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. 2017 Apr 18;16(2):126–132. doi: 10.1002/rmb2.12014

Table 2.

Cycle‐based registry form: obstetric outcome of pregnancy

Number of gestational sacs (req) ( )
Number of fetal heartbeat ( )
Outcome of pregnancy (req)

  1. Miscarriage

  2. Ectopic pregnancy

  3. Heterotopic pregnancy

  4. Elective termination of pregnancy (reason: )

  5. Live birth

  6. Stillbirth

  7. Selective reduction performed (number of fetus before reduction [ ], number of fetuses after reduction [ ])

  8. Unknown
Number of live births ※ If check (5. Live birth) or (6. Stillbirth) in (Outcome of pregnancy), input is necessary
Number ( ) (Date of delivery [day/month/year])
Style of delivery

  1. Vaginal delivery

  2. Cesarean delivery

  3. Vaginal and cesarean delivery

  4. Unknown
Obstetric complications of pregnancy

  1. None

  2. Yes

  3. Unknown
Finding of the baby
  Sex Gestational age Birthweight State of baby Prognosis after delivery
Live birth or stillbirth Monozygotic Malformation Under 7 days Under 28 days Date of death
1 1. Male 1. ( ) weeks 1. ( ) g 1. Live birth 1. Yes ( ) 1. Survival 1. Survival (Day/month/year)
2. Female 2. Unknown 2. Unknown 2. Stillbirth 2. No 2. Death 2. Death
3. Unknown       3. Unknown 3. Unknown 3. Unknown
2 1. Male 1. ( ) weeks 1. ( ) g 1. Live birth 1. Yes ( ) 1. Survival 1. Survival (Day/month/year)
2. Female 2. Unknown 2. Unknown 2. Stillbirth 2. No 2. Death 2. Death
3. Unknown       3.Unknown 3. Unknown 3. Unknown
3 1. Male 1. ( ) weeks 1. ( ) g 1. Live birth 1. Yes ( ) 1. Survival 1. Survival (Day/month/year)
2. Female 2. Unknown 2. Unknown 2. Stillbirth 2. No 2. Death 2. Death
3. Unknown       3. Unknown 3. Unknown 3. Unknown
4 1. Male 1. ( ) weeks 1. ( ) g 1. Live birth 1. Yes ( ) 1. Survival 1. Survival (Day/month/year)
2. Female 2. Unknown 2. Unknown 2. Stillbirth 2. No 2. Death 2. Death
3. Unknown       3. Unknown 3. Unknown 3. Unknown

req, required.