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

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

Content Transitions

Page standards status: Informative

January 2024 Ballot of STU2

The STU2 versions of the BFDR and VRCL FHIR IGs are part of an effort to harmonize and reduce duplication among FHIR IGs for vital records and medico-legal investigation. As a result of this effort there has been a significant realignment of content among these FHIR IGs. The tables below show the provenance of all current content of the BFDR STU2 IG, as well as content that was previously included and has been moved, superceded, or obsoleted.







STU2 Bundles and Compositions

Name Previous Version/Location Comments/Updates
BundleDocumentBirthReport BFDR Separated Birth and Fetal Death into separate bundles
BundleDocumentDemographicCodedCauseOfFetalDeath New New Addition
BundleDocumentDemographicCodedContent New New Addition
BundleDocumentFetalDeathReport BFDR Separated Birth and Fetal Death into separate bundles
CompositionCodedCauseOfFetalDeathBFDR-
CompositionCodedRaceAndEthnicity BFDR-
CompositionJurisdictionFetalDeathReportBFDR emergingIssues section added
CompositionJurisdictionLiveBirthReportBFDR emergingIssues section added
CompositionProviderFetalDeathReportBFDR emergingIssues section added
CompositionProviderLiveBirthReportBFDR emergingIssues section added

STU2 Profiles

Name Previous Version/Location Comments/Updates
ConditionChorioamnionitis BFDR Added requiredCategory slice, see categories
ConditionCongenitalAnomalyOfNewborn BFDR -
ConditionEclampsiaHypertension VRCL Added requiredCategory slice, see categories
ConditionFetalDeathInitiatingCauseOrCondition BFDR -
ConditionFetalDeathOtherCauseOrCondition BFDR -
ConditionGestationalDiabetes VRCL Added requiredCategory slice, see categories
ConditionGestationalHypertension VRCL Added requiredCategory slice, see categories
ConditionInfectionPresentDuringPregnancy BFDR -
ConditionPerinealLaceration BFDR Added requiredCategory slice, see categories
ConditionPrepregnancyDiabetes VRCL Added requiredCategory slice, see categories
ConditionPrepregnancyHypertension VRCL Added requiredCategory slice, see categories
ConditionRupturedUterus BFDR Added requiredCategory slice, see categories
ConditionSeizure BFDR Added requiredCategory slice, see categories
CoveragePrincipalPayerDelivery BFDR -
EncounterMaternity BFDR Added a role extension to differentiate from Encounter Birth
EncounterBirth BFDR Added a role extension to differentiate from Encounter Maternity
ObservationAntibioticsAdministeredDuringLabor BFDR -
ObservationApgarScore VRCL -
ObservationAutopsyHistologicalExamResultsUsed BFDR -
ObservationAutopsyPerformedIndicator VRCL Value field now a slice definition ("actual result") and "autopsy was performed?" is reported under valueCodeableConcept field
ObservationBirthPluralityOfPregnancy VRCL Changed name to better reflect LOINC code description. It is not used by the birth and fetal death use cases, but is provided for general utility.
ObservationBirthWeight VRCL Now includes birthWeight bypassEditFlag
ObservationCigaretteSmokingBeforeDuringPregnancy BFDR Focus generalized to Patient
ObservationCodedInitiatingFetalDeathCauseOrCondition BFDR Changed from Condition to Observation
ObservationCodedOtherFetalDeathCauseOrCondition BFDR Changed from Condition to Observation. Added component:position to represent order of fetal death cause or condition codes
ObservationDateOfFirstPrenatalCareVisit BFDR -
ObservationDateOfLastLiveBirth BFDR -
ObservationDateOfLastOtherPregnancyOutcome BFDR -
ObservationFetalDeathTimePoint BFDR -
ObservationFetalPresentation BFDR -
ObservationGestationalAgeAtDelivery VRCL Now includes estimateOfGestation bypassEditFlag
ObservationHistologicalPlacentalExamPerformed BFDR -
ObservationICUAdmission BFDR -
ObservationInfantBreastfedAtDischarge BFDR -
ObservationInfantLiving VRCL -
