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Referral date*

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Patient Details

Patient Name*

Age

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Obstetrical History

LMP

EDD

Gravida

Parity

Current EGA*

Reason for Referral

PERINATOLOGY CONSULTATION

Medical conditionPreconceptionOther

DIABETES CO- MANAGEMENT

Gestational diabetesType IType II

HYPERTENSION CO-MANAGEMENT

Chronic hypertensionPre-eclampsia

OB ULTRASOUND

1st trimester screenAnatomy surveyMedication exposurePositive maternal serum screenMultifetal gestationPlacenta location/abnormal conditionPolyhydramniosOligohydramniosRule out anomaliesAbnormal ultrasoundAmniocentesisBiophysical profileSize< datesSize> datesMorbid obesityOther

GENETIC COUNSELING

Advanced maternal ageMedication exposurePositive maternal serum screenFetal anomalyPrevious child withFamily History ofMultiple lossesOther

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Get in touch

+97167411031

+97167411031
Mother and Fetuses Medical Center

458 Wasit Street, Al Azra,

Sharjah.
info@motherfetus.com

+97167411031
+97167411031

ABOUT
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Who Are MFM Specialists?
Oasis Hospital
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PreConception Care
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First trimester nuchal translucency scan
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Preconception Care
Prenatal Screening
- Chromosomal and Genetic Screening
- Ultrasound
Fetal Testing & Treatment
- Invasive
- Non-invasive
Special pregnancy care
Clinical Genetics
- Genetics Services
- Dr. Ayman El-Hattab
Health Topics
About
Our Team
Gallery
Contact us
Refer now
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