contributory conditions
and amniotic cavity and possible
delivery problems
O31 Complications specific to multiple morbidity contributory conditions
gestation
O31.0 Papyraceous fetus morbidity contributory conditions
O31.1 Continuing pregnancy after abortion morbidity contributory conditions
of one fetus or more
O31.2 Continuing pregnancy after morbidity contributory conditions
intrauterine death of one fetus or
more
O31.8 Other complications specific to morbidity contributory conditions
multiple gestation
O32 Maternal care for known or morbidity contributory conditions
suspected malpresentation of fetus
O32.0 Maternal care for unstable lie morbidity contributory conditions
O32.1 Maternal care for breech morbidity contributory conditions
presentation
O32.2 Maternal care for transverse and morbidity contributory conditions
oblique lie
O32.3 Maternal care for face, brow and morbidity contributory conditions
chin presentation
O32.4 Maternal care for high head at term morbidity contributory conditions
O32.5 Maternal care for multiple gestation morbidity contributory conditions
with malpresentation of one fetus or
more
O32.6 Maternal care for compound morbidity contributory conditions
presentation
O32.8 Maternal care for other morbidity contributory conditions
malpresentation of fetus
O32.9 Maternal care for malpresentation of morbidity contributory conditions
fetus, unspecified
suspected disproportion
O33.0 Maternal care for disproportion due morbidity contributory conditions
to deformity of maternal pelvic bones

to generally contracted pelvis
to inlet contraction of pelvis
to outlet contraction of pelvis
O33.4 Maternal care for disproportion of morbidity contributory conditions
mixed maternal and fetal origin
to unusually large fetus
to hydrocephalic fetus
to other fetal deformities
O33.8 Maternal care for disproportion of morbidity contributory conditions
other origin
O33.9 Maternal care for disproportion, morbidity contributory conditions
unspecified
suspected abnormality of pelvic
organs
O34.0 Maternal care for congenital morbidity contributory conditions
malformation of uterus
O34.1 Maternal care for tumour of corpus morbidity contributory conditions
uteri
O34.2 Maternal care due to uterine scar morbidity contributory conditions
from previous surgery
O34.3 Maternal care for cervical morbidity contributory conditions
incompetence
O34.4 Maternal care for other abnormalities morbidity contributory conditions
of cervix
of gravid uterus
O34.6 Maternal care for abnormality of morbidity contributory conditions
vagina
vulva and perineum
of pelvic organs
pelvic organ, unspecified
suspected fetal abnormality and
damage
O35.0 Maternal care for (suspected) central morbidity contributory conditions
nervous system malformation in
fetus
O35.1 Maternal care for (suspected) morbidity contributory conditions
chromosomal abnormality in fetus
hereditary disease in fetus
damage to fetus from viral disease in
mother
damage to fetus from alcohol
damage to fetus by drugs
damage to fetus by radiation
damage to fetus by other medical
procedures
O35.8 Maternal care for other (suspected) morbidity contributory conditions
fetal abnormality and damage
O35.9 Maternal care for (suspected) fetal morbidity contributory conditions
abnormality and damage,
unspecified
O36 Maternal care for other known or morbidity contributory conditions
suspected fetal problems
O36.0 Maternal care for rhesus morbidity contributory conditions
isoimmunization
O36.1 Maternal care for other morbidity contributory conditions
isoimmunization
O36.2 Maternal care for hydrops fetalis morbidity contributory conditions
O36.3 Maternal care for signs of fetal morbidity contributory conditions
hypoxia
O36.4 Maternal care for intrauterine death morbidity contributory conditions
O36.5 Maternal care for poor fetal growth morbidity contributory conditions
O36.6 Maternal care for excessive fetal morbidity contributory conditions
growth
O36.7 Maternal care for viable fetus in morbidity contributory conditions
abdominal pregnancy
O36.8 Maternal care for other specified morbidity contributory conditions
fetal problems
O36.9 Maternal care for fetal problem, morbidity contributory conditions
unspecified
O40 Polyhydramnios morbidity contributory conditions
O41 Other disorders of amniotic fluid and morbidity contributory conditions
membranes
O41.0 Oligohydramnios morbidity contributory conditions
O41.8 Other specified disorders of amniotic morbidity contributory conditions
fluid and membranes
O41.9 Disorder of amniotic fluid and morbidity contributory conditions
membranes, unspecified
O42 Premature rupture of membranes morbidity contributory conditions
O42.0 Premature rupture of membranes, morbidity contributory conditions
onset of labour within 24 hours
onset of labour after 24 hours
labour delayed by therapy
unspecified
O43.0 Placental transfusion syndromes morbidity contributory conditions
O43.1 Malformation of placenta morbidity contributory conditions
O43.8 Other placental disorders morbidity contributory conditions
O43.9 Placental disorder, unspecified morbidity contributory conditions
O47 False labour morbidity contributory conditions
O47.0 False labour before 37 completed morbidity contributory conditions
weeks of gestation
O47.1 False labour at or after 37 completed morbidity contributory conditions
weeks of gestation
O47.9 False labour, unspecified morbidity contributory conditions
O48 Prolonged pregnancy morbidity contributory conditions
O60 Preterm labour and delivery morbidity contributory conditions
O60.0 Preterm labour without delivery morbidity contributory conditions
O60.1 Preterm spontaneous labour with morbidity contributory conditions
preterm delivery
O60.2 Preterm labour with term delivery morbidity contributory conditions
O60.3 Preterm delivery without morbidity contributory conditions
spontaneous labour
O61 Failed induction of labour morbidity contributory conditions
O61.0 Failed medical induction of labour morbidity contributory conditions
O61.1 Failed instrumental induction of morbidity contributory conditions
labour
O61.8 Other failed induction of labour morbidity contributory conditions
O61.9 Failed induction of labour, morbidity contributory conditions
unspecified
O62 Abnormalities of forces of labour morbidity contributory conditions
O62.0 Primary inadequate contractions morbidity contributory conditions
O62.1 Secondary uterine inertia morbidity contributory conditions
O62.2 Other uterine inertia morbidity contributory conditions
O62.3 Precipitate labour morbidity contributory conditions
O62.4 Hypertonic, incoordinate, and morbidity contributory conditions
prolonged uterine contractions
O62.8 Other abnormalities of forces of morbidity contributory conditions
labour
O62.9 Abnormality of forces of labour, morbidity contributory conditions
unspecified
O63 Long labour morbidity contributory conditions
O63.0 Prolonged first stage (of labour) morbidity contributory conditions
O63.1 Prolonged second stage (of labour) morbidity contributory conditions
O63.2 Delayed delivery of second twin, morbidity contributory conditions
triplet, etc.
O63.9 Long labour, unspecified morbidity contributory conditions
O64 Obstructed labour due to malposition morbidity contributory conditions
and malpresentation of fetus
O64.0 Obstructed labour due to incomplete morbidity contributory conditions

