ID

3259

Description

The Division of Cancer Prevention's pregnancy outcome case report form (CRF) template. Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=51ABB467-3B46-21F2-E044-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=51ABB467-3B46-21F2-E044-0003BA3F9857

Keywords

Versions (9)
  1. 9/19/12 9/19/12 -
  2. 3/19/14 3/19/14 - Martin Dugas
  3. 8/9/14 8/9/14 - Martin Dugas
  4. 6/26/15 6/26/15 - Martin Dugas
  5. 7/28/15 7/28/15 - Julian Varghese
  6. 9/29/15 9/29/15 - Martin Dugas
  7. 3/15/21 3/15/21 - Dr. rer. medic Philipp Neuhaus
  8. 4/13/21 4/13/21 - Dr. rer. medic Philipp Neuhaus
  9. 9/20/21 9/20/21 -
Uploaded on

September 19, 2012

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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Outcome of Pregnancy - 2764926v1.0

English

No Instruction available.

1 forms  
  1. StudyEvent: Outcome of Pregnancy
    1. No Instruction available.
Screening
Description

Screening

DCP Protocol #
Description

ProtocolNCIIdentifierNumber

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C25320
UMLS 2011AA ObjectClass
C1507394
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus Property
C19202
UMLS 2011AA Property
C1513882
Institution Code
Description

NationalCancerInstituteInstituteCode

Data type

text

Alias
NCI Thesaurus ValueDomain
C25162
UMLS 2011AA ValueDomain
C0805701
NCI Thesaurus ObjectClass
C21541
UMLS 2011AA ObjectClass
C0018704
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Participant ID
Description

ParticipantIdentifier

Data type

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ValueDomain
C25364
UMLS 2011AA ValueDomain
C0600091
Visit Type
Description

VisitTypeText

Data type

text

Alias
NCI Thesaurus Property
C25284
UMLS 2011AA Property
C0332307
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ObjectClass
C25716
UMLS 2011AA ObjectClass
C0545082
Visit Date
Description

VisitDate

Data type

date

Alias
NCI Thesaurus Property
C25164
UMLS 2011AA Property
C0011008
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ValueDomain
C25367
NCI Thesaurus ObjectClass
C25716
UMLS 2011AA ObjectClass
C0545082
Outcome Of Pregnancy
Description

Outcome Of Pregnancy

Pregnancy Test Date
Description

PatientMostRecentPregnancyTestDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Metathesaurus Property
C0032976
NCI Thesaurus Property
C25577
UMLS 2011AA Property
C1513491
Delivery Date
Description

PregnancyDeliveryDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C25742
UMLS 2011AA ObjectClass
C0032961
NCI Thesaurus Property
C61560
Delivery Type
Description

PregnancyDeliveryType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C25742
UMLS 2011AA ObjectClass
C0032961
NCI Thesaurus Property
C61560
NCI Thesaurus ValueDomain
C61560
Reason for Cesarean
Description

CaesarianSectionReasonText

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus Property
C25638
UMLS 2011AA Property
C0392360
NCI Thesaurus ObjectClass
C46088
UMLS 2011AA ObjectClass
C0007876
Gender
Description

GenderText

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C17357
UMLS 2011AA Property
C0079399
Weight
Description

PersonWeightValue

Data type

double

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C25208
UMLS 2011AA Property
C0043100
NCI Thesaurus ValueDomain
C25208
UMLS 2011AA ValueDomain
C0043100
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
Units
Description

WeightUnitofMeasureCode

Data type

text

Alias
NCI Thesaurus ValueDomain
C25162
UMLS 2011AA ValueDomain
C0805701
NCI Thesaurus ObjectClass
C25208
UMLS 2011AA ObjectClass
C0043100
NCI Thesaurus Property
C25709
UMLS 2011AA Property
C1519795
Length (cm)
Description

NewbornLengthCentimeterNumber

Data type

double

Measurement units
  • cm
Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ValueDomain
C49668
UMLS 2011AA ValueDomain
C0475210
NCI Thesaurus ObjectClass
C16731
UMLS 2011AA ObjectClass
C2939425
NCI Thesaurus Property
C25334
UMLS 2011AA Property
C1444754
cm
One minute Apgar Score
Description

