Okla. Admin. Code § 310:395-5-8

Current through Vol. 42, No. 3, October 15, 2024

Section 310:395-5-8 - Required medical consultation or referral, antepartum and intrapartum periods

(a) The Licensed Midwife shall make an immediate Referral for any woman who during the antepartum period:

(1) Develops edema of the face and hands, severe, persistent headaches, epigastric pain, or visual disturbances concerning for preeclampsia;

(2) Develops eclampsia;

(3) Develops a systolic blood pressure of 140 or greater or diastolic blood pressure of 90 or greater on two separate occasions 4 hours apart, or develops a systolic blood pressure over 150 or greater or a diastolic blood pressure of 100 or greater on a single reading;

(4) Has persistent, frank vaginal bleeding before onset of labor;

(5) Has rupture of membranes prior to 37 weeks gestation;

(6) Has marked decrease in or cessation of fetal movement;

(7) Has polyhydramnios or oligohydramnios;

(8) Develops gestational diabetes by history or testing, unresponsive to dietary and exercise changes per American Diabetes Association (ADA) guidelines within two (2) weeks of implementing dietary and lifestyle changes;

(9) Has sexually transmitted infection including but not limited to, HIV, Syphilis, and HSV-1 or HSV-2 with an active infection or prodromal symptoms in the last trimester or at time of delivery; or

(10) Identifies twins other than di/di.

(b) The Licensed Midwife shall obtain Medical Consultation for a woman who during the antepartum period:

(1) Develops marked glucosuria or proteinuria on two consecutive separate visits;

(2) Has abnormal vaginal discharge with no signs of improvement with medication;

(3) Has symptoms of urinary tract infection that does not improve with treatment;

(4) Has inappropriate gestational size, through physical evaluation or diagnostic examination;

(5) Has demonstrated anemia by blood test (hematocrit less than 30 percent, hemoglobin under 10) that does not improve with treatment;

(6) Has demonstrated Thrombocytopenia by blood test (platelets under 150) that does not improve with treatment;

(7) Has an unexplained fever of equal or greater than 101°F or 38°C;

(8) Has hyperemesis;

(9) Has severe, protruding varicose veins of extremities or vulva with no signs of improvement after treatment;

(10) Has known structural abnormalities of the reproductive tract which are incompatible with vaginal birth;

(11) Has an abnormal Pap smear;

(12) Has sexually transmitted infection including but not limited to, Chlamydia, Gonorrhea, Trichomoniasis, Bacterial Vaginosis, HSV-1, HSV-2, HPV, Condylomata Acuminata;

(13) Reaches a gestation of 41 weeks, 3 days by dates and examination;

(14) Hepatitis C; and

(15) Any other infection requiring treatment or monitoring.

(c) The Licensed Midwife shall make an immediate Referral for any woman who during the intrapartum period:

(1) Goes into labor prior to 37 weeks 0/7 days gestation;

(2) Develops a systolic blood pressure of 140 or greater or diastolic blood pressure of 90 or greater on two separate occasions 4 hours apart, or develops a systolic blood pressure over 150 or greater or a diastolic blood pressure of 100 or greater on a single reading;

(3) Develops severe headache, epigastric pain, or visual disturbance concerning for eclampsia;

(4) Develops a fever over 100.4 0 F or 38 0 C;

(5) Develops respiratory distress;

(6) Has persistent baseline or recurrent fetal heart tones below 110 or above 160 beats per minute, or a fetal heart rate that is abnormal and does not improve with attempts to correct;

(7) Has ruptured membranes and birth has not reached active labor after 18 hours;

(8) Has unresolving, frank bleeding prior to delivery (other than bloody show);

(9) Has thick meconium or blood-stained amniotic fluid with non-reassuring fetal heart tones;

(10) Has a malpresentation incompatible with vaginal delivery;

(11) Does not progress in effacement, dilation, or station after 4 hours of adequate uterine activity in active labor;

(12) Does not show continued progress to deliver in second stage labor after adequate pushing effort for 4 hours;

(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) Exhibits signs or symptoms of hypovolemia (low blood volume) and has a blood pressure below 100 systolic if the sustained pulse rate exceeds 100 beats per minute or who is symptomatic;

(16) Estimated blood loss greater than 500 ml with or after the delivery of the placenta and the mother is symptomatic;

(17) Has placental fragment or membranes (pieces of the placenta or amniotic sac) retained in the uterus; or

(18) Desires transfer.

Okla. Admin. Code § 310:395-5-8

Adopted by Oklahoma Register, Volume 38, Issue 06, December 1, 2020, eff. 11/2/2020

Adopted by Oklahoma Register, Volume 38, Issue 12, March 1, 2021, eff. 2/2/2021

Adopted by Oklahoma Register, Volume 38, Issue 24, September 1, 2021, eff. 9/11/2021