1. Coding of Fetal Deaths October 2009

2. A desire for further guidance in the coding of Fetal Death records was expressed at the NAPHSIS conference this past June. This presentation will attempt to fulfill that request.

3. Click the left mouse button to move through the slides. Click the Esc button on the keyboard to quit at any time. Please have the following material ready: 2009 ICD Volumes 1 and 3 (or Perinatal Subset) 2009 Instruction Manual Part 2c, ICD-10 ACME Decision Tables Procedures for Coding Cause of Fetal Death Under ICD- 10, Last revised 11/15/2005 This document can be accessed at the following link: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_D ocumentation/NVSS/fetal_death_2003/

4. This presentation will: Help the user become more familiar with the Procedures for Coding Cause of Fetal Death document Demonstrate coding of specific examples Provide examples to code for anyone desiring further practice

5. The document Procedures for Coding Cause of Fetal Death Under ICD-10 is based on the 2003 revision of the US Standard Report of Fetal Death. This certificate can be accessed at the following link: http://www.cdc.gov/nchs/data/dvs/FDEATH11- 03finalACC.pdf

6. Please refer to the Procedures for Coding Cause of Fetal Death document. The second paragraph of the instruction document contains the definition of Fetal Death: ‘‘Fetal death’’ means death prior to the complete expulsion or extraction from its mother of a product of human conception, irrespective of the duration of pregnancy and which is not an induced termination of pregnancy.……….

7. The rules for selection of the initiating cause are listed on the second page. These are very similar to the rules used in underlying cause- of-death coding and involve use of the 2c ACME Decision Tables.

8. The first step is summarized below. The other steps, can be recognized from the underlying cause-of-death rules and are listed on the next slide. Step 1, summarized Select the first condition reported in Section 18a of the death certificate, or if the terminology “due to” is used, select the condition that is stated as causing the other.

9. Remaining Steps Step 2 – DS Step 3 – Ill-defined conditions Step 4 – Trivial conditions Step 5 – Linkage Step 6 – Specificity Step 7 – Early and late stages of disease

10. The third page of the document contains information about Live Births and Abortions Both are sometimes included in the Fetal Death file in error.

11. Live births and induced terminations of pregnancy are excluded from the fetal death file Do include in the fetal file:induced terminations if fetus died before procedure and procedure done to remove an already dead fetus Don’t include in the fetal file: induced terminations if fetus died during or after procedure

12. There are 3 tables at the end of the instruction document. Take special note of Table 3 Terms Indicating Induced Abortions. Records with these terms reported are excluded from the Fetal Death File.

13. A few additional terms that can also be considered Induced Terminations of Pregnancy but are not on the list are: Medical interruption of pregnancy Elective termination Medically indicated termination of pregnancy Inevitable abortion

14. The following certificates have been coded and include explanations based on use of the NCHS Volume 3. Please review carefully to ensure understanding of basic Fetal Death coding guidelines.

15. 18a. INITIATING CAUSE/CONDITION (AMONG THE CHOICES BELOW, PLEASE SELECT THE ONE WHICH MOST LIKELY BEGAN THE SEQUENCE OF EVENTS RESULTING IN THE DEATH OF THE FETUS) Maternal Conditions/Diseases (Specify)___________________ Complications of Placenta, Cord or Membranes □ Rupture of membranes prior to onset of labor □ Abruptio placenta □ Placental insufficiency □ Prolapsed cord □ Chorioamnionitis □ Other (Specify)_____________________________ Other Obstetrical or Pregnancy Complications (Specify)_______________________________ Fetal Anomaly (Specify)________________________ Fetal Injury (Specify)__________________________ Fetal Infection (Specify)________________________ Other Fetal Conditions/Disorders (Specify) _____ Fetal Hydrops ______ □ Unknown 18b. OTHER SIGNIFICANT CAUSES OR CONDITIONS (SELECT OR SPECIFY ALL OTHER CONDITIONS CONTRIBUTING TO DEATH IN ITEM 18b) Maternal Conditions/Diseases (Specify)_____________________________ Complications of Placenta, Cord or Membranes □ Rupture of membranes prior to onset of labor □ Abruptio placenta □ Placental insufficiency □ Prolapsed cord □ Chorioamnionitis □ Other (Specify)_______________________________ Other Obstetrical or Pregnancy Complications (Specify)________________________________ Fetal Anomaly (Specify)_________________________ __________ Turners Syndrome ____ Fetal Injury (Specify)_____________________ Fetal Infection (Specify)___________________ Other Fetal Conditions/Disorders (Specify)___ Cystic Hygroma _______ □ Unknown Example 1 Codes:18a. P832IC: P832Steps: 1 18b. Q969 D181 Code as indexed:Hydrops - fetal(is) or newborn P832 Turner’s - syndrome Q969 Hygroma (cystic) D181 Select P832 by Step 1. No other steps apply.

