ID:□□□□□ Medical record number: ______________ Name: _______Age (years): _______Occupation: _______ Pre-pregnancy body weight (kg): _______ Maternal height (m): _______ Telephone number: _______ Last menstrual period: _______ Date of delivery: _______ Gestational age: _______ Pre-delivery body weight (kg): _______ Parity: _______ Length of the newborn (cm): ________ Weight of newborn (g): _______ Newborn sex: _______ Apgar score: 1-minute:_______5-minute: _______10-minute: _______ Amount of postpartum hemorrhage: _______ Mode of delivery: □Cesarean section □Vaginal delivery