Mont. Admin. r. 24.159.1477

Current through Register Vol. 21, November 2, 2024

Rule 24.159.1477 - CIRCUMSTANCES CONSTITUTING A LOW RISK OF ADVERSE HOMEBIRTH OUTCOMES

(1) A low risk of adverse birth outcomes indicates a clinical scenario for which there is not clear demonstratable benefit for a medical intervention or transfer to a physician's care.

(2) Consultation with a physician does not preclude a low risk of adverse birth outcomes.

(3) Preexisting arrangements for emergency transportation to a nearby hospital if needed do not preclude a low risk of adverse birth outcomes.

(4) The following conditions preclude a low risk of adverse birth outcomes.

(a) Pre-existing conditions (not gynecological):

(i) subarachnoid hemorrhage, aneurysm;

(ii) recent or acute herniated nucleus pulposus;

(iii) active tuberculosis or ongoing treatment;

(iv) human immunodeficiency virus, acquired immunodeficiency syndrome, hepatitis B or hepatitis C;

(v) heart defect with hemodynamic consequences;

(vi) clotting disorders;

(vii) kidney dysfunction;

(viii) hypertension;

(ix) diabetes mellitus;

(x) unmedicated thyroid disorders with present TSH receptor antibodies;

(xi) inflammatory bowel disease, including ulcerative colitis and Crohn's disease;

(xii) systemic and rare disorders, including Addison's disease, Cushing's syndrome, systemic lupus erythematosus, antiphospholipid syndrome, scleroderma, rheumatoid arthritis, polyarteritis nodosa, Raynaud's disease, and Marfan syndrome;

(xiii) illegal drug use; or

(xiv) alcoholism.

(b) Pre-existing gynecological conditions:

(i) pelvic floor reconstruction;

(ii) conization;

(iii) myomectomy or other uterine surgery; or

(iv) uterine distortion, including bicornuate, septate, unicornuate, or didelphic conditions.

(c) Obstetric history:

(i) blood group antagonism, including Rhesus, Kell, Duffy, and Kidd glycoproteins;

(ii) previous pre-term (before 34 weeks) birth. If a normal pregnancy occurred after the premature birth, the current birth may be considered to be low risk;

(iii) cervical insufficiency or cerclage;

(iv) placental abruption;

(v) caesarean section - must transfer current pregnancy at 37 weeks if no reason for transfer prior;

(vi) dysmaturity;

(vii) uncontrolled post-partum hemorrhage;

(viii) manual placental removal;

(ix) placenta accreta; and

(x) total uterine rupture with no functional recovery; or

(xi) history of intrauterine fetal demise.

(d) Occurring or diagnosed during pregnancy:

(i) rubella;

(ii) cytomegalovirus;

(iii) genital herpes (primo infection);

(iv) parvovirus;

(v) tuberculosis;

(vi) human immunodeficiency virus or acquired immunodeficiency syndrome;

(vii) syphilis;

(viii) illegal drug use;

(ix) alcoholism;

(x) maternal anemia;

(xi) extrauterine pregnancy;

(xii) amniotic fluid loss or preterm labor before 37 weeks;

(xiii) uncontrolled diabetes mellitus;

(xiv) gestational diabetes mellitus;

(xv) gestational hypertension with diastolic blood pressure above 100 or systolic blood pressure above 160;

(xvi) preeclampsia, superimposed preeclampsia, hemolysis, or elevated liver enzymes and low platelets (HELLP) syndrome;

(xvii) blood group antagonism;

(xviii) deep vein thrombosis;

(xix) clotting disorders;

(xx) vasa previa;

(xxi) velamentous cord insertion;

(xxii) placenta previa;

(xxiii) placental abruption;

(xxiv) serotonin syndrome;

(xxv) cervical insufficiency prior to 37 weeks of gestation;

(xxvi) multiple pregnancy;

(xxvii) breech or abnormal position at term; or

(xxviii) fetal mortality; or

(xxix) prolonged gestation > 42 weeks.

Mont. Admin. r. 24.159.1477

NEW, 2023 MAR p. 1561, Eff. 11/4/2023

AUTH: 37-1-131, MCA; IMP: 37-8-202, MCA