16. 18a. INITIATING CAUSE/CONDITION (AMONG THE CHOICES BELOW, PLEASE SELECT THE ONE WHICH MOST LIKELY BEGAN THE SEQUENCE OF EVENTS RESULTING IN THE DEATH OF THE FETUS) Maternal Conditions/Diseases (Specify)___________________ Complications of Placenta, Cord or Membranes □ Rupture of membranes prior to onset of labor □ Abruptio placenta □ Placental insufficiency □ Prolapsed cord □ Chorioamnionitis □ Other (Specify)_____________________________ Other Obstetrical or Pregnancy Complications (Specify)_______________________________ Fetal Anomaly (Specify)________________________ Fetal Injury (Specify)__________________________ Fetal Infection (Specify)________________________ Other Fetal Conditions/Disorders (Specify) __ Cardiac arrest, in utero __ □ Unknown 18b. OTHER SIGNIFICANT CAUSES OR CONDITIONS (SELECT OR SPECIFY ALL OTHER CONDITIONS CONTRIBUTING TO DEATH IN ITEM 18b) Maternal Conditions/Diseases (Specify)_____________________________ Complications of Placenta, Cord or Membranes □ Rupture of membranes prior to onset of labor □ Abruptio placenta □ Placental insufficiency □ Prolapsed cord □ Chorioamnionitis □ Other (Specify)_______________________________ Other Obstetrical or Pregnancy Complications (Specify)________________________________ Fetal Anomaly (Specify)__________________ ____ Dysplastic unilateral kidney _ ____ Double outlet right ventricle __ Fetal Injury (Specify)_____________________ Fetal Infection (Specify)___________________ Other Fetal Conditions/Disorders (Specify)_____________________________ □ Unknown Example 2 Codes:18a. P291IC: Q201Steps: 1,2 18b. Q614 Q600 Q201 Code as indexed:Arrest - cardiac - - newborn P291 Dysplasia - kidney Q614 Unilateral - organ or site, congenital NEC – see Agenesis, by site Agenesis - kidney - - unilateral Q600 Double - outlet - - right ventricle Q201 Select P291 by Step 1. In Modification Table E, P291 is a DS to Q201. Select Q201 by Step 2.

