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 1.1.0. 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