Birth And Fetal Death (BFDR) FHIR Implementation Guide
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Birth And Fetal Death (BFDR) FHIR Implementation Guide, published by HL7 International / Public Health. This guide is not an authorized publication; it is the continuous build for version 2.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-bfdr/ and changes regularly. See the Directory of published versions

Mapping Electronic Health Record Data to the Birth and Fetal Death Record Data Elements

Data elements that are included in a birth or fetal death report are based on data that are part of the mother, child or fetus' electronic health record (EHR). The following PHINVADs-hosted valuesets were published as part of the IHE Quality, Research and Public Health Technical Framework Supplement Birth and Fetal Death Reporting-Enhanced (BFDR-E) to support query of data elements from an EHR. Implementers can use these valuesets as a supplement to the Guide to Completing the Facility Worksheets for the Certificate of Live Birth and Report of Fetal Death.

The table shows the name of the data element, the IJE element that corresponds to the data element, the FHIR profile in this IG used to represent the data element, the type of element, and the valueset that can be used as part of a query. Please note that the referenced value sets have not been updated since the publication of the IHE document in 2021. Therefore, implementers should consider these value sets as an informative guide rather than a definitive resource.

This content is provided in support of implementers of this IG, but is not formally a part of the FHIR specification for exchange of birth and fetal death records.

Note: In some cases, there is not a direct mapping between data element and IJE element, and the IJE element that is most closely associated with the the data element is denoted with an asterisk.