17. 18a. INITIATING CAUSE/CONDITION (AMONG THE CHOICES BELOW, PLEASE SELECT THE ONE WHICH MOST LIKELY BEGAN THE SEQUENCE OF EVENTS RESULTING IN THE DEATH OF THE FETUS) Maternal Conditions/Diseases (Specify)___________________ Complications of Placenta, Cord or Membranes □ Rupture of membranes prior to onset of labor □ Abruptio placenta □ Placental insufficiency □ Prolapsed cord □ Chorioamnionitis □ Other (Specify)_____________________________ Other Obstetrical or Pregnancy Complications (Specify)_______________________________ Fetal Anomaly (Specify)________________________ Fetal Injury (Specify)___ Fetal Anoxia __ Fetal Infection (Specify)________________________ Other Fetal Conditions/Disorders (Specify) ______________________ □ Unknown 18b. OTHER SIGNIFICANT CAUSES OR CONDITIONS (SELECT OR SPECIFY ALL OTHER CONDITIONS CONTRIBUTING TO DEATH IN ITEM 18b) Maternal Conditions/Diseases (Specify)_____________________________ Complications of Placenta, Cord or Membranes □ Rupture of membranes prior to onset of labor □ Abruptio placenta □ Placental insufficiency □ Prolapsed cord □ Chorioamnionitis X Other (Specify)_ Strangulation _____ _______________ umbilical cord ______ Other Obstetrical or Pregnancy Complications (Specify)________________________________ Fetal Anomaly (Specify)_________________________ ______________ Fetal Injury (Specify)_____________________ Fetal Infection (Specify)___________________ Other Fetal Conditions/Disorders (Specify)_____________________ □ Unknown Example 3 Codes:18a. P209IC: P025Steps: 1, 3 18b. P025 Code as indexed:Anoxia (See also Hypoxia) Hypoxia - fetal – see Distress, fetal Distress - fetal (syndrome) P20.- Go to Volume 1 to select 4 th character.9. Strangulation - umbilical cord - see also Compression, umbilical cord P025 - - fetus or newborn P025 Select P209 by Step 1. Since this is one of the ill-defined conditions listed in Step 3, reselect as though the P209 had not been reported. Select P025 by Step 3.

18. 18a. INITIATING CAUSE/CONDITION (AMONG THE CHOICES BELOW, PLEASE SELECT THE ONE WHICH MOST LIKELY BEGAN THE SEQUENCE OF EVENTS RESULTING IN THE DEATH OF THE FETUS) Maternal Conditions/Diseases (Specify)___________________ Complications of Placenta, Cord or Membranes □ Rupture of membranes prior to onset of labor □ Abruptio placenta □ Placental insufficiency □ Prolapsed cord □ Chorioamnionitis □ Other (Specify)_____________________________ Other Obstetrical or Pregnancy Complications (Specify)_______________________________ Fetal Anomaly (Specify)________________________ Fetal Injury (Specify)__________________________ Fetal Infection (Specify)________________________ Other Fetal Conditions/Disorders (Specify) _ Interrupted pregnancy _ □ Unknown 18b. OTHER SIGNIFICANT CAUSES OR CONDITIONS (SELECT OR SPECIFY ALL OTHER CONDITIONS CONTRIBUTING TO DEATH IN ITEM 18b) Maternal Conditions/Diseases (Specify)_____________________________ Complications of Placenta, Cord or Membranes □ Rupture of membranes prior to onset of labor □ Abruptio placenta □ Placental insufficiency □ Prolapsed cord □ Chorioamnionitis □ Other (Specify)_______________________________ Other Obstetrical or Pregnancy Complications (Specify)________________________________ Fetal Anomaly (Specify)_________________________ _______________________________ Fetal Injury (Specify)_____________________ Fetal Infection (Specify)___________________ Other Fetal Conditions/Disorders (Specify)___________________________ □ Unknown Example 4 Interrupted pregnancy is listed on Table 3, meaning that it is a term that indicates an induced termination of pregnancy. Since this reporting does not meet the definition of fetal death, the record should be deleted from the fetal death file and an appropriate certificate completed. Refer to the third page of the instruction document, the section entitled Inclusions in the File.