rotation of fetal head
O64.1 Obstructed labour due to breech morbidity contributory conditions
presentation
O64.2 Obstructed labour due to face morbidity contributory conditions
presentation
O64.3 Obstructed labour due to brow morbidity contributory conditions
presentation
O64.4 Obstructed labour due to shoulder morbidity contributory conditions
presentation
O64.5 Obstructed labour due to compound morbidity contributory conditions
presentation
O64.8 Obstructed labour due to other morbidity contributory conditions
malposition and malpresentation
O64.9 Obstructed labour due to malposition morbidity contributory conditions
and malpresentation, unspecified
O65 Obstructed labour due to maternal morbidity contributory conditions

pelvic abnormality
O65.0 Obstructed labour due to deformed morbidity contributory conditions
pelvis
O65.1 Obstructed labour due to generally morbidity contributory conditions
contracted pelvis
O65.2 Obstructed labour due to pelvic inlet morbidity contributory conditions
contraction
O65.3 Obstructed labour due to pelvic morbidity contributory conditions
outlet and mid-cavity contraction
O65.4 Obstructed labour due to fetopelvic morbidity contributory conditions
disproportion, unspecified
O65.5 Obstructed labour due to abnormality morbidity contributory conditions
of maternal pelvic organs

maternal pelvic abnormalities
O65.9 Obstructed labour due to maternal morbidity contributory conditions
pelvic abnormality, unspecified
O66 Other obstructed labour morbidity contributory conditions
dystocia
O66.1 Obstructed labour due to locked morbidity contributory conditions
twins
O66.2 Obstructed labour due to unusually morbidity contributory conditions
large fetus
abnormalities of fetus
O66.4 Failed trial of labour, unspecified morbidity contributory conditions
O66.5 Failed application of vacuum morbidity contributory conditions
extractor and forceps, unspecified
O66.8 Other specified obstructed labour morbidity contributory conditions
O66.9 Obstructed labour, unspecified morbidity contributory conditions
O68 Labour and delivery complicated by morbidity contributory conditions
fetal stress [distress]
O68.0 Labour and delivery complicated by morbidity contributory conditions
fetal heart rate anomaly
meconium in amniotic fluid
fetal heart rate anomaly with
meconium in amniotic fluid
biochemical evidence of fetal stress
other evidence of fetal stress
fetal stress, unspecified
O69 Labour and delivery complicated by morbidity contributory conditions
umbilical cord complications
prolapse of cord
cord around neck, with compression
other cord entanglement, with
compression
short cord
vasa praevia
vascular lesion of cord
other cord complications
cord complication, unspecified
O70 Perineal laceration during delivery morbidity contributory conditions
O70.0 First degree perineal laceration morbidity contributory conditions
during delivery
O70.1 Second degree perineal laceration morbidity contributory conditions
during delivery
O70.2 Third degree perineal laceration morbidity contributory conditions
during delivery
O70.3 Fourth degree perineal laceration morbidity contributory conditions
during delivery
O70.9 Perineal laceration during delivery, morbidity contributory conditions
unspecified
induced headache during labour and
delivery
O75 Other complications of labour and morbidity contributory conditions
delivery, not elsewhere classified
O75.0 Maternal distress during labour and morbidity contributory conditions
delivery
O75.1 Shock during or following labour and morbidity contributory conditions
delivery
O75.2 Pyrexia during labour, not elsewhere morbidity contributory conditions
classified
O75.5 Delayed delivery after artificial morbidity contributory conditions
