Fetal Death Report Example - Not Named - Birth And Fetal Death (BFDR) FHIR Implementation Guide v2.0.0

Birth And Fetal Death (BFDR) FHIR Implementation Guide
2.0.0 - STU2 United States of America flag

This page is part of the Vital Records Birth and Fetal Death Reporting (v2.0.0: STU2) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. 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

Decedent Fetus Fetus Not Named

Mother Carmen Teresa Lee

Father Tom Yan Lee. Only included in questionnaire

Attendant Janet Seito

Maternity Encounter Maternity Encounter

Author Jessica Leung

Intiating Cause of Fetal Death Premature Rupture of Membrances

Other Causes of Fetal Death Placental insufficiency

Newborn Birthweight 1530g

Obstetric Estimate of Gestation 20 wk

Fetal Death Time Point Fetal intrapartum death after first assessment

Autopsy Performed Yes

Placental Exam Performed

Histological Exam Results Used Yes

Mother's Education Some secondary or high school education

Mother's Present Job-Occupation Secretary

Mother's Present Job-Industry State Agency

Mother's Race and Ethnicity White/Black/AIAN/Hispanic

Father's Present Job-Occupation Teaching Assistant

Father's Present Job-Industry Elementary and Secondary Schools

First Prenatal Care Visit Date 2018-05-18

Mother's Height 65 in

Mother's Prepregnancy Weight 180 lb

Mother WIC Food No

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

Last Live Birth Date 2016-01-28

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

Last Normal Menses Date 2018-04-18

Number of Deaths this Delivery 1

Mother Transferred No

Risk Factors During Pregnancy Gestational Diabetes

Number of Previous Cesareans Cesareans = 1

Fetal Presentation Breech

Final Route/Method of Delivery Vaginal

Field(s)	Example Instance
Decedent Fetus	`Fetus Not Named`
Mother	`Carmen Teresa Lee`
Father	`Tom Yan Lee`. Only included in `questionnaire`
Attendant	`Janet Seito`
Maternity Encounter	`Maternity Encounter`
Author	`Jessica Leung`
Intiating Cause of Fetal Death	`Premature Rupture of Membrances`
Other Causes of Fetal Death	`Placental insufficiency`
Newborn Birthweight	`1530g`
Obstetric Estimate of Gestation	`20 wk`
Fetal Death Time Point	`Fetal intrapartum death after first assessment`
Autopsy Performed	`Yes`
Placental Exam	`Performed`
Histological Exam Results Used	`Yes`
Mother's Education	`Some secondary or high school education`
Mother's Present Job-Occupation	`Secretary`
Mother's Present Job-Industry	`State Agency`
Mother's Race and Ethnicity	`White/Black/AIAN/Hispanic`
Father's Present Job-Occupation	`Teaching Assistant`
Father's Present Job-Industry	`Elementary and Secondary Schools`
First Prenatal Care Visit Date	`2018-05-18`
Mother's Height	`65 in`
Mother's Prepregnancy Weight	`180 lb`
Mother WIC Food	`No`
Number of Previous Live Births	`Living = 1`, `Dead = 0`
Last Live Birth Date	`2016-01-28`
Cigarette Smoking	`First Trimester = 0`, `Second Trimester = 0`, `Third Trimester = 1`, `Fourth Trimester = 0`
Last Normal Menses Date	`2018-04-18`
Number of Deaths this Delivery	`1`
Mother Transferred	`No`
Risk Factors During Pregnancy	`Gestational Diabetes`
Number of Previous Cesareans	`Cesareans = 1`
Fetal Presentation	`Breech`
Final Route/Method of Delivery	`Vaginal`