19. 18a. INITIATING CAUSE/CONDITION (AMONG THE CHOICES BELOW, PLEASE SELECT THE ONE WHICH MOST LIKELY BEGAN THE SEQUENCE OF EVENTS RESULTING IN THE DEATH OF THE FETUS) Maternal Conditions/Diseases (Specify)___________________ Complications of Placenta, Cord or Membranes □ Rupture of membranes prior to onset of labor □ Abruptio placenta □ Placental insufficiency □ Prolapsed cord □ Chorioamnionitis X Other (Specify)_ Cord Accident ____ Other Obstetrical or Pregnancy Complications (Specify)_______________________________ Fetal Anomaly (Specify)________________________ Fetal Injury (Specify)__________________________ Fetal Infection (Specify)________________________ Other Fetal Conditions/Disorders (Specify) ___________ □ Unknown 18b. OTHER SIGNIFICANT CAUSES OR CONDITIONS (SELECT OR SPECIFY ALL OTHER CONDITIONS CONTRIBUTING TO DEATH IN ITEM 18b) Maternal Conditions/Diseases (Specify)_____________________________ Complications of Placenta, Cord or Membranes □ Rupture of membranes prior to onset of labor □ Abruptio placenta □ Placental insufficiency □ Prolapsed cord □ Chorioamnionitis X Other (Specify)_ Nuchal Cord ________ Other Obstetrical or Pregnancy Complications (Specify)________________________________ Fetal Anomaly (Specify)_________________________ _______________________________ Fetal Injury (Specify)_____________________ Fetal Infection (Specify)___________________ Other Fetal Conditions/Disorders (Specify)_____________________________ □ Unknown Example 5 Codes:18a. P026IC: P025Steps: 1, 6 18b. P025 To be indexed:Accident - cord (umbilical) P026 Code as indexed:Nuchal cord P025 Select P026 by Step 1. In Modification Table E, P026 is an SMP maybe to P025. Ambivalent Table F says “Addr must be unspecified condition of umbilical cord.” Since cord accident meets this criteria, select P025 by Step 6.

20. The next 9 screens contain examples that can be coded on a separate sheet of paper for practice. Please identify codes, initiating cause (IC), and steps for each record, as in sample below: Correct answers will appear upon clicking so that you can self-check your results. Codes: 18a. _______ _______ 18b. _______ _______ IC: ______ Steps:_________

21. 18a. INITIATING CAUSE/CONDITION (AMONG THE CHOICES BELOW, PLEASE SELECT THE ONE WHICH MOST LIKELY BEGAN THE SEQUENCE OF EVENTS RESULTING IN THE DEATH OF THE FETUS) Maternal Conditions/Diseases (Specify)___________________ Complications of Placenta, Cord or Membranes X Rupture of membranes prior to onset of labor □ Abruptio placenta □ Placental insufficiency □ Prolapsed cord □ Chorioamnionitis □ Other (Specify)_____________________________ Other Obstetrical or Pregnancy Complications (Specify)_______________________________ Fetal Anomaly (Specify)________________________ Fetal Injury (Specify)__________________________ Fetal Infection (Specify)___________________________ Other Fetal Conditions/Disorders (Specify) _________________________ □ Unknown 18b. OTHER SIGNIFICANT CAUSES OR CONDITIONS (SELECT OR SPECIFY ALL OTHER CONDITIONS CONTRIBUTING TO DEATH IN ITEM 18b) Maternal Conditions/Diseases (Specify)_____________________________ Complications of Placenta, Cord or Membranes □ Rupture of membranes prior to onset of labor □ Abruptio placenta □ Placental insufficiency □ Prolapsed cord □ Chorioamnionitis □ Other (Specify)_______________________________ Other Obstetrical or Pregnancy Complications (Specify)________________________________ Fetal Anomaly (Specify)_________________________ __________ Unknown anomaly ____ Fetal Injury (Specify)_____________________ Fetal Infection (Specify)___________________ Other Fetal Conditions/Disorders (Specify)_____________________________ □ Unknown Practice Example 1 Codes:18a. P011IC: P011Steps: 1 18b. Q899 Code as indexed:Rupture - membranes - - premature - - - affecting fetus or newborn P011 Anomaly Q899 Select P011 by Step 1.

