Handbook on the 

Reporting of Induced 

Termination 

Of Pregnancy 

Reprinted from 1988, Includes Revised Instructions 

and Reporting Form, 1997 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Centers for Disease Control and Prevention 

National Center for Health Statistics 

Hyattsville, Maryland 

April 1998 

DHHS Publication No. (PHS) 98-l 117 
National Center for Health Statistics 

Edward J. Sondik, Ph.D., Director 

Jack R. Anderson, Deputy Director 

Jack R. Anderson, Acting Associate Director for 

International Statistics 

Lester R. Curtin, Ph.D., Acting Associate Director for 

Research and Methodology 

Jennifer H. Madans, Ph.D., Acting Associate Director for 

Analysis, Epidemiology, and Health Promotion 

P. Douglas Williams, Acting Associate Director for Data 

Standards, Program Development, and Extramural Programs 

Edward L. Hunter, Associate Director for Planning, Budget, 

and Legislation 

Jennifer H. Madans, Ph.D., Acting Associate Director for 

Vital and Health Statistics Systems 

Stephen E. Nieberding, Associate Director for Management 

Charles J. Rothwell, Associate Director for Data Processing 

and Services 

Division of vital Statistics 

Mary Anne Freedman, Director 

James A. Weed, Ph.D., Deputy Director 

George A. Gay, Special Assistant for Registration Methods 

Kenneth G. Keppel, Ph.D., Acting ChieJ Reproductive Statistics Branch 
This handbook is prepared by the National Center for Health Statistics, Centers for Disease Control and Prevention, U.S. Department of Health 

and Human Services, and contains instructions for persons with responsibilities for completing and filing reports of induced terminations of pregnancy (induced abortions). It pertains to the 1989 revision of the U.S. 

Standard Report of Induced Termination of Pregnancy as modified in 1996 

by the Division of Reproductive Health, National Center for Chronic Disease 

Prevention and Health Promotion and the 1992 revision of the Model State 

Vital Statistics Act and Regulations. This handbook is intended to serve as 

a model for adaptation by any vital statistics registration area. 

Other handbooks available as references on preparing and registering 

vital records are: 

w Hospitals’ and Physicians’ Handbook on Birth Registration and Fetal 

Death Reporting 

I Medical Examiners’ and Coroners’ Handbook on Death Registration 

and Fetal Death Reporting 

n Physicians’ Handbook on Medical Certijication of Death 

n Funeral Directors’ Handbook on Death Registration and Fetal Death 

Reporting 

H Guidelines for Reporting Occupation and Industry on Death Certificates 

n Handbook on Marriage Registration 

n Handbook on Divorce Registration 
Contents 

Preface ............................................................ 

Introduction ....................................................... 

Purpose .......................................................... 

Importance of induced termination of pregnancy reporting ......... 

State reporting requirements ..................................... 

Live birth ........................................................ 

U.S. Standard Report of Induced Termination of Pregnancy. ....... 

Statehealthdepartment ........................................ 

Local registrar .................................................. 

Confidentiality ................................................... 

Specifx responsibihties. .......................................... 

Hospital or clinic ............................................... 

Physician ...................................................... 

Part I. General instructions for completing reports. .................. 

Part II. Completing the report of induced termination of 

pregnancy ....................................................... 

Place of termination (Items l-3). .................................. 

Patient information (Items 4-11). ................................. 

Date last normal menses began (Item 12) ......................... 

CIinicaI estimate of gestation (Item 13). ........................... 

Previous pregnancies (Item 14a-d). ............................... 

“Qpe of termination procedure (Item 15) .......................... 

Name of attending physician (Item 16) ............................ 

Name of person completing report (Item 17). ...................... 

Appendixes 

A . U.S. Standard Report of Induced Termination of Pregnancy. . . . . 

B . Definitions of live birth, fetal death, and induced termination 

of pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

C . Definitions of induced abortion procedures.. . . . . . . . . . . . . . . . . . . . 

iii 

1 

1 

1 

2 

2 

2 

3 

3 

3 

4 

4 

4 

5 

6 

6 

6 

10 

11 

11 

12 

13 

13 

15 

16 

17 

V 
Introduction 

Purpose 

This handbook is designed as an aid to acquaint hospital and clinic 

personnel, physicians, and others with responsibilities related to completing and filing reports of induced termination of pregnancy (induced abortion). Background information is included on the importance of these 

documents for statistical purposes and specific instructions for recording 

entries. 