ApgarScoreOneMinuteNumberValue

Data type

double

Alias
NCI Thesaurus ObjectClass
C73437
UMLS 2011AA ObjectClass
C0003533
NCI Thesaurus Property
C48154
UMLS 2011AA Property
C0439232
NCI Thesaurus Property
C66832
UMLS 2011AA Property
C0205447
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ValueDomain
C66833
UMLS 2011AA ValueDomain
C0205448
NCI Thesaurus ValueDomain
C73791
UMLS 2011AA ValueDomain
C0582802
Five minute Apgar Score
Description

ApgarScoreFiveMinuteNumberValue

Data type

double

Alias
NCI Thesaurus ObjectClass
C73437
UMLS 2011AA ObjectClass
C0003533
NCI Thesaurus Property
C48154
UMLS 2011AA Property
C0439232
NCI Thesaurus Property
C66836
UMLS 2011AA Property
C0205451
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ValueDomain
C66833
UMLS 2011AA ValueDomain
C0205448
NCI Thesaurus ValueDomain
C73791
UMLS 2011AA ValueDomain
C0582802
Was the abnormality discovered when neonate was assessed? (If yes, complete SAE Report Form)
Description

SeriousAdverseEventCongenitalAbnormalityResultInd-2

Data type

text

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus Property
C20200
UMLS 2011AA Property
C1274040
NCI Thesaurus ObjectClass
C41335
UMLS 2011AA ObjectClass
C1519255
NCI Thesaurus Property
C2849
UMLS 2011AA Property
C0000768
Specify abnormality
Description

PatientCongenitalAbnormalitySpecify

Data type

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C2849
UMLS 2011AA Property
C0000768
Contributing Factors
Description

NewbornAbnormalityContributingFactorText

Data type

text

Alias
NCI Thesaurus ObjectClass
C16731
UMLS 2011AA ObjectClass
C2939425
NCI Thesaurus Property
C9440
UMLS 2011AA Property
C1704258
NCI Thesaurus Property
C61412
UMLS 2011AA Property
C1880177
NCI Thesaurus Property
C25506
UMLS 2011AA Property
C1521761
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
Pregnancy Outcome
Description

PersonPregnancyResultOutcomeType

Data type

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ObjectClass
C25742
UMLS 2011AA ObjectClass
C0032961
NCI Thesaurus Property
C20200
UMLS 2011AA Property
C1274040
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ValueDomain
C20200
UMLS 2011AA ValueDomain
C1274040
NCI Thesaurus ValueDomain
C25742
UMLS 2011AA ValueDomain
C0032961
Weeks Gestation
Description

PregnancyWeekNumberCount

Data type

double

Alias
NCI Thesaurus Property
C25337
UMLS 2011AA Property
C0237753
NCI Thesaurus ValueDomain
C25463
UMLS 2011AA ValueDomain
C0750480
NCI Thesaurus ObjectClass
C25742
UMLS 2011AA ObjectClass
C0032961
NCI Thesaurus Property
C29844
UMLS 2011AA Property
C0439230
Obstetric History (Check all that apply)
Description

ParticipantObstetricHistoryType

Data type

text

Alias
NCI Thesaurus ObjectClass
C29867
UMLS 2011AA ObjectClass
C0679646
NCI Thesaurus Property
C18772
UMLS 2011AA Property
C0262926
NCI Thesaurus Property
C16928
UMLS 2011AA Property
C0028773
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ValueDomain
C54625
UMLS 2011AA ValueDomain
C2004062
NCI Thesaurus ValueDomain
C16928
UMLS 2011AA ValueDomain
C0028773
Total number of pregnancies including current
Description

PatientPregnancyCount

Data type

double

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ValueDomain
C25463
UMLS 2011AA ValueDomain
C0750480
NCI Thesaurus Property
C25742
UMLS 2011AA Property
C0032961
Total number of pregnancies resulting in live births
Description

PregnancyLiveBirthCount

Data type

double

Alias
NCI Thesaurus ValueDomain
C25463
UMLS 2011AA ValueDomain
C0750480
Total number of stillbirths
Description