Observations

Name IJE Name Purpose Profile Codesystem
10 Min Apgar Score APGAR10 10 Min Apgar Score ObservationApgarScore LOINC
5 Min Apgar Score APGAR5 5 Min Apgar Score ObservationApgarScore LOINC
Augmentation of Labor Finding AUGL* Labor was augmented ProcedureAugmentationOfLabor SNOMED-CT
Birth Plurality of Delivery PLUR Plurality, which is the number of fetuses delivered live or dead at any time in the pregnancy regardless of gestational age or if the fetuses were delivered at different dates in the pregnancy. (“Reabsorbed” fetuses, those which are not “delivered” (expulsed or extracted from the mother) should not be counted.) PatientChildVitalRecords LOINC
Birth Weight BWG Birth Weight ObservationBirthWeight LOINC
Birth Place Home Intended Birth occurred in the at home as intended ObservationPlannedToDeliverAtHome SNOMED-CT
Birth Place Home Unintended Birth occurred in the at home as unintended ObservationPlannedToDeliverAtHome SNOMED-CT
Birthplace Setting Birthplace of the newborn (setting) LOINC
Body Weight Body weight of the patient LOINC
Breastfed Infant BFED Breastfed Infant at discharge ObservationInfantBreastfedAtDischarge SNOMED-CT
Conception Date Conception Date LOINC
Date of Last Live Birth YLLB, MLLB Date of Last Live Birth ObservationDateOfLastLiveBirth LOINC
Date of Last Menses DLMP_YR, DLMP_MO, DLMP_DY Date of Last Menses ObservationLastMenstrualPeriod LOINC
Date of Last Other Pregnancy Outcome YOPO, MOPO Date of Last Other Pregnancy Outcome such as spontaneous or induced losses or ectopic pregnancy ObservationDateOfLastOtherPregnancyOutcome LOINC
Estimated Time Of Fetal Death ETIME Question as to the estimated time of fetal death ObservationFetalDeathTimePoint LOINC
Fetal Presentation at Birth- Breech PRES* Fetal Presentation at Birth- Breech method of delivery ObservationFetalPresentation SNOMED-CT
Fetal Presentation at Birth- Cephalic PRES* Fetal Presentation at Birth- Cephalic method of delivery ObservationFetalPresentation SNOMED-CT
Fetal Presentation at Birth- Other PRES* Fetal Presentation at Birth- Other ObservationFetalPresentation SNOMED-CT
Fever Greater Than 100.4 Fever Greater Than 100.4 During Labor SNOMED-CT
First Prenatal Care Visit DOFP_YR, DOFP_MO, DOFP_DY Date of the First Prenatal Care Visit ObservationDateOfFirstPrenatalCareVisit LOINC
Height HFT, HIN Mother’s height ObservationMotherHeight LOINC
Induction of Labor Finding INDL* Labor was induced ProcedureInductionOfLabor SNOMED-CT
Institution Referred to Institution to which the patient was referred LOINC
Karyotype Confirmed Karyotype Confirmed as an anomaly of the newborn SNOMED-CT
Karyotype Result Karyotyping to determine that the result is pending LOINC
Method of Delivery Cesarean Finding Delivery of the entire fetus through the vaginal wall (cesarean) ProcedureFinalRouteMethodDelivery SNOMED-CT
Method of Delivery Vaginal Forceps Finding ATTF - NOT IMPLEMENTED Delivery of the fetus using vaginal forceps ProcedureFinalRouteMethodDelivery SNOMED-CT
Method of Delivery Vaginal-Spon Finding Delivery of the entire fetus through the vagina by the natural force of labor with or without manual assistance from the delivery attendant. ProcedureFinalRouteMethodDelivery SNOMED-CT
Method of Delivery Vaginal Vacuum Finding ATTV - NOT IMPLEMENTED Delivery of the fetus using vaginal vacuum ProcedureFinalRouteMethodDelivery SNOMED-CT
Mothers Delivery Weight DWGT Mother’s Delivery Weight ObservationMotherDeliveryWeight LOINC
Number of Fetal Deaths This Delivery FDTH Number of Fetal Deaths This Delivery ObservationNumberFetalDeathsThisDelivery LOINC
Number of Live Births LIVEB Number of Live Births for the current pregnancy ObservationNumberLiveBirthsThisDelivery LOINC
Number of Preterm Births Number of preterm births in prior pregnancies LOINC
Number of Previous Cesareans NPCES Number of Previous Cesareans as a Risk Factor in Pregnancy ObservationNumberPreviousCesareans LOINC
Number of Previous Live Births Now Dead PLBD Number of Previous Live Births Now Dead ObservationNumberBirthsNowDead LOINC
Number of Previous Live Births Now Living PLBL Number of Live Births Now Living ObservationNumberBirthsNowLiving LOINC
Number of Prior Pregnancies Number of Prior Pregnancies LOINC
Number Prenatal Care Visits NPREV Number Prenatal Care Visits ObservationNumberPrenatalVisits LOINC
Obstetric Estimate of Gestation OWGEST Obstetric Estimate of Gestation of the newborn ObservationGestationalAgeAtDelivery LOINC
Pre-Pregnancy Weight PWGT Mother’s Pre-Pregnancy Weight ObservationMotherPrepregnancyWeight LOINC
Previous Cesarean PCES Risk Factors of Pregnancy Previous Cesarean ObservationPreviousCesarean SNOMED-CT
Previous Other Pregnancy Outcomes POPO Previous Other Pregnancy Outcomes ObservationNumberOtherPregnancyOutcomes LOINC
Scheduled Cesarean Finding Cesarean Section was scheduled SNOMED-CT
Seizure or Serious Neurologic Dysfunction SEIZ Newborn suffered a Seizure or Serious Neurologic Dysfunction reflecting an abnormal condition of the newborn ConditionSeizure SNOMED-CT
Spontaneous Onset of Labor Spontaneous Onset of Labor SNOMED-CT

