La. Admin. Code tit. 46 § XLV-5339

Current through Register Vol. 50, No. 5, May 20, 2024

Section XLV-5339 - Required Physician Consultation, Antepartum and Intrapartum Periods [Formerly Section 5363.A - B]

A. The midwife shall obtain medical consultation or refer for medical care any woman who during the antepartum period:

1. develops edema of the face and hands;

2. develops severe, persistent headaches, epigastric pain, or visual disturbances;

3. develops a blood pressure of 140/90 or greater;

4. does not gain 14 pounds by 30 weeks gestation or at least 4 pounds a month in the last trimester or gains more than 6 pounds in two weeks in any trimester;

5. develops greater than trace glucosuria or greater than trace proteinuria on two consecutive separate visits;

6. has abnormal vaginal discharge with no signs of improvement with medication;

7. has symptoms of urinary tract infection;

8. has vaginal bleeding before onset of labor;

9. has rupture of membranes prior to 37 weeks gestation;

10. has marked decrease in or cessation of fetal movement;

11. has inappropriate gestational size;

12. has demonstrated anemia by blood test (hematocrit less than 30 percent);

13. has a fever of equal or greater than 100.4°F or 38°C for 24 hours;

14. has polyhydramnios or oligohydramnios;

15. has excessive vomiting or continued vomiting after 24 weeks gestation;

16. has severe, protruding varicose veins of extremities or vulva;

17. has known structural abnormalities of the reproductive tract;

18. has a history of stillbirth from any cause;

19. has an abnormal Pap smear;

20. reaches a gestation of 41 weeks, 3 days by dates and examination.

B. The midwife shall obtain medical consultation or refer for medical care any woman who during the intrapartum period:

1. develops a blood pressure of 140/90 or greater;

2. develops severe headache, epigastric pain, or visual disturbance;

3. develops proteinuria;

4. develops a fever over 100.4°F or 38°C;

5. develops respiratory distress;

6. has persistent or recurrent fetal heart tones below 100 or above 160 beats per minute between or during contractions, or a fetal heart rate that is irregular;

7. has ruptured membranes without onset of labor after 12 hours;

8. has bleeding prior to delivery (other than bloody show);

9. has meconium or blood stained amniotic fluid with abnormal fetal heart tones;

10. has an abnormal presentation other than vertex;

11. does not progress in effacement, dilation, or station in accordance with practice standards;

12. does not show continued progress to deliver in second stage labor in accordance with practice standards;

13. does not deliver the placenta within one hour if there is no bleeding and the fundus is firm;

14. has a partially separated placenta during the third stage of labor with bleeding;

15. has a blood pressure below 100 systolic if the pulse rate exceeds 100 beats per minute or who is weak and dizzy;

16. bleeds more than 500 cc with or after the delivery of the placenta;

17. has retained placental fragment or membranes; or

18. desires medical consultation or transfer.

La. Admin. Code tit. 46, § XLV-5339

Promulgated by the Department of Health and Human Resources, Board of Medical Examiners, LR 12:519 (August 1986), amended by the Department of Health and Hospitals, Board of Medical Examiners, LR 17:779 (August 1991), Amended by the Department of Health, Board of Medical Examiners, LR 421293 (8/1/2016).

AUTHORITY NOTE: Promulgated in accordance with R.S.37:1270 and 37:3241-3259.