22. 18a. INITIATING CAUSE/CONDITION (AMONG THE CHOICES BELOW, PLEASE SELECT THE ONE WHICH MOST LIKELY BEGAN THE SEQUENCE OF EVENTS RESULTING IN THE DEATH OF THE FETUS) Maternal Conditions/Diseases (Specify)___________________ Complications of Placenta, Cord or Membranes □ Rupture of membranes prior to onset of labor □ Abruptio placenta □ Placental insufficiency □ Prolapsed cord □ Chorioamnionitis □ Other (Specify)_____________________________ Other Obstetrical or Pregnancy Complications (Specify)_______________________________ Fetal Anomaly (Specify)________________________ Fetal Injury (Specify)__________________________ Fetal Infection (Specify)________________________ Other Fetal Conditions/Disorders (Specify) _ Extreme Prematurity ____ □ Unknown 18b. OTHER SIGNIFICANT CAUSES OR CONDITIONS (SELECT OR SPECIFY ALL OTHER CONDITIONS CONTRIBUTING TO DEATH IN ITEM 18b) Maternal Conditions/Diseases (Specify)_ Cervical incompetence ____________________________________ Complications of Placenta, Cord or Membranes □ Rupture of membranes prior to onset of labor □ Abruptio placenta □ Placental insufficiency □ Prolapsed cord □ Chorioamnionitis □ Other (Specify)_______________________________ Other Obstetrical or Pregnancy Complications (Specify)________________________________ Fetal Anomaly (Specify)_________________________ _______________________________ Fetal Injury (Specify)_____________________ Fetal Infection (Specify)___________________ Other Fetal Conditions/Disorders (Specify)____________________________ □ Unknown Practice Example 2 Codes:18a. P072IC: P010Steps: 1, 6 18b. P010 Code as indexed:Prematurity - extreme P072 Incompetency, incompetent - cervix - - in pregnancy - - - affecting fetus or newborn P010 Select P072 by Step 1. Since this is one of the ill-defined conditions listed in Step 3, reselect as though the P072 had not been reported. Select P010 by Step 3.

23. 18a. INITIATING CAUSE/CONDITION (AMONG THE CHOICES BELOW, PLEASE SELECT THE ONE WHICH MOST LIKELY BEGAN THE SEQUENCE OF EVENTS RESULTING IN THE DEATH OF THE FETUS) Maternal Conditions/Diseases (Specify)___________________ Complications of Placenta, Cord or Membranes □ Rupture of membranes prior to onset of labor □ Abruptio placenta □ Placental insufficiency □ Prolapsed cord □ Chorioamnionitis □ Other (Specify)_____________________________ Other Obstetrical or Pregnancy Complications (Specify)_______________________________ Fetal Anomaly (Specify)__ Multiple Fetal Anomalies _____________________ Fetal Injury (Specify)__________________________ Fetal Infection (Specify)________________________ Other Fetal Conditions/Disorders (Specify) ______________________ __________________________________ □ Unknown 18b. OTHER SIGNIFICANT CAUSES OR CONDITIONS (SELECT OR SPECIFY ALL OTHER CONDITIONS CONTRIBUTING TO DEATH IN ITEM 18b) Maternal Conditions/Diseases (Specify)_____________________________ Complications of Placenta, Cord or Membranes □ Rupture of membranes prior to onset of labor □ Abruptio placenta □ Placental insufficiency □ Prolapsed cord □ Chorioamnionitis □ Other (Specify)_______________________________ Other Obstetrical or Pregnancy Complications (Specify)________________________________ Fetal Anomaly (Specify)_____________ ____ Double outlet rt ventricle _____ Dysplastic unilateral kidney Fetal Injury (Specify)_____________________ Fetal Infection (Specify)___________________ Other Fetal Conditions/Disorders (Specify)_____________________________ □ Unknown Practice Example 3 Codes:18a. Q897IC: Q201Steps: 1, 6 18b. Q201 Q614 Q600 Code as indexed:Anomaly - multiple NEC Q897 Double - outlet - - right ventricle Q201 Dysplasia - kidney Q614 Unilateral - organ or site, congenital NEC – see Agenesis, by site Agenesis - kidney - - unilateral Q600 Select Q897 by Step 1. In Modification Table E, Q897 is an SMP to all 3 of the other conditions reported. Select the first mentioned, Q201. Since there is no further modification, Q201 is the IC by Step 6.