The purpose is to achieve improved reporting by promoting better 

understanding of the forms and of the uses of information entered on 

them. 

Although State laws vary in specific requirements, generally the person in charge of the institution or facility where the induced abortion is 

performed has the overall responsibility for obtaining the required data, 

preparing the report, and filing the report with the State registrar. For 

abortions performed outside a hospital, clinic, or other institution, the 

physician performing the abortion is responsible for preparing and sling 

the report. 

Importance of induced termination of pregnancy reporting 

Reports of induced termination of pregnancy are not legal records and 

are not maintained permanently in the files of the State office of vital 

statistics. However, the data they provide are very important from both a 

demographic and a public health viewpoint. 

In January 1973, the U.S. Supreme Court ruled that the restrictive 

abortion laws in two States were unconstitutional and that, within the first 

two trimesters after conception, whether an abortion was to be performed 

or not was a matter between the woman and her doctor (Roe v. Wade, 410 

U.S. 113 (1973); and Doe v. Bolton, 410 U.S. 179 (1973)). The net result of 

this ruling is that induced abortion under these criteria is 1egaI in all 

States. In July 1976, the Supreme Court ruled that it is legal for States to 

require the reporting of certain information about induced abortions performed in that State (Planned Parenthood of Central Missouri v. Danforth, 

96 Supreme Court 283 1 (1976)). As a result of these two rulings, many 

States have established mandatory induced abortion reporting systems. 

1 
Data from reports of induced termination of pregnancy provide unique 

information on the characteristics of women having induced abortions. 

Uniform annual data of such quality are nowhere else available. MedicaI 

and health information is provided to evaluate risks associated with induced abortion at various lengths of gestation and by the type of abortion 

procedure used. Information on the characteristics of the women is used 

to evaluate the impact that induced abortion has on the birth rate, teenage 

pregnancy, and out-of-wedlock births. The data also help measure the role 

that induced abortion plays in birth prevention as compared with contraception. Because these abortion data provide information necessary to 

promote and monitor health, it is important that the forms be completed 

carefully. 

State reporting requirements 

In those States requiring the reporting of information on induced 

abortions, various methods are used to collect the data. Some States 

include induced abortion reporting as a part of their fetdl death reporting 

system by collecting additional information on induced terminations on 

their fetal death report. A majority of the States use a separate form, 

usually called Report of Induced Termination of Pregnancy, for the reporting of induced abortions. In a few States, a combination system is used 

whereby induced abortions above a certain gestational age are reported on 

the fetal death report and those below that gestational age are reported on 

the induced termination of pregnancy report. However, regardless of the 

reporting system used, ail States with reporting systems require the reporting of ail induced abortions regardless of length of gestation. 

Because of the variations that exist from State to State, it is imperative 

that those persons having responsibilities in the reporting of induced 

abortions familiarize themselves with the procedures and forms used in 

their State. 

Live birth 

Although unlikely, the induced abortion procedure may result in a live 

birth. Should this occur, the report of induced termination of pregnancy is 

not to be completed and filed. Rather, a certificate of live birth is to be 

prepared for the infant. In the event the infant should later die, a death 

certificate would also have to be prepared and flied. 

U.S. Standard Report of Induced Termination of Pregnancy 

The National Center for Health Statistics, Centers for Disease Control 

and Prevention, U.S. Department of Health and Human Services has historically provided leadership and coordination in the development of the 

2 
Standard Report of Induced Termination of Pregnancy to serve as a model 

for use by States. This report has been revised periodically in collaboration 

with State health ofEciaIs, registrars, and statisticians; Federal agencies; 

local registrars, and medical record personnel. In these revisions, each 

item is evaluated thoroughly for its registration, statistical, health, and 

research value. 

