DATA ENTRY FORM

Check your entries for accuracy and click here to submit the data. You will then have the option to submit another case.  

Patient identifier Gestational age at enrollment (sample collection) Samples collected (check all that apply) Amniotic fluid sample Initial serum sample Postop serum sample POD # 1 serum sample Please indicate which intervention was performed at the time of sample collection (regardless of later interventions) Amniocentesis only Amnioreduction only Laser ablation Cord ligation Ultrasound findings in the DONOR (check all that apply) Donor bladder seen Donor AEDF in UA Donor REDF in UA Donor RF in ductus venosus Donor pericardial effusion Donor pleural effusion Donor ascites Donor skin edema Deepest AF pocket around DONOR (in cm) Ultrasound findings in the RECIPIENT (check all that apply) Recipient pulsatile UV flow Recipient RF in ductus venosus Recipient TR Recipient MR Recipient pericardial effusion Recipient pleural effusion Recipient ascites Recipient skin edema Deepest AF pocket around RECIPIENT (in cm)

After delivery, you will need to fill out and send the follow-up data form on this patient. Be sure to use the patient's same unique identifier for the follow-up data.