Conditions

Name IJE Name Purpose Profile Codesystem
Anencephaly of the Newborn ANEN Anencephaly of the Newborn as an anomaly of the newborn ConditionCongenitalAnomalyOfNewborn SNOMED-CT
Chlamydia CHAM Chlamydia as Infections present and treated during this pregnancy ConditionInfectionPresentDuringPregnancy SNOMED-CT
Chorioamnionitis During Labor CHOR Chorioamnionitis During Labor ConditionChorioamnionitis SNOMED-CT
Cleft Lip with or without Cleft Palate CL Cleft Lip with/without Cleft Palate as an anomaly of the newborn ConditionCongenitalAnomalyOfNewborn SNOMED-CT
Cleft Palate Alone CP Cleft Palate alone as an anomaly of the newborn ConditionCongenitalAnomalyOfNewborn SNOMED-CT
Congenital Diaphragmatic Hernia CDH Congenital Diaphragmatic Hernia as an anomaly of the newborn ConditionCongenitalAnomalyOfNewborn SNOMED-CT
Cyanotic Congenital Heart Disease CCHD Cyanotic Congenital Heart Disease as an anomaly of the newborn ConditionCongenitalAnomalyOfNewborn SNOMED-CT
Cytomegalovirus Infection with Cytomegalovirus SNOMED-CT
Downs Syndrome DOWT Downs Syndrome as an anomaly of the newborn ConditionCongenitalAnomalyOfNewborn SNOMED-CT
Eclampsia EHYPE Risk Factors of Eclampsia ConditionEclampsiaHypertension SNOMED-CT
Fourth Degree Perineal Laceration PLAC Fourth Degree Perineal Laceration as a maternal morbidity ConditionPerinealLaceration SNOMED-CT
Gastroschisis of the Newborn GAST Gastroschisis of the Newborn as an anomaly of the newborn ConditionCongenitalAnomalyOfNewborn SNOMED-CT
Gestational Diabetes GDIAB Risk Factors of Gestational Diabetes ConditionGestationalDiabetes SNOMED-CT
Gestational Hypertension GHYPE Risk Factors of Gestational Hypertension ConditionGestationalHypertension SNOMED-CT
Gonorrhea GON Gonorrhea as Infections present and treated during this pregnancy ConditionInfectionPresentDuringPregnancy SNOMED-CT
Group B Streptococcus GBS - NOT IMPLEMENTED Infection with Group B Streptococcus ConditionInfectionPresentDuringPregnancy SNOMED-CT
Hepatitis B HEPB Hepatitis B as Infections present and treated during this pregnancy ConditionInfectionPresentDuringPregnancy SNOMED-CT
Hepatitis C HEPC Hepatitis C as Infections present and treated during this pregnancy ConditionInfectionPresentDuringPregnancy SNOMED-CT
Hypospadias HYPO Hypospadias as an anomaly of the newborn ConditionCongenitalAnomalyOfNewborn SNOMED-CT
Limb Reduction Defect LIMB Limb Reduction Defect as an anomaly of the newborn ConditionCongenitalAnomalyOfNewborn SNOMED-CT
Listeria Listeria as Infections present and treated during this pregnancy ConditionInfectionPresentDuringPregnancy SNOMED-CT
Meningomyelocele/Spina Bifida - Newborn MNSB Meningomyelocele/Spina Bifida of the Newborn as an anomaly of the newborn ConditionCongenitalAnomalyOfNewborn SNOMED-CT
Neonatal Sepsis Newborn had suspected neonatal sepsis reflecting an abnormal condition of the newborn SNOMED-CT
Omphalocele of the Newborn OMPH Omphalocele of the Newborn as an anomaly of the newborn ConditionCongenitalAnomalyOfNewborn SNOMED-CT
Parvovirus Infection with Parvovirus ConditionInfectionPresentDuringPregnancy SNOMED-CT
Precipitous Labor PRIC - NOT IMPLEMENTED Onset of labor with Precipitous Labor SNOMED-CT
Premature Rupture PROM - NOT IMPLEMENTED Onset of labor with Premature Rupture SNOMED-CT
Prepregnancy Diabetes PDIAB Risk Factors of Prepregnancy Diabetes ConditionPrepregnancyDiabetes SNOMED-CT
Prepregnancy Hypertension PHYPE Risk Factors of Prepregnancy Hypertension ConditionPrepregnancyHypertension SNOMED-CT
Prolonged Labor PROL - NOT IMPLEMENTED Onset of labor with Prolonged Labor SNOMED-CT
Ruptured Uterus RUT Ruptured Uterus as a maternal morbidity ConditionRupturedUterus SNOMED-CT
Significant Birth Injury BINJ - NOT IMPLEMENTED Newborn suffered a Significant Birth Injury (skeletal fracture(s), peripheral nerve injury, and/ or soft tissue/solid organ hemorrhage which requires intervention) reflecting an abnormal condition of the newborn SNOMED-CT
Suspected Chromosomal Disorder CDIT Suspected Chromosomal Disorder as an anomaly of the newborn ConditionCongenitalAnomalyOfNewborn SNOMED-CT
Syphilis SYPH Syphilis as Infections present and treated during this pregnancy ConditionInfectionPresentDuringPregnancy SNOMED-CT
Third Degree Perineal Laceration PLAC Third Degree Perineal Laceration as a maternal morbidity ConditionPerinealLaceration SNOMED-CT
Toxoplasmosis Infection with Toxoplasmosis ConditionInfectionPresentDuringPregnancy SNOMED-CT