In recent years, responsibility for the collection of abortion data from 

the ofElcial files of the States has rested with the Division of Reproductive 

Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention. In 1996, in response to 

the emerging use of medical procedures to induce abortion, the Division of 

Reproductive Health, in consultation with a working group of experts, 

revised Item 15: Type of Termination Procedure. The instructions for completing several sections of the form were also revised at this time. This 

Handbook reflects those revisions. 

Each State is encouraged to adopt the recommended standard report 

as a means of developing a uniform national induced abortion reporting 

and statistics system. Although many States use the recommended standard report, some States modify it to comply with State laws and regulations or to meet their own particular needs for information. 

State health department 

The State health department administers the induced termination of 

pregnancy reporting system under the laws and regulations of the State. 

The State health department is responsible for developing forms and procedures and for ensuring adherence to the requirements of the laws and 

regulations. It also publishes statistical data derived from the reports of 

induced termination of pregnancy it receives. 

Local registrar 

Generally, the Report of Induced Termination of Pregnancy is Bled 

directly with the State registrar. In a few States, however, these reports are 

filed with the local registrar who then forwards them to the State registrar. 

Confidentiality 

The Report of Induced Termination of Pregnancy is designed to collect 

information for statistical and research purposes only. These reports are 

not maintained permanently in the official files of the State health department. The data that are gathered from these reports are presented in 

aggregate statistics, not individually, so that specific individuals may not 

be identified. 

3 
Hospitals, clinics, and physicians are assured that extensive legal and 

administrative measures are used to protect individuals from unauthorized disclosure of personal information contained on the reporting form. 

Specific responsibilities 

Hospital or clinic 

The hospital, clinic, or other institution or facility where the induced 

abortion is performed is responsible for obtaining the necessary data, 

completing the form, and fling it with the State registrar within the time 

period specified by law. To ensure the proper performance of these responsibilities, it is preferable that one staff member be given the overall responsibility and authority to see that the reports are completed and filed on 

time. Specifically, the hospital, clinic, or other institution should: 

Develop efficient procedures for prompt preparation and filing of the 

reports. 

Collect and record the information required by the report. 

Prepare a correct and legible report, making certain that every item is 

completed. 

File the report with the proper ofIkial within the time specified in the 

vital statistics laws of the State. 

Cooperate with State or local registrars concerning queries on report 

entries. 

Call on the State or local ofke of vital statistics for advice and assistance when necessary. 

Physician 

For induced abortions performed in a hospital, clinic, or other institution, the physician performing the abortion is responsible for providing the 

medical information required by the report. When an induced abortion is 

performed outside a hospital, clinic, or other institution, the physician 

performing the abortion is responsible for obtaining all of the necessary 

data, completing the form, and filing it with the State registrar within the 

time period specified by law. 
Part I. General instructions for completing reports 

The data necessary for preparation of the induced termination of 

pregnancy report are obtained from the: 

l Patient 

l Attending physician 

l Hospital or clinic records 

Reports of induced termination of pregnancy are not permanent records 

and are used only for statistical purposes. However, the data obtained 

from these reports are very important from both a demographic and a 

public health viewpoint. Therefore, it is essential that these reports be 

prepared accurately. These general rules should be followed: 

File the original report with the registrar. Reproductions or duplicates 

are not acceptable. 

Avoid abbreviations except those recommended in the specmc item 

instruction. 

Spell entries correctly. 

Refer problems not covered in these instructions to the State o&e of 

vital statistics. 

Use the current form designated by the State. 

Type all entries whenever possible. Do not use worn typewriter ribbons. 

If a typewriter cannot be used, print legibly in black ink. 

Complete each item following the specific instructions for that item. 

Do not make alterations or erasures. 
Part Il. Completing the report of induced 

termination of pregnancy 

These instructions pertain to the 1989 revision of the U.S. Standard 

Report of Induced Termination of Pregnancy. 

I’) PLACE OF TERMINATION 

1. FACILITY NAME (If not clinic or hospital, give address) 

Enter the full name of the hospital or clinic where the induced termination of pregnancy 

occurred. 

If the induced termination of pregnancy occurred in a hospital or a clinic that is 

physically situated within a hospital or is administratively a part of a hospital, enter the 

full name of the hospital. 

If the induced termination of pregnancy occurred in a freestanding clinic, a clinic that is 

physically and administratively separate from a hospital, enter the full name of the clinic. 