ObservationLaborTrialAttempted BFDR -
ObservationLastMenstrualPeriod VRCL -
ObservationFetalRemainsDispositionMethod BFDR -
ObservationMotherDeliveryWeight VRCL Now includes pregnancyReport bypassEditFlag
ObservationMotherHeight VRCL Now includes pregnancyReport bypassEditFlag. Base profile changed to use USCoreBodyHeight
ObservationMotherMarriedDuringPregnancy BFDR -
ObservationMotherPrepregnancyWeight VRCL Now includes pregnancyReport bypassEditFlag
ObservationMotherReceivedWICFood BFDR -
ObservationNICUAdmission BFDR snomed code change from 405269005 Neonatal intensive care unit to 830077005 Admission to neonatal intensive care unit
ObservationNoneOfSpecifiedAbnormalConditionsOfNewborn BFDR See categories
ObservationNoneOfSpecifiedCharacteristicsOfLaborAndDelivery BFDR See categories
ObservationNoneOfSpecifiedCongenitalAnomoliesOfTheNewborn New New Addition, see categories
ObservationNoneOfSpecifiedInfectionsPresentDuringPregnancy New New Addition, see categories
ObservationNoneOfSpecifiedMaternalMorbidities BFDR See categories
ObservationNoneOfSpecifiedObstetricProcedures New New Addition, see categories
ObservationNoneOfSpecifiedPregnancyRiskFactors VRCL See categories
ObservationNumberBirthsNowDead VRCL -
ObservationNumberBirthsNowLiving VRCL -
ObservationNumberFetalDeathsThisDelivery VRCL -
ObservationNumberLiveBirthsThisDelivery VRCL -
ObservationNumberOtherPregnancyOutcomes VRCL -
ObservationNumberPrenatalVisits VRCL Now includes pregnancyReport bypassEditFlag
ObservationNumberPreviousCesareans VRCL Now includes numberPreviousCeseareans bypassEditFlag
ObservationPaternityAcknowledgementSigned BFDR -
ObservationPlannedToDeliverAtHome BFDR Encounter profiles now handle home delivery plan. It is no longer used by the birth and fetal death use cases, but is provided for general utility.
ObservationPresentJob New New Addition
ObservationPreviousCesarean VRCL -
ObservationPreviousPretermBirth VRCL -
ObservationSSNRequestedForChild BFDR -
ObservationSteroidsFetalLungMaturation BFDR -
ObservationUnknownFinalRouteMethodDelivery New New Addition, see categories
PatientDecedentFetus VRCL Now includes a bypassEditFlag extension on multipleBirth
PractitionerBirthAttendant New Includes a role extension to differentiate from BirthCertifier practitioner
PractitionerBirthCertifier New Includes a role extension to differentiate from BirthAttendant practitioner
ProcedureAntibioticSuspectedNeonatalSepsis BFDR Added LOINC category value, see categories
ProcedureFertilityEnhancingDrugTherapyArtificialInsemination VRCL Added LOINC category value, see categories. The profile was renamed to reflect its intent and that it includes artificial insemination.
ProcedureAssistedReproductiveTechnology VRCL Added LOINC category value, see categories. The profile was renamed to reflect its intent.
ProcedureAssistedVentilationFollowingDelivery BFDR Added LOINC category value, see categories
ProcedureAssistedVentilationMoreThanSixHours BFDR Added LOINC category value, see categories
ProcedureAugmentationOfLabor BFDR Added LOINC category value, see categories
ProcedureBloodTransfusion BFDR Added LOINC category value, see categories
ProcedureEpiduralOrSpinalAnesthesia BFDR Added LOINC category value, see categories
ProcedureFinalRouteMethodDelivery BFDR Added LOINC category value, see categories
ProcedureInductionOfLabor BFDR Added LOINC category value, see categories
ProcedureInfertilityTreatment VRCL Added LOINC category value, see categories
ProcedureObstetric BFDR Added LOINC category value, see categories. Outcome constrained to new valueset that contains subset of ProcedureOutcomeCodes(SNOMEDCT)
ProcedureSurfactantReplacementTherapy BFDR Added LOINC category value, see categories
ProcedureUnplannedHysterectomy BFDR Added LOINC category value, see categories

STU2 Extensions

Name Previous Version/Location Comments/Updates
JurisdictionalFacilityIdentifier New New Addition
ExtensionRole New New Addition

