Excerpt from Evaluation of Fetal Death

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The loss of a fetus at any stage is a fetal demise. According to the 2003 revision of the Procedures for Coding Cause of Fetal Death Under ICD-10, the National Center for Health Statistics defines fetal death as "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. The death is indicated by the fact that after such expulsion or extraction, the fetus does not breathe or show any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles. Heartbeats are to be distinguished from transient cardiac contractions; respirations are to be distinguished from fleeting respiratory efforts or gasps." It is further classified as early (<20 weeks' gestation), intermediate (20-27 weeks' gestation), or late (>28 weeks' gestation).

In an attempt to separate early pregnancy loss (spontaneous abortion) from later pregnancy loss, both the World Health Organization and the American College of Obstetricians and Gynecologists have recommended that statistics for fetal death include only deaths occurring in utero in which the fetus or neonate weighs 500 g or more. The American College of Obstetricians and Gynecologists also recommends including deaths occurring at 22 weeks of gestation or greater (other groups use 20 wk of gestation).

Although this definition of fetal death is the most frequently used in medical literature, it is by no means the only definition in use. Even within the United States, the differences in the definitions used are substantial. The US National Center for Health Statistics, a division of the Centers for Disease Control and Prevention, periodically updates the Model State Vital Statistics Act and the regulations to assist states in developing vital statistics laws. They recommend reporting fetal deaths occurring in fetuses weighing 350 g or more or those of 20 weeks of gestation or greater (see National Center for Health Statistics). This policy is, however, only a guideline and reporting practices vary among states (see The 1997 fetal death reporting requirements).

In addition, not all states interpret the weeks of gestation in the same manner. In California, 20 weeks' gestation is worded "twenty utero gestational weeks" and has therefore been interpreted to be 23 weeks from the last menstrual period. (Implantation in the uterus does not occur until 1 wk after fertilization.) Physicians must check the reporting requirements for the state(s) in which they practice.

The 1997 fetal death reporting requirements from the National Center for Health Statistics

• Gestation of 20 weeks or longer - Alabama, Alaska, California, Connecticut, Florida, Illinois, Indiana, Iowa, Maine, Maryland, Minnesota, Nebraska, Nevada, New Jersey, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Texas, Utah, Vermont, Washington, West Virginia, Wyoming

• All products of conception - American Samoa, Arkansas, Colorado, Georgia, Hawaii, New York, Northern Mariana Islands, Rhode Island, Virginia, Virgin Islands

• Birth weight of 350 g or more or gestation of 20 weeks or longer - Arizona, Delaware, Guam, Idaho, Kentucky, Louisiana, Massachusetts, Mississippi, Missouri, Montana, New Hampshire, South Carolina, Wisconsin

• Birth weight of 400 g or more or gestation of 20 weeks or longer - Michigan

• Birth weight of 500 g or more or gestation of 20 weeks or longer - District of Columbia

• Birth weight of 350 g or more - Kansas

• Gestation of 16 weeks or longer - Pennsylvania

• Birth weight of 500 g or more - New Mexico, South Dakota, Tennessee

• Gestation of 5 months or longer - Puerto Rico

Please click here to view the full topic text: Evaluation of Fetal Death