Fetus

Purpose

To support genetic interpretation of tests and samples for fetuses. To provide a clear divide between mother and fetus and support the management of multiple fetuses.

Notes

Mapped to its own Patient resource, optionally tagged via a proposed birthStatus extension or future dated EDD in place of birthDate, as well as linked observations.

Correct representation of fetal data is under review within the Interoperability Standards Team and is subject to change

Life Status

For Life Status at time of request for Foetal records, as per PRSB guidance, this should be inferred through outcome codes attached to the Pregnancy observation.

e.g. under Observation with code 77386006, Observation.component.valueCodeableConcept (with Observation.component.code = 267013003 | Past pregnancy outcome (observable entity) |)

The component SNOMED codes SHOULD match the following list to map from foetal life statuses:

PRSB Prgnancy Outcome GEL Foetal Life Status SNOMED CT Pregnancy Outcome Code
01 Live birth N/A - not included in GEL list 281050002 - Livebirth (finding) (or captured through Patient.extension:fetalStatus)
02 Antepartum Stillbirth stillborn 713202001 - Antepartum stillbirth (finding)
03 Intrapartum Stillbirth stillborn 921611000000101 - Intrapartum stillbirth (finding)
04 Stillbirth – timing unknown stillborn 237364002 - Stillbirth (finding)
05 Termination of Pregnancy equal to or greater than 24 weeks aborted 57797005 - Induced termination of pregnancy (disorder)
98 Other (not listed) N/A not part of GEL life status ValueSet potentially captured through Patient.extension:fetalStatus = unknown
N/A not mapped exactly to PRSB ValueSet miscarriage 17369002 - Miscarriage (disorder)
N/A no pregnancy outcome code unborn N/A no pregnancy outcome code (captured through Patient.extension:fetalStatus)

Mapping

ID Source Data item Target FHIR Element HL7v2.5.1 Mapping Description
F-1 Fetus - Local identifier Patient.identifier:system != https://fhir.nhs.uk/Id/nhs-number PID-3 where PID-3.5 = 2.16.840.1.113883.2.1.3.2.4.18.24 Fetus identification code other than NHS number.
F-7 Fetus - ODS code of organisation which assigned local identifier Patient.identifier.assigner.identifier.value PID-3.4 ODS code of the organisation which assigned the local identifier F-1.
F-2 Fetus - Observed sex Patient.gender PID-8 Fetus' phenotypic sex classification. Estimated physical characteristic. Currently determined by ultrasound. Gender for PLCM.
F-3 Fetus - Chromosomal sex Observation.code( subject=Patient, code = code under 734840008 or 95462004 as examples ) OBX-5 with appropriate SNOMED/READ/LOINC code Fetus' genomic / karyotypic characteristic. Determined by genomic testing.
F-6 Fetus - Life status at time of request For Foetal records, foetal death SHOULD be recorded through the Patient.extension:fetalStatus field. The type of death can be inferred through Observation components related to the mother's pregnancy observation. PID-30 (OBX segments should be used for types of fetal death) Fetus' alive or deceased status details at the point of test ordering.
F-8 Fetus - Pregnancy id Observation.identifier for pregnancy observation, though EpisodeOfCare is being investigated (TBC). OBX-3 for pregnancy The id of a given pregnancy which this fetus belongs to.