24. 18a. INITIATING CAUSE/CONDITION (AMONG THE CHOICES BELOW, PLEASE SELECT THE ONE WHICH MOST LIKELY BEGAN THE SEQUENCE OF EVENTS RESULTING IN THE DEATH OF THE FETUS) Maternal Conditions/Diseases (Specify)___________________ Complications of Placenta, Cord or Membranes □ Rupture of membranes prior to onset of labor □ Abruptio placenta □ Placental insufficiency □ Prolapsed cord □ Chorioamnionitis □ Other (Specify)_____________________________ Other Obstetrical or Pregnancy Complications (Specify)_______________________________ Fetal Anomaly (Specify)____ Turners _____ Syndrome ________________ Fetal Injury (Specify)__________________________ Fetal Infection (Specify)________________________ Other Fetal Conditions/Disorders (Specify) __________ □ Unknown 18b. OTHER SIGNIFICANT CAUSES OR CONDITIONS (SELECT OR SPECIFY ALL OTHER CONDITIONS CONTRIBUTING TO DEATH IN ITEM 18b) Maternal Conditions/Diseases (Specify)_____________________________ Complications of Placenta, Cord or Membranes □ Rupture of membranes prior to onset of labor □ Abruptio placenta □ Placental insufficiency □ Prolapsed cord □ Chorioamnionitis □ Other (Specify)_______________________________ Other Obstetrical or Pregnancy Complications (Specify)________________________________ Fetal Anomaly (Specify)_________________________ ______________ Fetal Injury (Specify)_____________________ Fetal Infection (Specify)___________________ Other Fetal Conditions/Disorders (Specify)__ Fetal Hydrops ________ □ Unknown Practice Example 4 Codes:18a. Q969IC: Q969Steps: 1 18b. P832 Code as indexed:Turner’s - syndrome Q969 Hydrops - fetal(is or newborn) P832 Select Q969 by Step 1.

25. 18a. INITIATING CAUSE/CONDITION (AMONG THE CHOICES BELOW, PLEASE SELECT THE ONE WHICH MOST LIKELY BEGAN THE SEQUENCE OF EVENTS RESULTING IN THE DEATH OF THE FETUS) Maternal Conditions/Diseases (Specify)___________________ Complications of Placenta, Cord or Membranes □ Rupture of membranes prior to onset of labor □ Abruptio placenta □ Placental insufficiency □ Prolapsed cord □ Chorioamnionitis X Other (Specify)__ Placenta Previa ____ Other Obstetrical or Pregnancy Complications (Specify)_______________________________ Fetal Anomaly (Specify)________________________ Fetal Injury (Specify)__________________________ Fetal Infection (Specify)________________________ Other Fetal Conditions/Disorders (Specify) _________________________ □ Unknown 18b. OTHER SIGNIFICANT CAUSES OR CONDITIONS (SELECT OR SPECIFY ALL OTHER CONDITIONS CONTRIBUTING TO DEATH IN ITEM 18b) Maternal Conditions/Diseases (Specify)_____________________________ Complications of Placenta, Cord or Membranes □ Rupture of membranes prior to onset of labor □ Abruptio placenta □ Placental insufficiency □ Prolapsed cord □ Chorioamnionitis □ Other (Specify)_______________________________ Other Obstetrical or Pregnancy Complications (Specify)________________________________ Fetal Anomaly (Specify)_________________________ ______________ Fetal Injury (Specify)_____________________ Fetal Infection (Specify)___________________ Other Fetal Conditions/Disorders (Specify)_____________________________ □ Unknown Practice Example 5 Codes:18a. P020IC: P020Steps: 1 Code as indexed:Placenta - previa - - affecting fetus or newborn P020 Select P020 by Step 1.

