5-C:75 Reporting Fetal Deaths. –
A completed fetal death report shall consist of the following:
I. Information regarding the fetus and delivery:
(a) The name of the fetus, if the parents choose to provide a name.
(b) If the parents do not choose to provide a name, the first name shall be listed as "baby girl," "baby boy," or "baby unknown."
(c) The name of the hospital or institution or the street and number of the location of delivery.
(d) The place where delivery occurred: hospital, freestanding birth center, home delivery and whether a home delivery was planned, clinic/doctor's office, or other location.
(e) The city, town, or location, county, and zip code, of delivery.
(f) The date and time of delivery.
(g) The sex of the fetus: male, female, or unknown.
II. Information regarding the mother, including her:
(a) Current full legal name.
(b) Full name prior to first marriage or civil union.
(c) Date of birth.
(d) Birthplace.
(e) Residence.
III. If available, information regarding the father/parent including:
(a) Current full legal name.
(b) Full name prior to first marriage or civil union.
(c) Date of birth.
(d) Birthplace.
IV. Method of disposition: burial, cremation, hospital disposition, donation, removal from state, or other.
(a) If a hospital disposition, the signature of the hospital administrator, or designee, and the date signed.
(b) If not a hospital disposition, the name of the cemetery or crematory and location by city or town and state. The name and address of the funeral home, next of kin, or designated agent and the signature of the funeral director, next of kin, or designated agent, the license number of the funeral director, if applicable, and the date signed.
V. Attendant and registration information.
(a) The delivery attendant's name and title.
(b) The name and title of the individual completing the report.
(c) Date report completed.
(d) Date report received by registrar, which will also be known as the date filed.
VI. Information regarding the fetal death, including:
(a) The fetal or maternal condition directly causing death.
(b) Any condition of which death was a consequence or to which it was due, either fetal or maternal.
(c) The conditions giving rise to the immediate cause of death.
(d) Any other significant conditions of fetus or mother contributing to fetal death but not related to immediate cause.
(e) The weight of the fetus, in grams.
(f) The clinical estimate of gestation, in weeks.
(g) Estimated time of fetal death: whether dead at time of first assessment, no labor ongoing; dead at time of first assessment, labor ongoing; died during labor, after first assessment; or unknown.
(h) Whether an autopsy was performed.
(i) Whether a histological placental examination was performed.
(j) Whether autopsy findings or histological placental examination results were considered in determining the cause of death.
VII. Statistical information regarding the mother and pregnancy, including:
(a) Mother's demographic information, including education, race, and if she is of Hispanic origin.
(b) The number of live births of children now living and now dead.
(c) The date of the last live birth by month and year.
(d) The number of other pregnancy outcomes, spontaneous or induced, at any time after conception.
(e) The date of the last other pregnancy outcome by month and year.
(f) Whether the mother was married at the time of delivery, conception, or any time between.
(g) The mother's height in feet/inches.
(h) The date that the last normal menses began by month, day, and year.
(i) The date of first and last prenatal care visit.
(j) The total number of prenatal visits.
(k) Whether the fetus was single, twin, triplet, or more.
(l) The birth order, if not a single birth.
(m) Whether mother obtained WIC food for herself during this pregnancy.
(n) If the mother was transferred for maternal medical or fetal indications for delivery. If transferred, the name of the facility transferred to.
VIII. Medical and health information regarding the pregnancy, including:
(a) Medical risk factors for the pregnancy.
(b) Infections present and/or treated during the pregnancy.
(c) Method of delivery, including obstetrical procedures employed.
(d) Complications associated with labor or delivery.
(e) Any congenital anomalies.
Source. 2005, 268:1, eff. Jan. 1, 2006. 2026, 2:2, eff. June 6, 2026; 260:1, eff. July 2, 2026.