If the induced termination of pregnancy occurred in a physician’s office or some other 

place, enter the number and street name or name of the place. 

2. CITY, TOWN, OR LOCATION OF PREGNANCY TERMINATION 

Enter the name of the city, town, or location where the pregnancy termination occurred. 

3. COUNTY OR PREGNANCY TERMINATION 

Enter the name of the county where the pregnancy termination occurred. 

Item 1 provides information about the types of facilities where induced terminations are 

performed Items 2 and 3 provide information that is used in the planning of health 

facilities and health education programs. 

4. PATIENT’S IDENTIFICATION 

Enter the hospital, clinic, or other patient identification number. This number must be one 

that would enable the facility or physician to access the medical file of this patient. 

This information is used with Items 1 and 2 for querying for missing information without 

identifying the patient. 

6 
5. AGE LAST BIRTHDAY 

Enter the age of the patient in years at her last birthday. 

This information permits analysis of health risks related to length of pregnancy and type 

of procedure among different age groups. It is also used to study the impact of induced 

terminations on the fertility rates of different age groups. 

6. MARRIED? 

0 Yes 0 No Specify: 

Check “Yes” if the patient was legally married (including separated) at the time of 

conception, at the time of termination, or at any time between conception and the 

termination. Otherwise, check “No.” 

This information is used to study the health risk of induced terminations by marital 

status. It also helps determine the impact of induced terminations on the fertility rates of 

married and unmarried women and aids in planning for and evaluating the effectiveness 

of family planning programs. 

7. DATE OF PREGNANCY TERMINATION (Month, Da, Year) 

Enter the exact month, day, and year of the pregnancy termination. 

The date the pregnancy was actually terminated should be entered. This may not 

necessarily be the date the procedure was begun. Exception: For termination procedures 

performed by medical (nonsurgical) methods, the date of the termination should be 

recorded as the actual date the initial dosage of the medication was given-not the actual 

date of termination of pregnancy. 

Enter the full name of the month-January, February, March, etc. Do not use a number or 

abbreviation to designate the month. 

This information is used to determine when the pregnancy termination occurred and to 

determine the length of gestation. Length of gestation is an essential element in the study 

of risks associated with induced terminations. 

8a-e RESIDENCE OF PATIENT 

The patient’s residence is the place where her household is located. This is not necessarily the same as her “home State,” “voting residence,” “mailing address,” or “legal 

residence.” The State, county, and city should be that of the place where the patient 

actually lives. Never enter a temporary residence such as one used during a visit, business 

trip, or a vacation. Residence for a short time at the home of a relative or friend is 

considered to be temporary and should not be -entered here. Place of residence during a 

tour of military duty or during attendance at college is not considered temporary and 

should be entered as the place of residence of the patient on the report. 

7 
If the patient has been living in a facility where an individual usually resides for a long 

period of time, such as a group home, mental institution, nursing home, penitentiary, or 

hospital for the chronically ill, this facility should be entered as the place of residence. 

aa. RESIDENCE-STATE 

Enter the name of the State where the patient lives. This may differ from the State in her 

mailing address. If the patient is not a resident of the United States, enter the name of the 

country and the name of the unit of government that is the nearest equivalent of a State. 

8b. RESIDENCE-COUNTY 

Enter the name of the county where the patient lives. 

8c. RESIDENCE-CITY, TOWN, OR LOCATION 

Enter the name of the city, town, or location where the patient lives. This may differ from 

the city, town, or location in her mailing address. 

ad. RESIDENCE-INSIDE CITY LIMITS? (Yes or no) 

Enter “Yes” if the location entered in item SC is incorporated and the patient’s residence 

is inside its boundaries. Otherwise, enter “No.” 

ae. RESIDENCE-ZIP CODE 

Enter the ZIP Code of the place where the patient lives. 

These items provide data for the analysis of induced termination by residence of the 

patient. This information is used with the city and county of termination to provide 

information on the amount of movement occurring within a State or between States to 

obtain an induced termination of pregnancy. This type of information is usefil in 

planning the location of health care facilities. 