PregnancyStillbirthCount

Data type

double

Alias
NCI Thesaurus ValueDomain
C25463
UMLS 2011AA ValueDomain
C0750480
NCI Thesaurus Property
C18772
UMLS 2011AA Property
C0262926
NCI Metathesaurus ObjectClass
C0595939
Total number of miscarriages
Description

PatientPregnancySpontaneousAbortionCount

Data type

double

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ValueDomain
C25463
UMLS 2011AA ValueDomain
C0750480
NCI Thesaurus Property
C25742
UMLS 2011AA Property
C0032961
Total number of therapeutic abortions
Description

PatientPregnancyTherapeuticAbortionCount

Data type

double

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ValueDomain
C25463
UMLS 2011AA ValueDomain
C0750480
NCI Thesaurus Property
C25742
UMLS 2011AA Property
C0032961
Dcp Template Footer
Description

Dcp Template Footer

Protocol Title
Description

ProtocolTitleName

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C25320
UMLS 2011AA ObjectClass
C1507394
NCI Thesaurus Property
C42774
UMLS 2011AA Property
C1705823
Protocol Version
Description

ProtocolVersion

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ObjectClass
C25320
UMLS 2011AA ObjectClass
C1507394
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Protocol Date
Description

ProtocolVersionDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C25320
UMLS 2011AA ObjectClass
C1507394
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ValueDomain
C25367
Page #
Description

PageNumber

Data type

double

Alias
NCI Thesaurus Property
C25337
UMLS 2011AA Property
C0237753
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Metathesaurus ObjectClass
C0439643
Total Page Number
Description

CaseReportFormTotalPageNumber

Data type

text

Alias
NCI Thesaurus ObjectClass
C40988
UMLS 2011AA ObjectClass
C1516308
NCI Thesaurus Property
C25337
UMLS 2011AA Property
C0237753
NCI Thesaurus Property
C25304
UMLS 2011AA Property
C0439810
NCI Thesaurus Property
C42783
UMLS 2011AA Property
C1704732
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
DCP Template Version
Description

