ANNEXURE-1

LETTER FROM ETHICAL COMMITTEE

ANNEXURE-2
INFORMED CONSENT FORM
TITLE: A study to develop and evaluate postograph for the health care professionals in selected
hospitals of Delhi.
You are being requested to be a part of the above mentioned study purely on voluntary basis. Before
agreeing to participate in the present study it is important that you read and understand the following
information. You will be provided two copies of this form, please sign the original copy and submit to us for
our records, please retain the duplicate copy for your reference and records.
PURPOSE: to assess postnatal mothers and newborn by using postograph by the health care professionals.
PROCEDURE: You will be administered the postograph to assess postnatal mothers and newborn condition
during postnatal period from day 1-5.
COMPENSATION: You will be not entitled to any compensation for participation in this study. Your
participation in this study is completely voluntary. Regarding any doubts/ questions about this study, you
may contact personally to the investigator.
CONFIDENTIALITY: Your name and other details will be kept confidential; will be accessible to the
study personnel.
RIGHT TO WITHDRAW: By your own free will, at any time you can withdraw from participation in the
study and by doing so it will not have any negative effect.
VOLUNTEERS DECLARATION: I have thoroughly read and understood the above information and I
am ready to participate in this study on voluntary basis.
Volunteers Name:
Mr. /Ms.: ..
Investigators Name: Ms. Varsha Sharma
Contact No. : (+91) 9910494810
E-mail ID: varshasharma0591@gmail.com

Volunteers signature:

ANNEXURE-3
FIRST DRAFT OF POSTOGRAPH

ANNEXURE-4
LIST OF EXPERTS FOR CONTENT VALIDITY OF POSTOGRAPH

ANNEXURE-5
LETTER SEEKING EXPERTS OPINION FOR CONTENT VALIDATION OF
POSTOGRAPH

ANNEXURE-6
SECOND DRAFT OF POSTOGRAPH
POSTOGRAPH

Name-

Age-

Sex of the baby/weight

FOR MOTHER
Days
Fundal height
(Cms)

Lochia
Bleeding
(no of pads)

>5
5
4
3
2
1
Any drug used / Iv fluids /
blood component

Pulse (.)
beats/min

180
170
160
150
140
130
120
B.P
110
(MmHg)
100
90
80
70
60
Respiration (breaths/min)
Temperature(0C)
Urine output(ml)
Bowel
Condition of Episiotomy /
perineum
Haemoglobin
Breast engorgement
Breast feeding
After pains
Homens sign
Emotional Response
Counselling
Nutrition/Breastfeeding/Care of
newborn/Family planning/postnatal
exercises/Danger signs/postnatal care.

FOR BABY

Date& time of the delivery

Day-1
14
12
10
8
6
4
2

IP No

Day-2

Day-3

Mode of delivery/Gravida:-

Day-4

Day-5

Days

B/OLength-

Day-1

Day-2

IP NoChest circumference-

Day-3

Day-4

Day-5

Apgar score at the time birth

Head circumference-

Temperature(0 c)

Hand washing before

touching baby

Pulse (.)
(Beats/min)

Respiration
(Breaths/min)

40
39
38
37
36
35
34
33
32
31
30
180
170
160
150
140
130
120
110
100
90
80
70
60
50
40
30

Urine
Meconium
Any drug used /Iv fluids

Seizures
Skin Colour
Umbilical cord
Blood sugar
cry
Weight(kg)
Immunization
Activity

Key
Instructions
Postograph should be filled by the health care professionals.
Postograph should be filled with the blue pen.
Anything abnormal parameter should be documented by the Red pen.
I.
1
a.
b.
c.

FOR MOTHER
Fundal height
Fundal height monitoring should be done for the normal vaginal delivery and assisted delivery.
Fundal height monitoring should not be done for the post C-section mothers.
Should be monitored every 24 hourly daily on the fixed time.
Normal
Involution of fundal height normally occurs at
the rate of 1.25cms/day