Procedures

Name IJE Name Purpose Profile Codesystem
Antibiotic Administration Procedure ANTI* Antibiotic Administration Procedure during labor and delivery ObservationAntibioticsAdministeredDuringLabor SNOMED-CT
Artificial or Intrauterine Insemination INFT_DRG Artificial or Intrauterine Insemination as a Risk Factor in Pregnancy [ProcedureArtificialInsemination] SNOMED-CT
Assisted Ventilation AVEN1*, AVEN6* Newborn was provided assisted ventilation reflecting an abnormal condition of the newborn ProcedureAssistedVentilationFollowingDelivery, ProcedureAssistedVentilationMoreThanSixHours SNOMED-CT
Assistive Reproductive Technology INFT_ART Assistive Reproductive Technology as a Risk Factor in Pregnancy [ProcedureAssistedFertilization] SNOMED-CT
Augmentation of Labor - Procedure AUGL Procedure of Augmentation of Labor ProcedureAugmentationOfLabor SNOMED-CT
Cervical Cerclage CERV - NOT IMPLEMENTED Obstetric Procedures as Cervical Cerclage SNOMED-CT
Delivery ROUT Delivery Procedure ProcedureFinalRouteMethodDelivery SNOMED-CT
Epidural Anesthesia - Procedure ESAN Epidural Anesthesia Procedure ProcedureEpiduralOrSpinalAnesthesia SNOMED-CT
External Cephalic Version ECVS Obstetric Procedures as External Cephalic Version ProcedureObstetric SNOMED-CT
Autopsy Performed AUTOP Autopsy was performed ObservationAutopsyPerformedIndicator SNOMED-CT
Hysterotomy Hysterectomy UHYS hysterotomy/hysterectomy as the method of delivery in fetal death ProcedureFinalRouteMethodDelivery SNOMED-CT
ICU Care AINT Mother was transferred to ICU following the birth ObservationICUAdmission SNOMED-CT
Induction of Labor INDL Induction of Labor ProcedureInductionOfLabor SNOMED-CT
Infertility Treatment INFT Risk Factors of Pregnancy Infertility Treatment ProcedureInfertilityTreatment SNOMED-CT
Karyotype Determination Karyotype determination as an anomaly of the newborn SNOMED-CT
Pregnancy Resulting From Fertility Enhancing Drugs INFT_DRG* Indicate whether a pregnancy resulted from fertility enhancing drugs [ProcedureArtificialInsemination] SNOMED-CT
Surfactant Replacement Therapy SURF Surfactant Replacement Therapy ProcedureSurfactantReplacementTherapy SNOMED-CT
NICU Care NICU Baby was transferred to NICU following the birth ObservationNICUAdmission SNOMED-CT
Route and Method of Delivery - Cesarean ROUT* Route and Method of Delivery as Cesarean Delivery ProcedureFinalRouteMethodDelivery SNOMED-CT
Route and Method of Delivery - Forceps ROUT* Route and Method of Delivery as Forceps Delivery ProcedureFinalRouteMethodDelivery SNOMED-CT
Route and Method of Delivery - Scheduled C ROUT* Route and Method of Delivery as Scheduled Cesarean ProcedureFinalRouteMethodDelivery SNOMED-CT
Route and Method of Delivery - Spontaneous ROUT* Route and Method of Delivery as Spontaneous Delivery ProcedureFinalRouteMethodDelivery SNOMED-CT
Route Method of Delivery - Trial of Labor TLAB Route and Method of Delivery if Cesarean was as Trial of Labor Attempted ObservationLaborTrialAttempted SNOMED-CT
Route and Method of Delivery - Vacuum ROUT* Route and Method of Delivery as Vacuum Delivery ProcedureFinalRouteMethodDelivery SNOMED-CT
Spinal Anesthesia - Procedure ESAN* Spinal Anesthesia Procedure ProcedureEpiduralOrSpinalAnesthesia SNOMED-CT
Steroids For Fetal Lung Maturation STER Indicate whether steroids (glucocorticoids) for fetal lung maturation was received by the mother before delivery ObservationSteroidsFetalLungMaturation SNOMED-CT
Tocolysis TOC - NOT IMPLEMENTED Obstetric Procedures as Tocolysis SNOMED-CT
Transfer to HOSPTO If the infant was transferred within 24 hours of delivery to another facility LocationBFDR SNOMED-CT
Transferred for Maternal Medical or Fetal Indications for Delivery TRAN Transferred for Maternal Medical or Fetal Indications for Delivery EncounterMaternity SNOMED-CT
Transfusion Whole Blood or Packed Red Bld MTR Transfusion Whole Blood or Packed Red Blood as a maternal morbidity ProcedureBloodTransfusion SNOMED-CT
Unplanned Hysterectomy UHYS Unplanned hysterectomy as a maternal morbidity ProcedureUnplannedHysterectomy SNOMED-CT
Unplanned Operation UOPR - NOT IMPLEMENTED Unplanned operation as a maternal morbidity SNOMED-CT