26. 18a. INITIATING CAUSE/CONDITION (AMONG THE CHOICES BELOW, PLEASE SELECT THE ONE WHICH MOST LIKELY BEGAN THE SEQUENCE OF EVENTS RESULTING IN THE DEATH OF THE FETUS) Maternal Conditions/Diseases (Specify)___________________ Complications of Placenta, Cord or Membranes □ Rupture of membranes prior to onset of labor □ Abruptio placenta □ Placental insufficiency □ Prolapsed cord □ Chorioamnionitis □ Other (Specify)_____________________________ Other Obstetrical or Pregnancy Complications (Specify)_______________________________ Fetal Anomaly (Specify)________________________ Fetal Injury (Specify)__________________________ Fetal Infection (Specify)________________________ Other Fetal Conditions/Disorders (Specify) _ Intrauterine Growth Retardation __________________ □ Unknown 18b. OTHER SIGNIFICANT CAUSES OR CONDITIONS (SELECT OR SPECIFY ALL OTHER CONDITIONS CONTRIBUTING TO DEATH IN ITEM 18b) Maternal Conditions/Diseases (Specify)_____________________________ Complications of Placenta, Cord or Membranes □ Rupture of membranes prior to onset of labor X Abruptio placenta □ Placental insufficiency □ Prolapsed cord □ Chorioamnionitis □ Other (Specify)_______________________________ Other Obstetrical or Pregnancy Complications (Specify)________________________________ Fetal Anomaly (Specify)_________________________ _______________________________ Fetal Injury (Specify)_____________________ Fetal Infection (Specify)___________________ Other Fetal Conditions/Disorders (Specify)___ Oligohydramnios _____ □ Unknown Practice Example 6 Codes:18a. P059IC: P059Steps: 1 18b. P021 P012 Code as indexed:Retardation - intrauterine growth P059 Abruptio placentae - affecting fetus or newborn P021 Oligohydramnios - affecting fetus or newborn P012 Select P059 by Step 1.

27. 18a. INITIATING CAUSE/CONDITION (AMONG THE CHOICES BELOW, PLEASE SELECT THE ONE WHICH MOST LIKELY BEGAN THE SEQUENCE OF EVENTS RESULTING IN THE DEATH OF THE FETUS) Maternal Conditions/Diseases (Specify)___________________ Complications of Placenta, Cord or Membranes □ Rupture of membranes prior to onset of labor □ Abruptio placenta □ Placental insufficiency □ Prolapsed cord □ Chorioamnionitis □ Other (Specify)_____________________________ Other Obstetrical or Pregnancy Complications (Specify)_______________________________ Fetal Anomaly (Specify)________________________ Fetal Injury (Specify)__________________________ Fetal Infection (Specify)________________________ Other Fetal Conditions/Disorders (Specify) _____ Intrauterine fetal _____ death ______ □ Unknown 18b. OTHER SIGNIFICANT CAUSES OR CONDITIONS (SELECT OR SPECIFY ALL OTHER CONDITIONS CONTRIBUTING TO DEATH IN ITEM 18b) Maternal Conditions/Diseases (Specify)_____________________________ Complications of Placenta, Cord or Membranes □ Rupture of membranes prior to onset of labor □ Abruptio placenta □ Placental insufficiency □ Prolapsed cord □ Chorioamnionitis □ Other (Specify)_______________________________ Other Obstetrical or Pregnancy Complications (Specify)________________________________ Fetal Anomaly (Specify)_ Trisomy 18 _____ ________________________________ Fetal Injury (Specify)_____________________ Fetal Infection (Specify)___________________ Other Fetal Conditions/Disorders (Specify)_____________________________ □ Unknow Practice Example 7 Codes:18a. P95IC: Q913Steps: 1, 3 18b. Q913 Code as indexed:Death - fetal (intrauterine) P95 Trisomy - 16-18 (partial) Q913 Select P95 by Step 1. Since this is one of the ill-defined conditions listed in Step 3, reselect as though the P95 had not been reported. Select Q913 by Step 3.