Lochia

Normal
R- Rubra (Red)-day 1-4
S-Serosa(yellowish or pink or
pale brownish)-Day 5-9

a. Monitoring of lochia should be done every 24 hourly daily on the fixed time.
3. Bleeding
Estimation of blood loss should be done by counting number of pads.
Normal
Abnormal
No of pads less than 5 within 24 hrs
Number of pads more than 5 within 24 hrs
4. Any drugs used /IV fluids/blood components
a. Used for the postnatal mothers during postnatal period from day 1 to 5.
b. Drugs used for the immediately management of postnatal complications e.g.: PPH, Pyrexia, Pain management
etc.
c. Any blood components used for the postnatal mothers.
5. Pulse rate
a. Denoted by (.)
b. Should be monitored 4 times a day every 6th hourly.
Normal
Abnormal
70-80beats/min
Less than 70beats/min
more than80 beats/min
6. Blood pressure
a. Denoted by () upper arrow indicates systolic pressure and lower arrow indicate diastolic pressure.
b. Pulse monitoring should be done 4 times a day every 6th hourly.
Normal
Normal
More than 60/100mmHg
Less than 60/100mmHg
Less than 90/140mmHg
More than 90/140mmHg
7. Temperature
a. Temperature monitoring should be done 4 times a day every 6th hourly.
Normal
Abnormal
0
97.5-99.5 F
Less than 97.50F
More than 99.50F
8. Urine output
a. Urine output monitoring should be done 6th hourly.
Normal
Urine output more than 30ml/hr

Abnormal
urine out less than 30ml/hr

9. Bowel denoted by

Normal
() if mother passed motion

Abnormal
() if not passed motion

10. Condition of Episiotomy and perineum

Monitoring should be done every 6th hourly.

NORMAL
0-6 Score according to REEDA
scale

ABNORMAL
More than 6 according to
REEDA scale

11. Breast engorgement

Assessment should be done every 6th hourly. Assessment should be done by storr. Scale from 0-4
Description of the tool:
Normal
Abnormal
0 - Normal as in pregnancy and
2 - Breast heavy and slightly warm and
no pain.
moderate pain.
1 - Breast beginning to feel full
3 - Breast warm and heavy and severe
and mild Pain.
Pain.
4 - Breast very hard and worst pain.
12. Breast feeding
Mothers is breastfeeding exclusive (adequately) to the baby yes () or no ()
Normal
Abnormal
Feeding adequately ()
Not feeding adequately ()
13. After pains
Pain grading by numerical pain grading scale form 0-10.
Pain assessment should be done every 6th hourly.
Normal
0-4 score

Abnormal
4-10 score

14. Homens sign

Monitoring should be done once in 24 hours.
Present () Absent ()
Normal
Absent()

Abnormal
Present()

15. Emotional response

Normal
1. Mother caring the baby, happy and good
bonding between mother and baby.

Abnormal
2. Refuse to feed the Baby, Unhappy,
and Excessive Crying and irritated.

16. Counselling
Includes Nutrition/Breastfeeding/Care of newborn/Family planning/postnatal exercises/Danger signs/postnatal
care.

II.
FOR THE NEWBORN
1. Urine
a. Number of times urine passed.
b. Assessment should be done every 6th hourly.
Normal
6-8 times (3-4ml/kg body weight)

Abnormal
Less than 6 times
More than 8 times

2. Meconium
Normal
Present ()
3.

Abnormal
Absent ()

Head circumference/ Chest circumference/

Assessment of head circumferences should be done at the time of the birth.
It should be measured in Cms.
Length of the baby from head to heel in Cms.
Apgar score at the time of birth.

4. Seizures
Normal
Absent ()
5. Skin colour
Normal
P-Pink
6. Umbilical cord
Normal
D-Dry

Abnormal
Present()
Abnormal
B- Blue
Y-Yellowish
Abnormal
R-Any discharge present

7. Cry
Assessment of cry will be done by FLACC scale (Comfort behaviour scale) for the newborn.
Normal
Abnormal
1- 0- No cry (awake or asleep)
3- Crying steadily, screams or sobs; frequent
2- Moans or whimpers, occasional complaint
Complaints
8. Activity
Monitoring of activity will be done by a component of FLACC scale (comfort behaviour scale)
Normal
Abnormal
Score 0 if the patient moves easily and
Score 2 if the patient is in a fixed
freely, normal activity or restrictions.
position, rocking; demonstrates side-to Score 1 if the patient shifts positions,
side head movement or rubbing of a body
appears hesitant to move demonstrates
part.
guarding, a tense torso, and pressure on a body
part.

ANNEXURE-7
THIRD DRAFT OF POSTOGRAPH

ANNEXURE-8
FINAL DRAFT OF POSTOGRAPH

ANNEXURE-9
PERMISSION LETTER FOR PILOT STUDY

ANNEXURE-10
PERMISSION LETTER FOR FINAL STUDY

ANNEXURE-11
PROFORMA FOR EXPERTS OPINION FOR THE CONTENT VALIDITY

ANNEXURE-12
PROFORMA FOR EXPERTS OPINION FOR THE CONTENT VALIDITY
INDEX

ANNEXURE-13
LETTER FROM THE EDITOR