Pregnancy Outcome Survey

Your Name (required)

Your Email (required)

Date of Birth

What was the outcome of your pregnancy?

What was baby(s) date of delivery?

What was the sex of your baby?

What was the weight of your baby? (lb's & ounces or grams)

Did you opt to screen for Down's syndrome?

If yes, what screening did you opt for?

Did you screen high risk?

Was amniocentisis or chorionic villus sampling performed?

What was the result?

Were you diagnosed as having pre-eclampsia?

Can you please give details of any abnormality detected

Any other details or information?

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