Cesarean Audit Data Collection Form
Please fill in the following details for each cesarean case audit. Do not include sensitive personal identifiers.
Audit Case ID (do not use patient name or MRN)
*
Date of Cesarean Delivery
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Time of Cesarean Delivery
*
Hour Minutes
AM
PM
AM/PM Option
Indication for Cesarean
*
Please Select
Previous cesarean
Fetal distress
Failure to progress
Malpresentation
Maternal request
Other
Type of Cesarean
*
Elective
Emergency
Level of Urgency
*
Please Select
Category 1 (immediate threat)
Category 2 (maternal/fetal compromise)
Category 3 (early delivery needed)
Category 4 (elective)
Primary Operator
*
Anesthesia Type
*
Spinal
Epidural
General
Other
Were there any intraoperative complications?
*
Yes
No
Additional Notes / Audit Comments
Submit Audit Data
Should be Empty: