We will update the description of Patient.multipleBirth and the patient-multipleBirthTotal extension to indicate that fetal losses are included in the counts.   Patient.multipleBirth [x] Definition : Indicates whether the patient is part of a multiple (boolean) or indicates the actual birth order (integer).  This count is relative to the total of live births and fetal losses. Comments :  Where the valueInteger is provided, the number is the birth number in the sequence. E.g. The middle birth in triplets would be valueInteger=2 and the third born would have valueInteger=3. If a boolean value was provided for this triplets example, then all 3 patient records would have valueBoolean=true (the ordering is not indicated).  If the first fetus was a loss, the second and third births would still be represented as valueInteger=2 and valueInteger=3, where you may have a Patient with valueInteger=1 with a fetal-delivery-status extension indicating fetal demise. patient-multipleBirthTotal   Definition: Where a patient is a part of a multiple birth, this is the total number of births that occurred in this pregnancy.  This includes all live births and all fetal losses.