9. OF HISPANIC ORIGIN? 

(Speciw No or Yes-If yes, speciv Cuban, Mexican, Puerto Rican, etc.) 

cl No 0 Yes Specify: 

Check “No” or “Yes.” If “Yes” is checked, enter the specific Hispanic group as obtained 

from the patient. Do not leave this item blank. The entry in this item should reflect the 

response of the patient. 

For the purposes of this item, “Hispanic,” refers to people whose origins are from Spain, 

Mexico, Puerto Rico, Cuba, or the Spanish-speaking countries of Central or South 

America. Origin can be viewed as the ancestry, nationality, lineage, or country in which 

the patient or her ancestors were born before their arrival in the United States. 

There is no set rule as to how many generations are to be taken into account in 

determining Hispanic origin. A patient may report Hispanic origin based on the country 

8 
of origin of a parent, grandparent, or some far-removed ancestor. The response should 

reflect what the patient considers herself to be and is not based on percentages of 

ancestry. Although the prompts include the major Hispanic groups of Cuban, Mexican,, 

and Puerto Rican, other Hispanic groups can also be identified in the space provided. 

If a patient indicates that she is of multiple Hispanic origin, enter the origins as reported 

(for example, Mexican-Puerto Rican). 

If a patient indicates that she is Mexican American or Cuban American, enter the 

Hispanic origin as stated. 

This item is not a part of the Race item. A person of Hispanic origin may be of any race. 

Each question, Race and Hispanic origin, should be asked independently. 

Hispanics comprise the second-largest minority in this country. This item provides data to 

measure differences in pregnancy outcome and variations in health care for people of 

Hispanic and non-Hispanic origin. Without collection of data on persons of Hispanic 

origin, it is impossible to obtain valid demographic and health information on this 

important group of Americans. 

Some States may wish to obtain data on other groups or may have a very small 

Hispanic population. Therefore, they may opt to include a general Ancestry item on 

their report instead of a specific Hispanic origin item. Instructions for the general 

Ancestry item follow: 

ANCESTRY-Mexican, Puerto Rican, Cuban, African, English, 

Irish-German, Hmong, etc. (Speciv) 

Enter the ancestry as obtained from the patient. Do not leave this item blank. The entry 

in this item should reflect the response of the patient. 

For purposes of this item, ancestry refers to the nationality, lineage, or country in which 

the patient or her ancestors were born before their arrival in the United States. American 

Indian or Alaskan Native ancestry should be entered as such. 

There is no set rule as to how many generations are to be taken into account in 

determining ancestry. A person may report ancestry based on the country of origin of a 

parent, grandparent, or some far-removed ancestor. The response should reflect what the 

patient considers herself to be and is not based on percentages of ancestry. 

Some persons may not identify with the foreign birthplace of their ancestors or with a 

nationality and may report “American. ” If, after clarification of the intent of this item, 

the patient still feels that she is an “American,” enter “American” on the record. 

If a patient indicates that she is of multiple ancestry, enter the ancestry as reported (for 

example, English-Scottish-Irish, Mexican American). 

If she gives a religious group-such as, Jewish, Moslem, or Protestant-ask for the 

country of origin or nationality. 

9 
This item is not a part of the Race item. Both questions, Race and Ancestry, should be 

asked independently. This means that for certain groups-such as Japanese, Chinese, or 

Hawaiian-the entry will be the same in both items. The entry should be made in both 

items even if it is the same. However, an entry of “Black” or “White” should never be 

recorded in the ancestry item. 

10. RACE 

0 American Indian 

0 Other (Speciv) 

q Black 0 White 

Check the box that describes the race of the patient. The entry in this item should reflect 

the response of the patient. 

If the patient is not American Indian, Black, or White, check “Other” and specify the 

race on the line provided. 

For Asian or Pacific Islanders, enter the national origin of the patient, such as Chinese, 

Japanese, Korean, Filipino, or Hawaiian. 

If the patient is of mixed race, check “Other” and enter both races or origins. 

Information on race is needed to study the impact of induced terminations on the birth, 

fertility, and out-of-wedlock rates of different racial groups. 