rupture of membranes
O75.6 Delayed delivery after spontaneous morbidity contributory conditions
or unspecified rupture of membranes
O75.7 Vaginal delivery following previous morbidity contributory conditions

caesarean section
O80 Single spontaneous delivery morbidity contributory conditions
O80.0 Spontaneous vertex delivery morbidity contributory conditions
O80.1 Spontaneous breech delivery morbidity contributory conditions
O80.8 Other single spontaneous delivery morbidity contributory conditions
O80.9 Single spontaneous delivery, morbidity contributory conditions
unspecified
O80-O84 Delivery morbidity contributory conditions
O81 Single delivery by forceps and morbidity contributory conditions
vacuum extractor
O81.0 Low forceps delivery morbidity contributory conditions
O81.1 Mid-cavity forceps delivery morbidity contributory conditions
O81.2 Mid-cavity forceps with rotation morbidity contributory conditions
O81.3 Other and unspecified forceps morbidity contributory conditions
delivery
O81.4 Vacuum extractor delivery morbidity contributory conditions
O81.5 Delivery by combination of forceps morbidity contributory conditions
and vacuum extractor
O82 Single delivery by caesarean section morbidity contributory conditions
O82.0 Delivery by elective caesarean morbidity contributory conditions
section
O82.1 Delivery by emergency caesarean morbidity contributory conditions
section
O82.2 Delivery by caesarean hysterectomy morbidity contributory conditions
O82.8 Other single delivery by caesarean morbidity contributory conditions
section
O82.9 Delivery by caesarean section, morbidity contributory conditions
unspecified
O83 Other assisted single delivery morbidity contributory conditions
O83.0 Breech extraction morbidity contributory conditions
O83.1 Other assisted breech delivery morbidity contributory conditions
O83.2 Other manipulation-assisted delivery morbidity contributory conditions
O83.3 Delivery of viable fetus in abdominal morbidity contributory conditions
pregnancy
O83.4 Destructive operation for delivery morbidity contributory conditions
O83.8 Other specified assisted single morbidity contributory conditions
delivery
O83.9 Assisted single delivery, unspecified morbidity contributory conditions
O84 Multiple delivery morbidity contributory conditions
O84.0 Multiple delivery, all spontaneous morbidity contributory conditions
O84.1 Multiple delivery, all by forceps and morbidity contributory conditions
vacuum extractor
O84.2 Multiple delivery, all by caesarean morbidity contributory conditions
section
O84.8 Other multiple delivery morbidity contributory conditions
O84.9 Multiple delivery, unspecified morbidity contributory conditions
O87.0 Superficial thrombophlebitis in the morbidity contributory conditions
puerperium
O87.2 Haemorrhoids in the puerperium morbidity contributory conditions
O87.8 Other venous complications in the morbidity contributory conditions
puerperium
induced headache during the
puerperium
O92 Other disorders of breast and morbidity contributory conditions
lactation associated with childbirth
O92.0 Retracted nipple associated with morbidity contributory conditions
childbirth
O92.1 Cracked nipple associated with morbidity contributory conditions
childbirth
O92.2 Other and unspecified disorders of morbidity contributory conditions
breast associated with childbirth
O92.3 Agalactia morbidity contributory conditions
O92.4 Hypogalactia morbidity contributory conditions
O92.5 Suppressed lactation morbidity contributory conditions
O92.6 Galactorrhoea morbidity contributory conditions
O92.7 Other and unspecified disorders of morbidity contributory conditions
lactation
O94 Sequelae of complication of morbidity contributory conditions
puerperium

