Fetal Death Report Example - Not Named - Birth And Fetal Death (BFDR)

Birth And Fetal Death (BFDR) - STU2-ballot
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This page is part of the Vital Records Birth and Fetal Death Reporting (v2.0.0-ballot: STU 2 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 2.0.0. For a full list of available versions, see the Directory of published versions

Fetal Death Report Example - Not Named

This example provides a narrative description of the fetal report for Fetus Not Named, following the fetal death report. This information is transmitted in both a Provider bundle to the VRO, and in a Jurisdiction bundle to NCHS. The main difference between the two bundles is the inclusion of edit flags.

Field(s) Example Instance

Child Fetus Not Named

Mother Carmen Teresa Lee

Father Tom Yan Lee. Only included in questionnaire

Attendant Janet Seito

Planned to deliver at home No

Maternity Encounter Maternity Encounter

Author Jessica Leung

Mother’s Education Secondary

Mother’s Race and Ethnicity White / Non-Hispanic

Mother’s Usual Work-Occupation Secretary

Mother’s Usual Work-Industry State Agency

Father’s Usual Work-Occupation Teaching Assistant

Father’s Usual Work-Industry Elementary and Secondary Schools

Mother Transferred Maternity Encounter

Intiating Cause of Fetal Death Premature Rupture of Membrances

Other Causes of Fetal Death Placental insufficiency

Fetal Death Time Point Fetal intrapartum death after first assessment

Autopsy Performed Yes

Placental Exam Performed

Histological Exam Results Used Yes

Number of deaths this delivery 1

First Prenatal Care 2018-05-18

Mother’s Height 56 in

Mother’s Prepregnancy Weight 180 lb

Mother WIC Food No

Cigarette Smoking First Trimester = 0, Second Trimester = 0, THird Trimester = 1, Fourth Trimester = 0

Number of Previous Live Births Living = 1, Dead = 0

Last Live Outcome 2016-01-28

Last Normal Menses Last Normal Menses

Risk Factors During Pregnancy Gestational Diabetes, Cesareans = 1

Final Route/Method of Delivery Vaginal with trial labor attempted

Fetal Presentation Breech

Newborn Birthweight 1530g

Obstetric Estimate of Gestation 20 wk

Field(s)	Example Instance
Child	`Fetus Not Named`
Mother	`Carmen Teresa Lee`
Father	`Tom Yan Lee`. Only included in `questionnaire`
Attendant	`Janet Seito`
Planned to deliver at home	`No`
Maternity Encounter	`Maternity Encounter`
Author	`Jessica Leung`
Mother’s Education	`Secondary`
Mother’s Race and Ethnicity	`White / Non-Hispanic`
Mother’s Usual Work-Occupation	`Secretary`
Mother’s Usual Work-Industry	`State Agency`
Father’s Usual Work-Occupation	`Teaching Assistant`
Father’s Usual Work-Industry	`Elementary and Secondary Schools`
Mother Transferred	`Maternity Encounter`
Intiating Cause of Fetal Death	`Premature Rupture of Membrances`
Other Causes of Fetal Death	`Placental insufficiency`
Fetal Death Time Point	`Fetal intrapartum death after first assessment`
Autopsy Performed	`Yes`
Placental Exam	`Performed`
Histological Exam Results Used	`Yes`
Number of deaths this delivery	`1`
First Prenatal Care	`2018-05-18`
Mother’s Height	`56 in`
Mother’s Prepregnancy Weight	`180 lb`
Mother WIC Food	`No`
Cigarette Smoking	`First Trimester = 0`, `Second Trimester = 0`, `THird Trimester = 1`, `Fourth Trimester = 0`
Number of Previous Live Births	`Living = 1`, `Dead = 0`
Last Live Outcome	`2016-01-28`
Last Normal Menses	`Last Normal Menses`
Risk Factors During Pregnancy	`Gestational Diabetes`, `Cesareans = 1`
Final Route/Method of Delivery	`Vaginal` with trial labor attempted
Fetal Presentation	`Breech`
Newborn Birthweight	`1530g`
Obstetric Estimate of Gestation	`20 wk`

IG © 2023+ HL7 International / Public Health. Package hl7.fhir.us.bfdr#2.0.0-ballot based on FHIR 4.0.1. Generated 2023-12-18
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