Antepartum Summary, published by IHE Patient Care Coordination Committee. This is not an authorized publication; it is the continuous build for version 0.0.1-current). This version is based on the current content of https://github.com/IHE/PCC.APS/ and changes regularly. See the Directory of published versions

1:XX. Antepartum Summary (APS) Volume 1

1:XX Antepartum Summary

Antepartum Summary is a content profile that defines the structure for the aggregation of significant events, diagnoses, and plans of care derived from the visits over the course of an antepartum episode.

This is intended to be a Content profile.

1:XX.1 Overview

TBD This FHIR document inherits its composition from the International Patient Summary and will have some dependencies on that Implementation guide.

The following table informs the Pregnancy observations that are defined in this profile, indicating where the observation is already included in the in the IPS. However, many of the sections and entries defined in the IPS were designed to be extensible, so the additional observations profiled by this specification do not impact conformance to the IPS document.

APS Pregnancy Observations	Inherited from IPS (Y/N)
Pregnancy History	N
Date Of First Prenatal Visit	N
Number Of Prenatal Visits For This Pregnancy	N
​Pregnancy Status	Y
Menstrual Status	N
Date Of Last Menstral Period	N
Delivery Date Clinical Estimate	N
Delivery Date Estimated From LMP	N
Delivery Date Estimated From Ovulation Date	N
Multiple Pregnancy	N
Gestational Age	N
Fetus Gestational Age	N
Body Weight Measured Pre Pregnancy	N
Labor Risk	N
Delivery Risk	N
Fetus Gestational Age Clinical Estimate	N
Fetus Gestational Age Estimated From LMP	N
Fetus Gestational Age Estimated From Ovulation Date	N
Number Of Live Births	N
Number Of Preterm Births	N
Number Of Births StillLiving	N
Number Of Births To Term	N
Number Of Total Births	N
Number Of Abortions	N
Number Of Abortions Induced	N
Number Of Abortions Spontanious	N
Number Of Ectopic Pregnancies	N
Number Of Stillborn Births	N
Number Of Pregnancies	N
Number Of Previous Live Births Now Dead	N
Date Of Last Live Birth	N
Number Of Previous Cesarean Deliveries	N
Number Of Other Pregnancy Outcomes	N
Date Of Last Other Pregnancy Outcome	N
Menses Monthly	N
Prior Menses Date	N
Duration Of Menstrual Flow	N
Frequency Of Menstrual Cycles	N
​On BirthControl Pills At Conception	N
Menarche	N
Employment Status	N
HCG+	N
Smoking Tobacco Use Frequency	N
​Smoking Status	Y
​alcohol Use	Y
Alcohol Use Frequency	N
Drug Use	N
Exercise	N
Diet	N
Toxic Exposure	N
Homelessness	N
Domestic Violence Risk	N
Pregnancy Education Observation	N
Advance Directives Observation	N

1:X.1 APS Actors, Transactions, and Content Modules

• Actors
  • ​ContentCreator
  • ​ContentConsumer

1:X.2 Use Cases

X.2.1.1 Use case 1

Precondition: The patient’s obstetrician sees the patient for her pregnancy in the ambulatory (office) setting. During the pregnancy, the patient is noted to have a medical problem requiring consultation with a Maternal-Fetal Medicine specialist (perinatologist). The office obtains pre-authorization from the insurance payer for the consult, and for the intended or anticipated route of delivery, and transmits that information to both the consultant and to the hospital.

Events: The patient is seen in the obstetrician’s office where a complete medical and relevant social history are taken by the nurse and recorded in the office EHR, incorporating data from the perinatologist’s consultation report as appropriate. Laboratory and imaging reports ordered by the perinatologist as well as the perinatologist’s consultation report are displayed electronically to the obstetrician. The obstetrician reviews the consultation report from the perinatologist’s office and imaging studies ordered by the perinatologist along with data recorded by the nurse. Physical exam reveals some abnormalities. The obstetrician orders additional laboratory studies, and sends the patient to the hospital to Labor and Delivery.

When the laboratory results return, the physician completes the admission H&P, Allergies, Medications, includes the data prepared or ordered by the perinatologist, and makes it available to L&D. This data includes an assessment of the patient’s health status, and the requisite data summarized from the antepartum care given. The charge nurse for L&D documents that the complete collection of documents needed is available. The Post-Partum discharge planning is notified and assures that there is a suitable environment with appropriate support for post-delivery after-care.

Postcondition: The Pre-delivery H&P and Antepartum Summary with appropriate relationships to the Perinatologist Consultation, and all the antepartum laboratory and imaging studies are available to the obstetrician and the birthing center personnel for incorporation into their respective EHRs. The H&P is also available to the patient for viewing and incorporation into the patient’s PHR, and into the newborn baby’s PHR.

This section defines the actors and transactions in this implementation guide.

Figure below shows the actors directly involved in the ANtepartum Summary document exchange
Profile and the relevant transactions between them.

• Content Creator
• Content Consumer

56.1.1 Actors

The actors in this profile are described in more detail in the sections below.

56.1.1.1 Content Creator

​The Content Creator creates the APS content and shares it using one of the methods defined in the IHE Document Sharing Health Information Exchange.

56.1.1.2 Content Consumer

​The Content Consumer consumes the APS content and obtains it using one of the methods defined in the IHE Document Sharing Health Information Exchange.

56.1.2 APS Content

The Content Creator and Content Consumer share the APS content using one of the methods defined in the IHE Document Sharing Health Information Exchange.

56.2 APS Actor Options

Options that may be selected for each actor in this implementation guide, are listed in Table 3.2-1 below. Dependencies between options when applicable are specified in notes.

Actor	Option
Content Consumer	View
Content Consumer	Document Import
Content Consumer	Discrete Data Import

56.2.1 View Option

​This option defines the processing requirements placed on Content Consumers for providing access, rendering and management of the medical document. See the View Option in IHE PCC TF-2:3.1.1 for more details on this option.

The Content Consumer Actor shall be able to present a view of the document. Minimal view guidance following FHIR core Document Presentation.

56.2.2 Document Import Option

​This option defines the processing requirements placed on Content Consumers for providing access, and importing the entire medical document and managing it as part of the patient record. See the Document Import Option in IHE PCC TF-2:3.1.2 for more details on this option.

56.2.3 Discrete Data Import Option

​This option defines the processing requirements placed on Content Consumers for providing access, and importing discrete data from selected sections of the medical document and managing them as part of the patient record. See the Discrete Data Import Option in IHE PCC TF-2:3.1.4 for more details on this option.

XX.3 APS Required Actor Groupings

N/A

XX.5 APS Security Considerations

See ITI TF-2x: Appendix Z.8 “Mobile Security Considerations”

XX.6 APS Cross-Profile Considerations

The content deffined in this profile can serve as source infomration for many pregancy related public health reporting and research efforts. Inormation from this profile may provide content to the Labor and delivery summary and may be a source for Birth and fetal death reporting (BFDRE).