11 l EDUCATION (Specij/ only highest grade completed) 

Elementary/Secondary (O-72) .- College (l-4 or 5+) - 

Enter the highest number of years of regular schooling completed by the patient in either 

the space for elementary/secondary school or the space for college. An entry should be 

made in only one of the spaces. The other space should be left blank. Report only those 

years of school that were completed. A person who enrolls in college but does not 

complete one full year should not be identified with any college education in this item. 

Count formal schooling. Do not include beauty, barber, trade, business, technical, or other 

special schools when determining the highest grade completed. 

This item is an important indicator of socioeconomic status of the patient. This information is used for studying the effect of induced terminations on the health and fertility of 

various educational and socioeconomic groups. This information is also usefur in planning educational programs that address family planning. 

12. DATE LAST NORMAL MENSES SEGAN (Month, Day, Year) 

Enter the exact date (month, day, and year) of the first day of the patient’s last normal 

menstrual period, as obtained from the hospital or clinic record or the patient herself. 

10 
Enter the full name of the month-January, February, March, etc. Do not use a number or 

abbreviation to designate the month. 

If the exact day is unknown but the month and year are known, obtain an estimate of the 

day from the patient, her physician, or the medical record. If an estimate of the date 

cannot be obtained, enter the month and year only. 

Enter “Unknown” if the date cannot be determined. Do not leave this item blank. 

This item is used in conjunction with the date of termination to determine the length of 

gestation. Gestational age is important in evaluating the effectiveness and safety of the 

various termination procedures. 

13. CLINICAL ESTIMATE OF GESTATION (weeks) 

Enter the length of gestation as estimated by the attending physician in completed 

menstrual weeks. Do not compute this information from the date last normal menses 

began and date of termination. If the attendant has not done a clinical estimate of 

gestation, enter “None.” Do not leave this item blank. Exception: For termination 

procedures performed by medical (nonsurgical) methods, gestational age should be 

recorded as the gestational age of the pregnancy on the actual date the initial dosage of 

medication was given. 

This item provides a check on the length of gestation as calculated from date of last 

normal menses. It permits the physician to report an estimate when there is doubt as to 

the accuracy of the length of gestation or when date of last normal menses is unavailable 

or misleading. 

14a-d PREVIOUS PREGNANCIES (Complete each section) 

14wb LIVE BIRTHS 

14a. Now living 

Number 0 None 

Enter the number of children born alive to this patient who are still living at the time of 

this termination. Do not include children by adoption. Check “None” if all previous 

children are dead. 

14b. Now dead 

Number 0 None 

Enter the number of children born alive to this patient who are no longer living at the 

time of this termination. Do not include children by adoption. Check “None” if all 

previous children are still living. 
14ed OTHER TERMINATIONS 

14~. Spontaneous 

Number q None 

Enter the number of previous pregnancies that ended spontaneously and did not result in 

a live born infant. This should not include induced terminations. Check “None” if the 

patient has had no previous pregnancies or if all previous pregnancies ended in live born 

infants. 

14d. Induced (Do not include current termination) 

Number q None 

Enter the number of previous induced terminations (induced abortions) that this patient 

has had. Do not include this termination. Check “None” if the patient has had no 

previous induced terminations. 

This information provides a pregnancy history and allows for insight into the use of 

induced terminations to limit family size. Because this item also collects information on 

the number of previous induced terminations, it provides some data on characteristics of 

women who may need alternative method& of family planning. 

15. TYPE OF TERMINATION PROCEDURE 

(Definitions of certain abortion procedures can be found in Appendix C.) 

0 Suction Curettage 

0 Medical (Nonsurgical), Specify Medication(s) 

0 Dilation and Evacuation (D&E) 

q Intrauterine Instillation (Saline or Prostaglandin) 

0 Sharp Curettage (D&C) 

0 Hysterotomy/Hysterectomy 

0 Other (Specify) 

Check the box that describes the procedure that actually terminated this pregnancy. 

Check only one box. , If a procedure not listed was used, check “Other” and specify, on 

the line provided. 

This item provides information on the frequency of specific procedures and the incidence 

of terminations involving multiple procedures. When used in conjunction with length of 

gestation it provides an indication of the safety, appropriateness, and health risks of the 

various termination procedures at different gestational ages. 