DCPTemplateVersionText

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Metathesaurus ObjectClass
C0728990
NCI Thesaurus Property
C25714
UMLS 2011AA Property
C0333052
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1 forms
  1. StudyEvent: Outcome of Pregnancy
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Screening
ProtocolNCIIdentifierNumber
Item
DCP Protocol #
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25320 (NCI Thesaurus ObjectClass)
C1507394 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C19202 (NCI Thesaurus Property)
C1513882 (UMLS 2011AA Property)
NationalCancerInstituteInstituteCode
Item
Institution Code
text
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
C21541 (NCI Thesaurus ObjectClass)
C0018704 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
ParticipantIdentifier
Item
Participant ID
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25364 (NCI Thesaurus ValueDomain)
C0600091 (UMLS 2011AA ValueDomain)
VisitTypeText
Item
Visit Type
text
C25284 (NCI Thesaurus Property)
C0332307 (UMLS 2011AA Property)
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25716 (NCI Thesaurus ObjectClass)
C0545082 (UMLS 2011AA ObjectClass)
VisitDate
Item
Visit Date
date
C25164 (NCI Thesaurus Property)
C0011008 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain)
C25716 (NCI Thesaurus ObjectClass)
C0545082 (UMLS 2011AA ObjectClass)
Item Group
Outcome Of Pregnancy
PatientMostRecentPregnancyTestDate
Item
Pregnancy Test Date
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C0032976 (NCI Metathesaurus Property)
C25577 (NCI Thesaurus Property)
C1513491 (UMLS 2011AA Property)
PregnancyDeliveryDate
Item
Delivery Date
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25742 (NCI Thesaurus ObjectClass)
C0032961 (UMLS 2011AA ObjectClass)
C61560 (NCI Thesaurus Property)
Item
Delivery Type
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25742 (NCI Thesaurus ObjectClass)
C0032961 (UMLS 2011AA ObjectClass)
C61560 (NCI Thesaurus Property)
C61560 (NCI Thesaurus ValueDomain)
CL.1
Code List
Delivery Type
CL Item
Vaginal (Vaginal)
C13309 (NCI Thesaurus)
C0042232 (UMLS 2011AA)
CL Item
Caesarian Section (Cesarean)
C46088 (NCI Thesaurus)
C0007876 (UMLS 2011AA)
CaesarianSectionReasonText
Item
Reason for Cesarean
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25638 (NCI Thesaurus Property)
C0392360 (UMLS 2011AA Property)
C46088 (NCI Thesaurus ObjectClass)
C0007876 (UMLS 2011AA ObjectClass)
Item
Gender
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C17357 (NCI Thesaurus Property)
C0079399 (UMLS 2011AA Property)
CL.2
Code List
Gender
CL Item
Female Gender (Female)
C46110 (NCI Thesaurus)
C0015780 (UMLS 2011AA)
CL Item
Male Gender (Male)
C46109 (NCI Thesaurus)
C1706180 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
PersonWeightValue
Item
Weight
double
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25208 (NCI Thesaurus Property)
C0043100 (UMLS 2011AA Property)
C25208 (NCI Thesaurus ValueDomain)
C0043100 (UMLS 2011AA ValueDomain)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
Item
Units
text
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
C25208 (NCI Thesaurus ObjectClass)
C0043100 (UMLS 2011AA ObjectClass)
C25709 (NCI Thesaurus Property)
C1519795 (UMLS 2011AA Property)
CL.3
Code List
Units
CL Item
Kilogram (kg)
C28252 (NCI Thesaurus)
C0439209 (UMLS 2011AA)
NewbornLengthCentimeterNumber
Item
Length (cm)
double
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C49668 (NCI Thesaurus ValueDomain)
C0475210 (UMLS 2011AA ValueDomain)
C16731 (NCI Thesaurus ObjectClass)
C2939425 (UMLS 2011AA ObjectClass)
C25334 (NCI Thesaurus Property)
C1444754 (UMLS 2011AA Property)
ApgarScoreOneMinuteNumberValue
Item
One minute Apgar Score
double
C73437 (NCI Thesaurus ObjectClass)
C0003533 (UMLS 2011AA ObjectClass)
C48154 (NCI Thesaurus Property)
C0439232 (UMLS 2011AA Property)
C66832 (NCI Thesaurus Property)
C0205447 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C66833 (NCI Thesaurus ValueDomain)
C0205448 (UMLS 2011AA ValueDomain)
C73791 (NCI Thesaurus ValueDomain)
C0582802 (UMLS 2011AA ValueDomain)
ApgarScoreFiveMinuteNumberValue
Item
Five minute Apgar Score
double
C73437 (NCI Thesaurus ObjectClass)
C0003533 (UMLS 2011AA ObjectClass)
C48154 (NCI Thesaurus Property)
C0439232 (UMLS 2011AA Property)
C66836 (NCI Thesaurus Property)
C0205451 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C66833 (NCI Thesaurus ValueDomain)
C0205448 (UMLS 2011AA ValueDomain)
C73791 (NCI Thesaurus ValueDomain)
C0582802 (UMLS 2011AA ValueDomain)
Item
Was the abnormality discovered when neonate was assessed? (If yes, complete SAE Report Form)
text
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C41335 (NCI Thesaurus ObjectClass)
C1519255 (UMLS 2011AA ObjectClass)
C2849 (NCI Thesaurus Property)
