Kotelchuck Index - The Kotelchuck Index, also called the Adequacy of Prenatal Care Utilization (APNCU) Index, uses two crucial elements obtained from birth certificate data-when prenatal care began (initiation) and the number of prenatal visits from when prenatal care began until delivery (received services). The Kotelchuck index classifies the adequacy of initiation as follows: pregnancy months 1 and 2, months 3 and 4, months 5 and 6, and months 7 to 9, with the underlying assumption that the earlier prenatal care begins the better. To classify the adequacy of received services, the number of prenatal visits is compared to the expected number of visits for the period between when care began and the delivery date. The expected number of visits is based on the American College of Obstetricians and Gynecologists prenatal care standards for uncomplicated pregnancies and is adjusted for the gestational age when care began and for the gestational age at delivery.

A ratio of observed to expected visits is calculated and grouped into four categories-Inadequate (received less than 50% of expected visits), Intermediate (50%-79%), Adequate (80%-109%), and Adequate Plus (110% or more). The final Kotelchuck index measure combines these two dimensions into a single summary score. The profiles define adequate prenatal care as a score of 80% or greater on the Kotelchuck Index, or the sum of the Adequate and Adequate Plus categories.

The Kotelchuck Index does not measure the quality of prenatal care. It also depends on the accuracy of the patient or health care provider's recall of the timing of the first visit and the number of subsequent visits. The Kotelchuck Index uses recommendations for low-risk pregnancies, and may not measure the adequacy of care for high-risk women. The Kotelchuck Index is preferable to other indices because it includes a category for women who receive more than the recommended amount of care (adequate plus, or intensive utilization).

Live Birth - 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 (definition recommended by the World Health Organization in 1950). Heartbeats are to be distinguished from transient cardiac contractions; respirations are to be distinguished from fleeting respiratory efforts or gasps.

Marital Status on Birth Certificate

Married - A birth which occurs to a woman who has been married or was married within 280 days from conception.

Paternity Acknowledgement - This gives authorization to list the name of the father on the birth certificate of a child born to an unmarried mother with written consent of the father and mother by means of an affidavit as required by South Carolina Law, Section 44-63-165. For statistical purposes, paternity acknowledgements are included in the married category.

Unmarried - A birth which occurs to a woman who has never been married or who has been widowed or legally divorced from her husband in excess of 280 days.

Occurrence Data - Data allocated to the place in South Carolina where the event occurred, regardless of the usual residence of the person involved.

Prenatal Care - If a patient went to a Primary Care physician for a pregnancy test and that is all she received, then this would not count as a prenatal care visit. However, if the patient, in addition to the pregnancy test, also received some "risk counseling" (counseling concerning nutrition, e.g.) then this would count as a prenatal care visit. Only the first day of hospitalization is counted as a prenatal care visit.

Race - As of 1990, Live Births are reported by race of mother instead of race of child. This change allows South Carolina's birth data to be consistent with the National Center for Health Statistics and other states throughout the United States.

Rate Calculations with Small Numbers - There are variations in all statistics which are the result of chance. This characteristic is of particular importance in classifications with small numbers of events where small variations are proportionately large in relation to the base figure. As an example, small changes in the number of deaths in small population areas or in the number of deaths from uncommon causes could result in large changes in these crude rates. For this reason, rates for counties with small populations or other small bases should be used cautiously. Multiple-year rates can be calculated to ensure that these rates are less influenced by chance variations, thus making them more stable and more appropriate for trend comparisons.

Residence Data - Data allocated to the place in South Carolina where the person normally resided, regardless of where the event occurred.

 

Changes in the 2004 birth certificates

In 2004, a revised certificate of live birth was implemented. This may affect comparisons of variables to previous years. Some of the questions were removed from the birth certificates while some new ones were added. With some questions, the way of describing the question or the layout of the questionnaire were different, thus it is possible that the same variable in the new birth record has a subtle difference from the old one. If user obtains statistics of both year 2004 and previous years, they should be cautious in interpreting the trend since it may not be a real trend but due to a different definition or data quality of the same variable.

To reflect the changes in the new 2004 birth certificate and avoid the possible confusion to the users, we implemented a dynamic birth characteristics selection window, in which only appropriate birth characteristics are shown and selectable depending on the selections of years in step three. Currently there are three scenarios as listed below,

Year selection	Selectable birth characteristics (BC)
2003 or before	BC from the original SCAN birth module
2004 or after	BC selected from the new 2004 birth certificates
Both "2003 or before" and "2004 or after"	BC that are common to both the new and old birth certificates or can be bridged