12 
16. NAME OF ATTENDING PHYSICIAN (Type/Print) 

Enter the Ml name of the attending physician. Be sure to spell it correctly and verify 

correct spelling. This item is used to query for missing or additional information. 

17. NAME OF PERSON COMPLETING REPORT (Type/Print,) 

Enter the full name of the person completing this report. 

This is the primary person who is queried for missing information on the report, although 

the physician is contacted in some instances. 

13 
Appendixes 

A . U.S. Standard Report of Induced Termination of Pregnancy . . . . 15 

B . Definitions of live birth, fetal death, and induced termination 

of pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 

C . Definitions of induced abortion procedures. . . . . . . . . . . . . . . . . . . . . 17 

14 
Appendix A 

U.S. Standard Report of Induced 

Termination of Pregnancy 

. . . 

PERMANENT 

8l.AcK INIC 

R)R 

IHglRucrloN8 

SEE 

HAI(o8acU 

U.S. STANDARD 

REPORT OF INDUCED TERMINATION OF PREGNANCY 

15 E 

5 

i 

8 

!i k 

F 

8 

ii 

1 

d 

f 

& 

c 

P 

i 

1 

!I 

h 

2 

!i 0 

A 

P 

z 

f 

P 

9 

$ 

f 

ii 4 

Ii 

. 

s 

FACIW NAME (if not cf& or ht@taI, 2. an, TOWN, OR 

PREGNANCY ~RMfNATlON 

Nerrywood Clinic Louisville Jefferson 

PATIENT’S IDENTlFlCAllON 6, AQE UST BIRTHDAY 

25466 23 q YES wo 

I I November XL1997 

L RESIDENCE-STAE 6b. couNrY 8c. Cd-W, TOWN, OR LOCATION ad. INSIDE CITY LIMI-I’S? 60. 2lPCGDE 

mww 

lhio Hamilton Cincinnati pJYES IllNO 

45202 

OF HISPANIC ORlGlN? 10. RACE 

I 

11. EDUC 

*m---u.* .a- --v-- Y--- HP---IL. -ml* LLa.^~ ~apwlly RO w rem - II yw, 

rpmlfy Cuhn, Mexican, Puerto RiCM, etc.) 

r **- I3 aI 

ATION 

I 

q Allulcall Indlul (CipGlly wuy llycd gfad" completed) I 

f-J Bkll ElanontaryjSecondaty , Calleg 

lQw?llta 

(0-W I (14 MS+) 

. 

LJNO mlV8 

miw,:Puerto Rican LwWl 

I 

12 ; 

14. PRMWS PREGNANCIES (Coqkfa 

SF+ I 

!. DAl ~eRchaoctbul) 

MEh3c3 ucumn 

I 

“I- IVI. 

fMonfh. Dax bb8rJ MgskSJ LIVE BIRTHS I OTHER TEMINATIONS 

- 

- _- - 

14a. NowLiving ‘14b. NowDead WI. Spontaneous ‘146. lnducd 

I 

September 10 weeks I ; f-nor- thii telmirrdion) 

Number------- Number 

I 

5, 1997 l Nu-- I Numbw 

i?!!l None r q Mone m None : aNone 

16. TYPE OF TERMlNAilON PROCXDURE 

(check 0nQ one) 

IXlSuctionCumttage 

0 Medical (Nonsurgical), Specify Medication(s) 

Cl Dilation and Evacuation (D&E) 

Cl lntre-Uterine Instillation (Saline or Prostaglandin) 

0 Sharp Curettage (D&C) 

0 Hysterotomy/Hysterectomy 

Cl Other (Specify} 

16. NAME OF ATTENDING PHYGIUAN (7@e#‘rhZ) 17. NAME OF PERSON COMPLETING RE?OFtT JQ’jWm 

Edmund Matthew Stone, M.D. Julia Lynn Koval 

PHS-ID08 

REV. 12197 
Appendix B 

Definitions of live birth, fetal death, and 

induced termination of pregnancy 

The following definitions are included in the 1992 revision of the Model 

State Vital Stalistics Act and Regulations. The definitions of live birth and 

fetal death conform to the definitions adopted by the Assembly of the 

World Health Organization. 

