Anda di halaman 1dari 2

RS SUMBER SENTOSA Nama :

JL. Raya Kebonsari No 221 Tumapng – Malang TTL :


Telp. 0341-787233. Fax. 0341-786756 No RM :

Lembar Observasi Kebidanan

A. Masuk kamar Bersalin Tgl : ........................................................ Jam .................................................


ANAMNESA (S) : Nama ibu : .................................................... Suami : ...........................................
Tgl Lahir : .............................................. Tgl Lahir Suami : .................................
Pekerjaan Ibu : ....................................... Suami : ..................................................
Alamat Rumah : .....................................................................................................
His mulai tgl : ............................................................ Jam : ..................................
Pengeluaran Pervagina : Lendir : ya / tidak Darah : ya / tidak
Cairan ketuban : pecah / belum Tgl : ...................... Jam : .....................................
Warna : ......................................... Berbau : ................................
Keluhan saat ini : .....................................................................................................
Riwayat alergi obat-obatan : ....................................................................................
Riwayat persalinan yang lalu : ................................................................................
..................................................................................................................................
..................................................................................................................................
..................................................................................................................................
..................................................................................................................................
B. (O) Keadaan Umum: Tekanan Darah : ............ Suhu : ......... Nadi : ......... Oedema : ..........................
c. Pemeriksaan : Palpasi : ..........................................................................................................
........................................................................................................................
........................................................................................................................
Penurunan Kepala ( Teraba ) : ............................................ Bagian
DJJ : ................./ menit,Kontraksi: ............/10 menit/...............detik
Pemeriksaan Dalam ( VT ) : Tgl ............... Jam ......... Oleh .................................................
Hasil VT : ..............................................................................................................................
................................................................................................................................................
................................................................................................................................................
................................................................................................................................................

C. ( A ) : ..................................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................

D. ( P/I ) : ..................................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................
Tgl Jam His ( 10’ ) DJJ T.D Suhu Nadi Pemeriksaan Dalam VT
Berapa Kali Lama

Anda mungkin juga menyukai