Coding for pregnancy

Coding for pregnancy

Pregnancy coding

Building accurate searches to identify pregnant patients presents a number of challenges in ensuring that the correct patients are identified.
Nationally defined business rules including pregnancy, such as for the seasonal flu programme, simply look for patients with a code in the PREG_COD reference set in the last 9 months. This is a very blunt method of identifying eligible patients since it will find the most recent code from the last 9 months. There are a several scenarios where this will identify patients who are no longer pregnant.
  1. A patient found out they were pregnant 17 months ago. Towards the end of their pregnancy, a pregnancy code was used as a problem header in an ante-natal consultation. They delivered soon after and now has a child aged 8 months old.
  2. A patient found out they were pregnant 6 months ago. They attended the GP who recorded that the patient was pregnant. Unfortunately the patient suffered a miscarriage at 10 weeks. The miscarriage was coded on the record.
In both of these scenarios, the business rules approach does not take into account how a pregnancy episode ends. This can lead to some difficult or embarrassing conversations if the patient is told they are eligible for a flu jab because they are pregnant.

Improving the pregnancy register

The ability to produce a pregnancy register listing just those who are currently pregnant would reduce the need for manually compiled lists, and assist with searches. The solution was to identify commonly used codes which indicated the end of a pregnancy. There are too many to list, but the general theme is:

Code terms
SNOMED codes
Delivery finding (eg: type of delivery)

118215003
268475008
Procedures related to delivering a baby

236973005
236991000
Miscarriage or foetal death

13769002
59291004
Termination

386639001
49416000
Ectopic pregnancy
34801009
Postnatal maternal examination

384634009
444136005
Any of the above types of code and their children effectively close an pregnancy episode, so the patient can be removed from the active pregnancy register.

Within a 9 month period it is plausible for patients to have two separate pregnancies. Even with the first pregnancy episode ended, it becomes necessary to include the patient on the pregnancy register again. The searches have been designed with this in mind, as long as a pregnancy code is not inadvertently added following the delivery.
Info
The searches have been built with a day's separation between the latest pregnancy code and an outcome code. If pregnancy and a delivery are coded on the same date, the patient will not immediately be removed from the register, but it is anticipated that coding of the postnatal maternal examination would remove the patient from the register.

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