Z&e birth---means the complete expulsion or extraction from its mother 

of a product of human conception, irrespective of the duration of pregnancy, which, after such expulsion or extraction, breathes, or shows any 

other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, whether or not the 

umbilical cord has been cut or the placenta is attached. Heartbeats are to 

be distinguished from transient cardiac contractions; respirations are to 

be distinguished from fleeting respiratory efforts or gasps. 

Important-If an infant breathes or shows any other evidence of life 

after complete delivery, even though it may be only momentary, the birth 

must be registered as a live birth and a death certifkate must also be fled. 

Fetal death-means 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. 

Induced termtnatlon ofpregnancy-means the purposeful interruption 

of an intrauterine pregnancy with the intention other than to produce a 

live-born infant, and which does not result in a live birth. This definition 

excludes management of prolonged retention of products of conception 

following fetal death. 

16 
Appendix C 

Definitions of induced abortion procedures 

Suction curettage (Also known as vacuum aspiration.In this procedure 

the cervical canal is dilated by the successive insertion of instruments of 

increasing diameter (dilators). When the cervix is suf3ciently dilated, a flexible 

tube (cannula) is inserted into the uterine cavity, and the fetal and placental 

tissues are then removed using an electric vacuum pump. 

Medical (NonsurgicaZ&This nonsurgical procedure involves the administration of a medication or medications to induce an abortion. Medications (e.g., methotrexate, mifepristone, misoprostol, etc.) are used most 

frequently early in the first trimester of pregnancy. However, some medications (e.g., prostaglandin suppositories, injectable prostaglandins, etc.) 

may be administered during the second trimester of pregnancy to induce 

abortion. Medications may be administered orally, by injection, or intravaginally. 

Dilation and evacuation (D&E&This procedure, used most frequently 

in the second trimester of pregnancy (greater than or equal to 13 weeks 

gestation) involves opening the cervix (dilation) and primarily using sharp 

instrument techniques, but also suction and other instrumentation such 

as forceps for evacuation. 

Intrauterine Instillation (saline or prostagZandln)--This procedure involves either withdrawing a portion of the amniotic fluid from the uterine 

cavity by a needle inserted through the abdominal wall and replacing this 

fluid with a concentrated salt solution (known as saline instillation, saline 

abortion, or saline amniotic fluid exchange) or injecting a prostaglandin-a 

substance with hormone-like activity-into the uterine cavity through a 

needle inserted through the abdominal wall (known as intrauterine prostaglandin instillation). The saline instillation process induces labor, which 

results in the expulsion of the fetus approximately 24 to 48 hours later. 

The interval between prostaglandin, injection and expulsion tends to be 

shorter than in a saline abortion. 

Sharp curettage (D&C) (Also known as dilatation and curettage, D&C, 

or surgical curettage)-This procedure involves the dilation of the cervix as 

in the suction curettage procedure, although usually to a larger diameter. 

The fetal and placental tissues are then removed with a sharp curette. 

17 
Hysterotomy/Hysterectomy-Hysterotomy involves surgical entry into 

the uterus to remove a fetus. Hysterotomy is usually performed only if 

other abortion procedures fail or if other abortion procedures are not 

appropriate. Hysterectomy is a procedure in which the uterus is removed 

(with the fetus inside). It is usually performed only when a pathological 

condition of the uterus, such as fibroid tumors, warrants its removal .or 

when a woman desires sterilization. 

AlI definitions, except for D&E, are from Legalized Abortion and the 

PubZlc Health (Institute of Medicine, 1975). The definition of D&E is based 

on NCHS consultation with the Center for Health Promotion and Education, Centers for Disease Control and Prevention. 

All other procedures should be shown as “Other” and the specific 

procedure listed. This category includes procedures using a combination 

of agents, such as urea and prostaglandin, prostaglandin and oxytocin, or 

prostaglandin and saline. 

18 
For a list of reports published by the National Center for 

Health Statistics contact: 

Data Dissemination Branch 

National Center for Health Statistics 

Centers for Disease Control and Prevention 

6525 Belcrest Road, Room 1064 

Hyattsville, MD 20782-2003 

(301) 436-8500 

Internet: www.cdc.gov/nchswww/