C0000768 (UMLS 2011AA Property)
CL.4
Code List
Was the abnormality discovered when neonate was assessed? (If yes, complete SAE Report Form)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
PatientCongenitalAbnormalitySpecify
Item
Specify abnormality
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C2849 (NCI Thesaurus Property)
C0000768 (UMLS 2011AA Property)
NewbornAbnormalityContributingFactorText
Item
Contributing Factors
text
C16731 (NCI Thesaurus ObjectClass)
C2939425 (UMLS 2011AA ObjectClass)
C9440 (NCI Thesaurus Property)
C1704258 (UMLS 2011AA Property)
C61412 (NCI Thesaurus Property)
C1880177 (UMLS 2011AA Property)
C25506 (NCI Thesaurus Property)
C1521761 (UMLS 2011AA Property)
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
Item
Pregnancy Outcome
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25742 (NCI Thesaurus ObjectClass)
C0032961 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C20200 (NCI Thesaurus ValueDomain)
C1274040 (UMLS 2011AA ValueDomain)
C25742 (NCI Thesaurus ValueDomain)
C0032961 (UMLS 2011AA ValueDomain)
CL.5
Code List
Pregnancy Outcome
CL Item
Full Term Live Birth (Full Term Live Birth)
CL Item
Induced/elective Abortion (Induced/Elective Abortion)
CL Item
Miscarriage/spontaneous Abortion (Miscarriage/Spontaneous Abortion)
CL Item
Neonatal Death (Neonatal Death)
CL Item
Preterm Live Birth (Preterm Live Birth)
CL Item
Stillbirth (Stillbirth)
PregnancyWeekNumberCount
Item
Weeks Gestation
double
C25337 (NCI Thesaurus Property)
C0237753 (UMLS 2011AA Property)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C25742 (NCI Thesaurus ObjectClass)
C0032961 (UMLS 2011AA ObjectClass)
C29844 (NCI Thesaurus Property)
C0439230 (UMLS 2011AA Property)
Item
Obstetric History (Check all that apply)
text
C29867 (NCI Thesaurus ObjectClass)
C0679646 (UMLS 2011AA ObjectClass)
C18772 (NCI Thesaurus Property)
C0262926 (UMLS 2011AA Property)
C16928 (NCI Thesaurus Property)
C0028773 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C54625 (NCI Thesaurus ValueDomain)
C2004062 (UMLS 2011AA ValueDomain)
C16928 (NCI Thesaurus ValueDomain)
C0028773 (UMLS 2011AA ValueDomain)
CL.6
Code List
Obstetric History (Check all that apply)
CL Item
Gravida (Gravida)
C73435 (NCI Thesaurus)
C0600457 (UMLS 2011AA)
CL Item
Parity (Para)
C16955 (NCI Thesaurus)
C0030563 (UMLS 2011AA)
CL Item
Abortus (Abortus)
C73436 (NCI Thesaurus)
C0000781 (UMLS 2011AA)
PatientPregnancyCount
Item
Total number of pregnancies including current
double
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C25742 (NCI Thesaurus Property)
C0032961 (UMLS 2011AA Property)
PregnancyLiveBirthCount
Item
Total number of pregnancies resulting in live births
double
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
PregnancyStillbirthCount
Item
Total number of stillbirths
double
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C18772 (NCI Thesaurus Property)
C0262926 (UMLS 2011AA Property)
C0595939 (NCI Metathesaurus ObjectClass)
PatientPregnancySpontaneousAbortionCount
Item
Total number of miscarriages
double
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C25742 (NCI Thesaurus Property)
C0032961 (UMLS 2011AA Property)
PatientPregnancyTherapeuticAbortionCount
Item
Total number of therapeutic abortions
double
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C25742 (NCI Thesaurus Property)
C0032961 (UMLS 2011AA Property)
Item Group
Dcp Template Footer
ProtocolTitleName
Item
Protocol Title
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C25320 (NCI Thesaurus ObjectClass)
C1507394 (UMLS 2011AA ObjectClass)
C42774 (NCI Thesaurus Property)
C1705823 (UMLS 2011AA Property)
ProtocolVersion
Item
Protocol Version
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25320 (NCI Thesaurus ObjectClass)
C1507394 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
ProtocolVersionDate
Item
Protocol Date
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25320 (NCI Thesaurus ObjectClass)
C1507394 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25367 (NCI Thesaurus ValueDomain)
PageNumber
Item
Page #
double
C25337 (NCI Thesaurus Property)
C0237753 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C0439643 (NCI Metathesaurus ObjectClass)
CaseReportFormTotalPageNumber
Item
Total Page Number
text
C40988 (NCI Thesaurus ObjectClass)
C1516308 (UMLS 2011AA ObjectClass)
C25337 (NCI Thesaurus Property)
C0237753 (UMLS 2011AA Property)
C25304 (NCI Thesaurus Property)
C0439810 (UMLS 2011AA Property)
C42783 (NCI Thesaurus Property)
C1704732 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
DCPTemplateVersionText
Item
DCP Template Version
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C0728990 (NCI Metathesaurus ObjectClass)
C25714 (NCI Thesaurus Property)
C0333052 (UMLS 2011AA Property)
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