28. 18a. INITIATING CAUSE/CONDITION (AMONG THE CHOICES BELOW, PLEASE SELECT THE ONE WHICH MOST LIKELY BEGAN THE SEQUENCE OF EVENTS RESULTING IN THE DEATH OF THE FETUS) Maternal Conditions/Diseases (Specify)___________________ Complications of Placenta, Cord or Membranes □ Rupture of membranes prior to onset of labor □ Abruptio placenta □ Placental insufficiency □ Prolapsed cord □ Chorioamnionitis □ Other (Specify)_____________________________ Other Obstetrical or Pregnancy Complications (Specify)_______________________________ Fetal Anomaly (Specify)________________________ Fetal Injury (Specify)__________________________ Fetal Infection (Specify)________________________ Other Fetal Conditions/Disorders (Specify) _____ Extreme Prematurity __ □ Unknown 18b. OTHER SIGNIFICANT CAUSES OR CONDITIONS (SELECT OR SPECIFY ALL OTHER CONDITIONS CONTRIBUTING TO DEATH IN ITEM 18b) Maternal Conditions/Diseases (Specify)_____________________________ Complications of Placenta, Cord or Membranes □ Rupture of membranes prior to onset of labor □ Abruptio placenta □ Placental insufficiency □ Prolapsed cord □ Chorioamnionitis □ Other (Specify)_______________________________ Other Obstetrical or Pregnancy Complications (Specify)________________________________ Fetal Anomaly (Specify)_________________________ __________ Anencephaly _______ Fetal Injury (Specify)_____________________ Fetal Infection (Specify)___________________ Other Fetal Conditions/Disorders (Specify)____________________________ □ Unknown Practice Example 8 Codes:18a. P072IC: Q000Steps: 1, 3 18b. Q000 Code as indexed:Prematurity - extreme P072 Anencephaly Q000 Select P072 by Step 1. Since this is one of the ill-defined Conditions listed in Step 3, reselect as though the P072 had not been reported. Select Q000 by Step 3.

29. 18a. INITIATING CAUSE/CONDITION (AMONG THE CHOICES BELOW, PLEASE SELECT THE ONE WHICH MOST LIKELY BEGAN THE SEQUENCE OF EVENTS RESULTING IN THE DEATH OF THE FETUS) Maternal Conditions/Diseases (Specify)___________________ Complications of Placenta, Cord or Membranes □ Rupture of membranes prior to onset of labor □ Abruptio placenta □ Placental insufficiency □ Prolapsed cord □ Chorioamnionitis □ Other (Specify)_____________________________ Other Obstetrical or Pregnancy Complications (Specify)_______________________________ Fetal Anomaly (Specify)________________________ Fetal Injury (Specify)__________________________ Fetal Infection (Specify)________________________ Other Fetal Conditions/Disorders (Specify) _ Intrauterine Fetal Demise _ □ Unknown 18b. OTHER SIGNIFICANT CAUSES OR CONDITIONS (SELECT OR SPECIFY ALL OTHER CONDITIONS CONTRIBUTING TO DEATH IN ITEM 18b) Maternal Conditions/Diseases (Specify)_____________________________ Complications of Placenta, Cord or Membranes □ Rupture of membranes prior to onset of labor □ Abruptio placenta □ Placental insufficiency □ Prolapsed cord □ Chorioamnionitis □ Other (Specify)_______________________________ Other Obstetrical or Pregnancy Complications (Specify)________________________________ Fetal Anomaly (Specify)_________________________ Fetal Injury (Specify)_____________________ Fetal Infection (Specify)___________________ Other Fetal Conditions/Disorders (Specify)_ Knot in umbilical cord ___ □ Unknown Practice Example 9 Codes:18a. P95IC: P025Steps: 1, 3 18b. P025 Code as indexed:Demise - fetal – see Death, fetal Death - fetus, fetal - - in fetal death file P95 Knot, umbilical cord - affecting fetus or newborn P025 Select P95 by Step 1. Since this is one of the ill-defined conditions listed in Step 3, reselect as though the P95 had not been reported. Select P025 by Step 3.

30. NCHS-RTP October 2009 The end