Variables in PREGNANT MOTHER'S EXAMINATION FORM (PME)
Question# Question Field name (Variable) Response nature Response options
1 PID Number     PID ### ###
2 Initials of the pregnant mother’s name pme_A XX XX
3 Researcher code (Gynecologist) pme _B ## ##
4 Date of Interview
(according to English calender)
pme _C ##-XXX-##  dd-mmm-yy 
5 Age of mother
(completed years)
pme _1 ##  
6 Weight (kg) pme _2 ##.##  
7 Height (cm) pme _3 ###.#  
8 MUAC (cm) pme _4 ##.#  
9 Blood pressure: systolic/diastolic (mmHg) pme _5 ##/##  
10 Last menstruation period (LMP)
(according to English calender) 
pme _6 ##-XXX-##  dd-mmm-yy (99/999/99 if not known)
11 Estimated date of delivery (EDD)
(according to English calender) 
pme _7 ##-XXX-##  dd-mmm-yy (99/999/99 if not known)
12 Gestational age by LMP (weeks) pme_8 ##  
13 Number of gravida pme _9 ##  
14 Number of para pme _10 ##  
15 Number of abortion pme _11 ##  
16 Number of still birth pme _12 ##  
17 Number of death of baby pme _13 ##  
18 High risk for pregnancy by obstetric history ? Pme_14 # 1=Yes, 2=No
19 Any complains by mother? Pme_15 # 2=No, 3= nausea/vomiting, 4=appetite loss, 5= lower abdomen pain, 6=dizziness/vertigo, 7= PV bleeding,
8= others
20 If other  specify pme_15  txt TXT TEXT if pme_15=8
NA if pme_15ǂ8
Examination:
21 CVS auscultation? pme_16 # 1= Normal findings, 2= Abnormal findings
22 Chest auscultation? pme_17 # 1= Normal findings, 2= Abnormal findings
23 Size of uterus by palpation (weeks) pme_18 ##  
24 Adnexal palpable pme_19 # 1=Yes, 2=No
25 Position pme_20 # 1= Axial, 2=Antroverted, 3=Retroverted, 4= Other
26 Any other abnormal findings or high risk for pregnancy by examination?   pme_21 # 1=Yes, 2=No
27 If abnormal findings , specify pme_21txt TXT TEXT if  pme_21= 1
NA if pme_21=2
Ask whether pregnant mother is taking any micronutrient/nutrient supplement currently: (1=Yes, 2=No) If any following answer will yes, write weeks of gestation when start to take the medicine, if not write 99.
28 Folic acid? pme_22 # 1=Yes, 2=No
29 If yes, when started? (weeks of gestation) pme_22 txt ##  ## if pme_22=1
99 if pme_22=2
30 Iron? pme_23 # 1=Yes, 2=No
31 If yes, when started? (weeks of gestation) pme_23 txt ## ## if pme_23=1
99 if pme_23=2
32 Calcium? pme_24 # 1=Yes, 2=No
33 If yes, when started? (weeks of gestation) pme_24 txt ## ## if pme_24=1
99 if pme_24=2
34 Any other vitamins or nutrient supplement? pme_25  # 1=Yes, 2=No
35 If yes specify pme_25 txt TXT TEXT if pme_25=1
NA if pme_25=2
36 Any other medication? pme_26 # 1=Yes, 2=No
37 If yes specify pme_26 txt TXT TEXT if pme_26=1
NA if pme_26=2
38 Remarks   TXT