This is a well overdue piece of work and it's great to see it finally being looked at!
Some comments:
Consider expanding the scope to include the over-arching 248982007|Pregnancy, childbirth and puerperium finding (finding)| It is also plagued by the same issues. Even if the inital phase is just to separate findings & disorders. And more importantly maternal and fetal (neonatal?) conditions. At least ensuring they're all identified and broadly organised (subsequent phases can refine). For example: 1269101009|Maternal disorder during antenatal and/or intrapartum and/or postpartum period| is currently a sibling of 248982007|Pregnancy, childbirth and puerperium finding (finding)|. Similarly should 41402500|Fetal and/or neonatal disorder| also be a subtype ? And it's sibling 106112009|Fetal finding|? and so on. We recognise this is a sizeable piece of work and this broader scope roughly doubles the affected concepts. But it's valuable. This will help break down subsequent progress phases - Maternal, Fetal, finding, disorder etc.
Agree with inativating the "complication of" concepts and the proposed groupers.
The introduction of Maternal and Fetal for other concepts would also help more broadly with ambiguity. For example 64229006|Traumatic lesion during delivery| 83095000|Fetal cephalhematoma| - "occur as a consequence of blood vessels rupturing between the periosteum and the skull due to torsion of the scalp during delivery"[1] would read as a subtype of the current FSN "Traumatic lesion during delivery (disorder)"
We found a bunch of suspect/potential duplicates for consideration.
1260427008|Maternal antepartum and/or intrapartum and/or postpartum period (qualifier value)| 1260236009|Maternal antenatal and/or intrapartum and/or postpartum period (qualifier value)| 1156671008|Maternal perinatal period (qualifier value)|
276986009 |Antepartum| 263675000 |Antenatal|
1156672001 |Maternal antenatal period| 1156679005 |Maternal antepartum period| Though we recognise there is a subtle distinction of Antepartum being late stage of antenatal. Just aware that this nuance might be a challenge for modelling.
Finally, it would be good to resolve the inconsistency in language in this content area. For both PTs and Synonyms. eg: Intrapartum and ‘During labour’ , prenatal, antenatal, antepartum etc.
Antenatal = usually defined as entire period between conception and onset of labour (or surgical delivery)
Antepartum = usually defined as period from 20th week after conception and until onset of labour (or surgical delivery), except in some contexts where it appears to be synonymous with antenatal (see above). Can also be defined as the period between last menstrual period and delivery, which can be VERY much shorter than the actual period of gestation.
Perinatal = internationally ambiguous. Usually from 28th week after conception (but some source state the 20th week..) and until end of 1st week after delivery (but some sources state the 4th week). Especially but not uniquely in context of pregnancy-related mental health, it often means the entire period between conception and one year after birth
Thanks. It is not really clear from the briefing note what is being proposed:
The paper states that "...The described policy will be authored during the remaining part of 2025..." which suggests that some kind of 'policy' is being written, but we are abruptly told that 'it' (presumably modified data) will be released "...in January 2026...", suggesting something altogether different.
Emphasis is placed on the release of a new set of 'groupers', but we are also told that "...the quality improvement initiative proposed will review all concepts within the class and apply a consistent benchmark relating to terms containing the words pregnancy, childbirth, obstetric, and gestational..."
What is this 'consistent benchmark'? I imagine it is a set of modelling rules, but if so what are they, and what is the evidence that they can be applied consistently by independent authors (given the paper's own observations and those of Matt above that the (a) source terms here are varied and (b) the scope of content affected may well lie beyond the implied limits of << 198609003)?
The point about distinguishing between 'maternal and/or fetal and/or neonate' vs. '(only) maternal' is fairly made, but we are then given no indication as to how this distinction will be represented. The modelling examples suggest a reliance on some of the more slippery attributes, and no examples are offered to illustrate a default approach to 'fetal' and 'neonatal' situations.
Finally, whilst we are told that the proposed reorganisation will result in "...dependable and rule based..." reference data better suited for "...reliable use and data retrieval..." no examples are given to support this claim.
3 Comments
Matt Cordell
This is a well overdue piece of work and it's great to see it finally being looked at!
Some comments:
It is also plagued by the same issues. Even if the inital phase is just to separate findings & disorders. And more importantly maternal and fetal (neonatal?) conditions. At least ensuring they're all identified and broadly organised (subsequent phases can refine).
For example: 1269101009|Maternal disorder during antenatal and/or intrapartum and/or postpartum period| is currently a sibling of 248982007|Pregnancy, childbirth and puerperium finding (finding)|. Similarly should 41402500|Fetal and/or neonatal disorder| also be a subtype ? And it's sibling 106112009|Fetal finding|? and so on.
We recognise this is a sizeable piece of work and this broader scope roughly doubles the affected concepts. But it's valuable.
This will help break down subsequent progress phases - Maternal, Fetal, finding, disorder etc.
83095000|Fetal cephalhematoma| - "occur as a consequence of blood vessels rupturing between the periosteum and the skull due to torsion of the scalp during delivery"[1] would read as a subtype of the current FSN "Traumatic lesion during delivery (disorder)"
1260236009|Maternal antenatal and/or intrapartum and/or postpartum period (qualifier value)|
1156671008|Maternal perinatal period (qualifier value)|
276986009 |Antepartum|
263675000 |Antenatal|
1156672001 |Maternal antenatal period|
1156679005 |Maternal antepartum period|
Though we recognise there is a subtle distinction of Antepartum being late stage of antenatal. Just aware that this nuance might be a challenge for modelling.
[1]
Jeremy Rogers
Antenatal = usually defined as entire period between conception and onset of labour (or surgical delivery)
Antepartum = usually defined as period from 20th week after conception and until onset of labour (or surgical delivery), except in some contexts where it appears to be synonymous with antenatal (see above). Can also be defined as the period between last menstrual period and delivery, which can be VERY much shorter than the actual period of gestation.
Perinatal = internationally ambiguous. Usually from 28th week after conception (but some source state the 20th week..) and until end of 1st week after delivery (but some sources state the 4th week). Especially but not uniquely in context of pregnancy-related mental health, it often means the entire period between conception and one year after birth
Ed Cheetham
Thanks. It is not really clear from the briefing note what is being proposed:
apply a consistent benchmark relating to terms containing the words pregnancy, childbirth, obstetric, and gestational..."
What is this 'consistent benchmark'? I imagine it is a set of modelling rules, but if so what are they, and what is the evidence that they can be applied consistently by independent authors (given the paper's own observations and those of Matt above that the (a) source terms here are varied and (b) the scope of content affected may well lie beyond the implied limits of << 198609003)?
The point about distinguishing between 'maternal and/or fetal and/or neonate' vs. '(only) maternal' is fairly made, but we are then given no indication as to how this distinction will be represented. The modelling examples suggest a reliance on some of the more slippery attributes, and no examples are offered to illustrate a default approach to 'fetal' and 'neonatal' situations.
Finally, whilst we are told that the proposed reorganisation will result in "...dependable and rule based..." reference data better suited for "...reliable use and data retrieval..." no examples are given to support this claim.
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