N.J. Admin. Code § 13:35-2A.9

Current through Register Vol. 56, No. 21, November 4, 2024

Section 13:35-2A.9 - Management of antepartum women at increased risk

(a) A licensee may participate in the management of antepartum patients at increased risk under the following conditions:

1. The consulting physician and licensee shall have agreed to include the woman at increased risk in the caseload;

2. The consulting physician and licensee shall have established and documented a management plan for all women identified as at increased risk, which shall delineate the role of both the consulting physician and the licensee in the care of the woman. The management plan shall set forth the following:

i. Frequency of physician visits;

ii. Timing of indicated diagnostic and evaluative procedures;

iii. Specific parameters for consultation; and

iv. A proposed plan for the birth, including the type, place and provider.

3. The management plan shall be reviewed periodically by the licensee and the consulting physician and revised when necessary.

(b) The following are risk factors that require management as outlined in (a) above:

1. Maternal health status:

i. Acute and/or chronic hypertension;

ii. Congenital or acquired heart disease;

iii. Anti-phospholipid syndrome;

iv. HIV positive or AIDS;

v. Chronic renal disease;

vi. Seizure disorder requiring medications;

vii. Chronic hemoglobinopathy with a history of transfusion;

viii. Diabetes mellitus;

ix. Any psychoactive substance addiction;

x. Psychosis;

xi. Severe asthma as defined in the December 12, 2013 International ERS/ATS Guidelines on Definition, Evaluation and Treatment of Severe Asthma, published by the European Respiratory Society/American Thoracic Society, 25 Broadway, New York, NY 10004, incorporated herein by reference, as amended and supplemented;

xii. Any connective tissue disorder;

xiii. Multiple sclerosis;

xiv. History of cerebrovascular accident;

xv. History of cancer;

xvi. Hepatitis with abnormal liver function and/or detectable viral loads; or

xvii. Body Mass Index (BMI) over 40.

2. Maternal reproductive health history:

i. Incompetent cervix;

ii. Two or more second or third trimester fetal losses;

iii. Preterm delivery;

iv. Grand multiparity;

v. Previous cesarean delivery;

vi. Surgery involving the uterine wall;

vii. Previous placental abruption or accreta;

viii. Previous postpartum blood transfusion;

ix. Previous cervical surgeries including Loop Electrosurgical Excision Procedures (LEEP), cone biopsies, or three or more surgical cervical dilitations, unless the patient has had a subsequent term pregnancy; or

x. Intra-uterine growth restriction.

3. Current maternal obstetrical status:

i. Obstructive uterine myomata;

ii. Polyhydramnios or oligohydramnios;

iii. Isoimmunization;

iv. Multiple gestation;

v. Intrauterine growth restriction;

vi. Current evidence of fetal chromosome disorder confirmed by amniocentesis and/or congenital anomaly;

vii. Gestational diabetes;

viii. Maternal age less than 14 years or more than 40 years;

ix. Cervical dysplasia requiring colposcopy;

x. Placenta previa persisting past 28 weeks gestation;

xi. Evidence of placenta accreta and/or abruption;

xii. Pre-term labor with cervical change; or

xiii. Preeclampsia.

N.J. Admin. Code § 13:35-2A.9

Amended by 51 N.J.R. 878(a), effective 6/3/2019