UNIT V STUDY GUIDE Obstetrical Related Rates & Autopsy Rates Course Learning Outcomes for Unit V Upon completion of this unit, students should be able to: 3. Formulate statistics that meet medical and administrative reporting needs and requirements of government regulatory and voluntary agencies. 3.1 Compute autopsy rates. 3.2 Determine which autopsies are included in hospital autopsies. 3.3 Identify autopsies net gross autopsy. 4. Prepare statistical reports to support healthcare information and department operations and services. 4.1 Classify the neonates according to the American College of Gynecologists (ACOG). 4.2 Determine fetal birth weights. 4.3 Calculate maternal death weights. Reading Assignment Chapter 8: Obstetrical-Related Rates Chapter 9: Autopsy Rates Unit Lesson Welcome to another informative unit together! We are now moving forward to Unit V and will continue to discuss the formalities of rates. Chapters 8 and 9 focus on two types of rates: obstetrical and autopsy rates. Just as you have found in previous units, it is important to understand and identify the terms and classifications clearly to ensure that you are calculating the correct rates. Now, let's get to the good stuff! Chapter 8 begins with a very distinctive overview of the terms related to pregnancy. Unfortunately, not every pregnancy is carried to term or considered normal, and there are several needs for other services that relate to reproductive health. The rates discussed in this chapter will help you learn how to report this maternal and obstetrical data. There are several terms that are related to obstetrics, let us first start with the terms related to pregnancy. Delivery- Giving birth to either a live infant or dead fetus by manual, instrumental, or a surgical means. Even if a woman gives birth to multiples such as twins or triplets, she is still considered to have one delivery. Not Delivered/Undelivered- When a woman may have complications with pregnancy, but is treated and sent home without having delivered. These may be considered as false labor or the treatment of a condition related to pregnancy. Partum- Childbirth: 1). Antepartum: period before giving birth 2). Postpartum: period after giving birth Pueperium- The 42 day period after delivery where the uterus returns to its normal size. Pregnancy Termination- Expulsion or extraction of a dead fetus, or a stillborn infant. HTH 1306, Introduction to Health Care Statistics 1 Induced Termination of Pregnancy- The purposeful termination or interruptionUNIT of pregnancy 2008). x STUDY(Koch, GUIDE Title Understanding these key terms will help contribute to your statistical knowledge of obstetrics. Now, we can discuss some of the terms and issues with maternal deaths. There are several classifications of maternal deaths, so it is critical to pay close attention to each presented circumstance. Maternal death is a death of a woman due to any cause while pregnant or within the 42 days following the termination or end of pregnancy. Those considered \"direct maternal\" deaths are those that are directly related to the pregnancy (Koch, 2008). These can include death during or following an abortion, deaths at type of delivery. Indirect maternal deaths are those not related to obstetric causes, but from a condition that may have been aggravated or amplified by the pregnancy. Newborn classifications are an entirely different category. Neonates are classified by two different categories: gestational age and birth weight. The gestational age is calculated by the woman's last normal menstrual period (LMP). The birth weight is much easier to define as it is in grams or pounds. 1,000 grams = 2lb 3oz 2,500 grams = 5lb 8oz The American College of Obstetricians and Gynecologists (ACOG) classify their neonates in four different categories. 1). Preterm Neonate- from birth to last day of 38th week 2). Term Neonate- from week 39 to last day of 42nd week 3). Post Term Neonate- from week 43 on 4). Low Birth Weight Neonate- less than 2500 grams The ACOG continues to provide extended classifications by fetal death gestational ages. 1). Early Fetal Death- less than 20 weeks 2). Intermediate Fetal Death- 20 weeks to less than 28 weeks 3). Late Fetal Death- 28 weeks or more gestation As you learned in Chapter 7, hospital mortality rates are expected on a regular or routine basis. This also goes for maternal death rates. Since maternal deaths are rare, they are generally calculated monthly (Koch, 2008). The following is the formula for calculating the maternal death rate: Total Direct Maternal Deaths for a Period ___________________________________________________ X 100 Total Maternal (obstetrical) Discharges for the Period (including deaths) Other popular rates gathered in the obstetrics department are cesarean section rates and vaginal birth rates, which you may see in your text. Now, let's move forward to Chapter 9, Autopsy Rates. Most commonly, autopsies are used to determine and identify the cause of death and are an inspection/dissection of a dead body. They are also an excellent tool to study and learn about diseases and results or methods of treatment. In that case, hospital autopsies can be used to help improve the clinical knowledge and can also be used to educate medical professionals. Hospital autopsies may be a result of three different categories: inpatient, outpatient, and former patient. Outside of the hospital, there are other forms of autopsies mainly used in deaths other than from natural causes. A coroner is an elected official whose job is to investigate any death where there is not a certain cause or there is an unnatural death. There is also a medical examiner who is a physician authorized by the city or county to determine the cause(s) of death from an unnatural circumstance (Koch, 2008). Please note that a physician obtains consent from the patient's next of kin when an autopsy is performed; however, consent is not required for a coroner's investigation. There are several different forms of autopsy rates to discuss. The first is gross autopsy rate. This includes autopsies performed on all inpatients (remember: gross means all). HTH 1306, Introduction to Health Care Statistics 2 Total autopsies performed on IP deaths for a period ___________________________________________ X100 UNIT x STUDY GUIDE Title Total IP deaths The second autopsy rate discussed in Chapter 9 is net autopsy rate. This is very similar to the gross autopsy rate as it includes all inpatients; however, the net rate also includes cases released to legal authorities (coroner/medical examiner) in which may not always be available for a hospital autopsy. Total autopsies performed on IP deaths for period _________________________________________ X100 Total IP deaths minus un-autopsied cases released to legal authorities for that period The next autopsy rate discussed is the hospital autopsy rate. This rate is different from the two previous rates as it not only includes inpatients, but also outpatients and former patients that have been autopsied by the hospital (Koch, 2008). Number of hospital autopsies for period __________________________________________ X100 Number of deaths of hospital patients whose bodies are available for hospital autopsy for that period The least common autopsy rates performed are the newborn and fetal autopsy rates. Thank you all for your hard work in the class! Please make sure to keep on track as we are now on the downhill slope. Reference Koch, G. (2008). Basic allied health statistics and analysis (3rd ed.). Clifton Park, NY: Delmar. HTH 1306, Introduction to Health Care Statistics 3