presentation
presentation
presentation
presentation
presentation

pelvic abnormality
pelvis
contracted pelvis
contraction

dystocia
twins
large fetus

presentation
presentation
presentation
presentation
presentation

pelvic abnormality
pelvis
contracted pelvis
contraction

dystocia
twins
large fetus

Pengisian Data Surveilans Kematian Ibu

Diunggah oleh

Informasi Dokumen

Judul Asli

Hak Cipta

Format Tersedia

Bagikan dokumen Ini

Bagikan atau Tanam Dokumen

Opsi Berbagi

Apakah menurut Anda dokumen ini bermanfaat?

Apakah konten ini tidak pantas?

Hak Cipta:

Format Tersedia

Pengisian Data Surveilans Kematian Ibu

Diunggah oleh

Hak Cipta:

Format Tersedia

PENGISIAN DATA SURVEILANS KEMATIAN IBU

Bagian dalam formulir ini:

Formulir yang diisi:

Jumlah kematian ibu yang terjadi pada periode laporan

Terdiri dari 10 kolom

Diisi dengan kode "Dilakukan" atau "Tidak"

Diisi dengan xxx digit kode desa sesuai BPS

1931750001 1 1 1 11 masa depan 1 1 35

Pendidikan ibu Pendidikan suami Usia

28/02/2018 3/1/2018 16:00 22.92 1 1 1 1 2

bayi 1 bayi 2 bayi 1 bayi 2 bayi 1 bayi 2 bayi 1 bayi 2 Bayi 1

HITUNG SEMUA (tgl/bln/thn jam:menit)

2/27/2018 13:32 2.10

Tidak tersedia Penyebab

Hambatan untuk Kurangnya Kurangnya fasilitas Kurangnya petugas/staf

1=Ya 1=Ya 1=Ya 1=Ya 1=Ya 1=Ya 1=Ya 1=Ya 1=Ya

Masalah untuk Masalah untuk asuhan Tindakan tidak profesional

1=Ya 1=Ya 1=Ya 1=Ya 1=Ya 1=Ya 1=Ya 1=Ya 1=Ya

RINGKASAN POIN PENTING DARI

Listing of ICD 10 codes for chapter 15

O11 Pre-eclampsia superimposed on 2 hypertensive disorders in pregnnacy, childbirth, and

O98.3 Other infections with a predominantly 7 non-obstetric complications

O33.1 Maternal care for disproportion due morbidity contributory conditions

O64.0 Obstructed labour due to incomplete morbidity contributory conditions

O65 Obstructed labour due to maternal morbidity contributory conditions

O65.8 Obstructed labour due to other morbidity contributory conditions

O75.7 Vaginal delivery following previous morbidity contributory conditions

O64.0 Obstructed labour due to incomplete morbidity contributory conditions

O65 Obstructed labour due to maternal morbidity contributory conditions

O65.8 Obstructed labour due to other morbidity contributory conditions

O64.0 Obstructed labour due to incomplete morbidity contributory conditions

O65 Obstructed labour due to maternal morbidity contributory conditions

O65.8 Obstructed labour due to other morbidity contributory conditions

Anda mungkin juga menyukai