216 R.I. Code R. 216-RICR-40-10-8.10

Current through December 26, 2024

Section 216-RICR-40-10-8.10 - Prenatal High-Risk Factors

8.10.1 Reproductive History

A. * Signifies that the risk factor could be clinically significant and, therefore, subject to the Director of Medical Affairs' final determination.

B. Maternal Characteristics.

1. Age: <16 and >40 years

2. *Height: <60 inches

3. *Weight: <100 lbs. and >200 lbs.

4. Parity: Four (4) or more

C. Past Obstetrical History.

1. *Habitual Abortion: more than two (2) consecutive spontaneous or two (2) or more induced abortions

2. Post Partum Hemorrhage or 3rd Stage problem(s), e.g., severe lacerations, inverted uterus, retained placenta, etc.

3. *Pre-Eclampsia

4. Hypertension - all hypertensive disorders of pregnancy

5. *Previous Second Stage Labor greater than two (2) hours

6. Previous Delivery:

a. Other than spontaneous or low forceps; and

b. Caesarian Section

7. Baby:

a. *Prematurity <37 weeks or <2500 grams or >4500 grams

b. *Respiratory Distress c. *Congenital abnormality

d. *Known genetic disorders

e. *Any Neonatal death

f. *Fetal death

g. *Significant birth injury

D. Associated Conditions.

1. Scarred uterus - vaginal plastic surgery - * Urinary tract surgery

2. Adrenal disease

3. Cardiovascular disease except for mild asymptomatic Class I without hemodynamic abnormality

4. Collagen disease

5. Renal disease (albuminuria, hematuria, casts)

6. Chronic or acute liver disease

7. Diabetes Mellitus

8. Gestational diabetes - (blood or plasma screening test or abnormal glucose tolerance test or equivalent)

9. *Gastrointestinal disorders, e.g., regional ileitis, ulcerative colitis, etc.

10. Genetic Disorder

11. Hematologic disease

12. Hypertension

13. *Pulmonary disease, (not requiring treatment) e.g., asthma, chronic bronchitis, etc.

14. *Pulmonary disease, requiring treatment

15. *Psychiatric

16. Neurologic disorder

17. Hyperthyroidism

18. Venereal and Related diseases

19. *Thrombophlebitis

20. *Alcohol abuse

21. *Drug abuse

22. *Smoking - (> 1 pkg. a day)

23. Such other medial/obstetrical/or surgical problem or condition as determined to be significant risk to the mother or fetus.

8.10.2 Prenatal Course of Current Pregnancy

A. Late Registration (see §8.6.1(D) of this Part)

B. Anemia (less than ten (10) gm Hgb concentration and not responding to therapy)

C. Uterine Bleeding (except for threatened abortion in first trimester)

D. Any presentations except vertex position at 37 weeks or beyond

E. Intra-uterine fetal growth retardation or fetus small for gestational age

F. Pre-Eclampsia

G. Hypertension - resting BP140/90 or an increase of 30 systolic or fifteen (15) diastolic over the patient's base line pressure

H. Known Multiple gestation

I. Premature Labor at less than thirty-seven (37) weeks

J. Premature rupture of membranes under thirty-seven (37) weeks

K. Prolonged rupture of membranes:

1. For fourteen (14) hours without regular contractions; or

2. For twenty-four (24) hours with contractions unless delivery is imminent.

L. Prolonged Pregnancy - (at 42 completed weeks or more)

M. Polyhydramnios

N. Significant isoimmunization against RH or other antigen which may affect the fetus

O. Development of any condition listed above under §8.10.1 of this Part

216 R.I. Code R. 216-RICR-40-10-8.10

Amended effective 11/25/2018