Medications

Name IJE Name Purpose Profile Codesystem
Antibiotics ANTI Antibiotics were received by the mother during delivery and by the newborn for suspected neonatal sepsis ProcedureAntibioticSuspectedNeonatalSepsis RxNorm
Augmentation of Labor - Medication AUGL* Medication used for the of Augmentation of Labor ProcedureAugmentationOfLabor RxNorm
Epidural/Spinal Anesthesia - Medication ESAN* Epidural and Spinal Anesthesia Medication ProcedureEpiduralOrSpinalAnesthesia RxNorm
Fertility Enhancing Drugs Medications INFT_DRG Fertility Enhancing Drugs were administered as a risk factor for pregnancy [ProcedureArtificialInsemination] RxNorm
Newborn Receiving Surfactant Replacement Therapy SURF* Newborn received Surfactant Replacement Therapy reflecting an abnormal condition of the newborn ProcedureSurfactantReplacementTherapy RxNorm

Locations

Name IJE Name Purpose Profile Codesystem
Facility Location ICU AINT Patient (mother) was treated in the ICU for complications associated with labor and delivery reflecting a maternal morbidity. ObservationICUAdmission HL7 Service Delivery Location
Facility Location NICU NICU Newborn was admitted to the NICU reflecting an abnormal condition of the newborn ObservationNICUAdmission HL7 Service Delivery Location
Facility Location OR Patient (mother) was treated in the OR for an unplanned operation for complications associated with labor and delivery reflecting unplanned operation HL7 Service Delivery Location

Miscellaneous

Name IJE Name Purpose Profile Codesystem
Autopsy Planned AUTOP* Autopsy was planned SNOMED-CT
Birth Place Clinic Office Birth occurred in the at clinic or office EncounterBirth SNOMED-CT
Birth Place Freestanding Birthing Center Birth occurred at a freestanding birthing center EncounterBirth SNOMED-CT
Birthplace Hospital Birth occurred in the hospital EncounterBirth SNOMED-CT
Certified Midwife ATTEND* Title of the Attendant responsible for the delivery Procedure as a Certified Midwife PractitionerBirthAttendant SNOMED-CT
Doctor of Osteopathic Medicine ATTEND* Title of the Attendant responsible for the delivery Procedure as a Doctor of Osteopathic Medicine PractitionerBirthAttendant SNOMED-CT
Fetal Death Time Point ETIME A list of time points during the delivery process at which the fetal death is thought to have occurred. Note, SNOMED is being used as the primary source for codes within the value set. ObservationFetalDeathTimePoint SNOMED-CT
Histological Placental Examination HISTOP Histological Placental Examination for fetal death ObservationHistologicalPlacentalExamPerformed SNOMED-CT
IM Medication Administration Route Intramuscular Medication Administration Route was used to administer a medication HL7 Route of Administration
IV Medication Administration Route IV Medication Administration Route was used to administer a medication HL7 Route of Administration
Midwife ATTEND* Title of the Attendant responsible for the delivery Procedure as a Midwife excluding registered midwife which is reflected in the ‘certified midwife’ value set PractitionerBirthAttendant SNOMED-CT
Neonatal Death Newborn died SNOMED-CT
Physician ATTEND* Title of the Attendant responsible for the delivery Procedure as a Physician PractitionerBirthAttendant SNOMED-CT
Preterm Birth PPB Risk Factors of Preterm Birth (history) ObservationPreviousPretermBirth SNOMED-CT
Problem Status Active Problem Status Active SNOMED-CT
Transfer In HOSPFROM If the mother was transferred to this facility LocationBFDR Admit source (HL7)