STU2 Valuesets

Name Previous Version/Location Comments/Updates
ApgarTimingVS VRCL -
BirthAttendantTitlesVS PHINVADS -
BirthAndFetalDeathFinancialClassVS PHINVADS -
BirthDeliveryOccurredVS PHINVADS -
BirthWeightEditFlagsVS PHINVADS -
CigaretteSmokingBeforeAndDuringPregnancyVS BFDR -
DeliveryRoutesVS PHINVADS -
EstimateOfGestationEditFlagsVS PHINVADS -
FetalDeathCauseOrConditionVS PHINVADS -
FetalDeathTimePointsVS PHINVADS -
FetalPresentationsVS PHINVADS -
FertilityEnhancingDrugTherapyArtificialInseminationVS New New Addition, including two SNOMEDCT codes for artificial insemination and fertility enhancing drug therapy
InfectionsDuringPregnancyLiveBirthVS PHINVADS -
InformantRelationshipToMotherVS PHINVADS -
FetalRemainsDispositionMethodVS PHINVADS -
NewbornCongenitalAnomaliesVS PHINVADS -
NumberPreviousCesareansEditFlagsVS PHINVADS -
ObstetricProcedureOutcomeVS New New Addition, contains subset of ProcedureOutcomeCodes(SNOMEDCT), indicating whether procedure was 'Successful' or 'Unsuccessful'
PerformedNotPerformedPlannedVS PHINVADS Renamed from HistologicalPlacentalExaminationVS to better reflect content
PregnancyReportEditFlagsVS PHINVADS Used in bypassEditFlag extension for ObservationMotherHeight, ObservationMotherDeliveryWeight, ObservationMotherPrepregnancyWeight, ObservationNumberPrenatalVisits

STU2 Codesystems

Name Previous Version/Location Comments/Updates
EditFlagsCS New New Addition
LocalBFDRCodesCS New New Addition

Removed Profiles

This section has been updated to reflect changes at ballot time, allowing the reader to follow the harmonization process. For details on the subsequent evolution of these profiles, see their new home IG.

Name Current Version/Location Comments/Updates
ObservationEditFlagBirthWeight Deleted bypassEditFlag extension added to ObservationBirthWeight
ObservationEditFlagEstimateOfGestation Deleted bypassEditFlag extension added to ObservationGestationalAgeAtDelivery
ObservationEditFlagFathersDateOfBirth Deleted bypassEditFlag extension added to RelatedPersonFatherVitalRecords
ObservationEditFlagFathersEducation Deleted bypassEditFlag extension added to ObservationEducationLevelVitalRecords
ObservationEditFlagMothersDateOfBirth Deleted bypassEditFlag extension added to PatientMotherVitalRecords
ObservationEditFlagMothersDeliveryWeight Deleted bypassEditFlag extension added to ObservationMotherDeliveryWeight
ObservationEditFlagMothersEducation Deleted bypassEditFlag extension added to ObservationEducationLevelVitalRecords
ObservationEditFlagMothersHeight Deleted bypassEditFlag extension added to ObservationMotherHeight
ObservationEditFlagMothersPrepregnancyWeight Deleted bypassEditFlag extension added to ObservationMotherPrepregnancyWeight
ObservationEditFlagNumberPrenatalCareVisits Deleted bypassEditFlag extension added to ObservationNumberPrenatalVisits
ObservationEditFlagNumberPreviousCesareans Deleted bypassEditFlag extension added to ObservationNumberPreviousCesareans
ObservationEditFlagPlurality Deleted bypassEditFlag extension added to PatientChildVitalRecords

Removed Extensions

Name Current Version/Location Comments/Updates
ExtensionDateFiledByRegistrar Deleted Deprecated
ExtensionDateReceivedByRegistrar Deleted Deprecated
ExtensionEncounterMaternityReference Deleted Deprecated
ExtensionFetalDeathLocalFileNumber Deleted Deprecated
ExtensionFetalDeathReportNumber Deleted Deprecated
ExtensionLiveBirthCertificateNumber Deleted Deprecated
ExtensionLiveBirthLocalFileNumber Deleted Deprecated
ExtensionReplacementStatus Deleted Deprecated

Removed Valuesets

Name Current Version/Location Comments/Updates
ValueSetReplacementStatus Deleted Deprecated
ValueSetYesNoNotApplicableVRCL Moved to VRCL
ObstetricProcedureVS Deleted Deprecated

Removed Codesystems

Name Current Version/Location Comments/Updates
CodeSystemReplacement Deleted Deprecated