Chapter SPS 182

SPS 182.03(4)(b)1.k. k. Isoimmunization, Rh-negative sensitized, positive titers, or any other positive antibody titer, which may have a detrimental effect on mother or fetus.

SPS 182.03(4)(b)1.L. L. Elevated blood glucose levels unresponsive to dietary management.

SPS 182.03(4)(b)1.m. m. Positive HIV antibody test.

SPS 182.03(4)(b)1.n. n. Primary genital herpes infection in pregnancy.

SPS 182.03(4)(b)1.o. o. Symptoms of malnutrition or anorexia or protracted weight loss or failure to gain weight.

SPS 182.03(4)(b)1.p. p. Suspected deep vein thrombosis.

SPS 182.03(4)(b)1.q. q. Documented placental anomaly or previa.

SPS 182.03(4)(b)1.r. r. Documented low lying placenta in woman with history of previous cesarean delivery.

SPS 182.03(4)(b)1.s. s. Labor prior to the 37th week of gestation.

SPS 182.03(4)(b)1.t. t. History of prior uterine incision.

SPS 182.03(4)(b)1.u. u. Lie other than vertex at term.

SPS 182.03(4)(b)1.v. v. Multiple gestation.

SPS 182.03(4)(b)1.w. w. Known fetal anomalies that may be affected by the site of birth.

SPS 182.03(4)(b)1.x. x. Marked abnormal fetal heart tones.

SPS 182.03(4)(b)1.y. y. Abnormal non-stress test or abnormal biophysical profile.

SPS 182.03(4)(b)1.z. z. Marked or severe poly- or oligo-dydramnios.

SPS 182.03(4)(b)1.za. za. Evidence of intrauterine growth restriction.

SPS 182.03(4)(b)1.zb. zb. Significant abnormal ultrasound findings.

SPS 182.03(4)(b)1.zc. zc. Gestation beyond 42 weeks by reliable confirmed dates.

SPS 182.03(4)(b)2. 2. Intrapartum.

SPS 182.03(4)(b)2.a. a. Rise in blood pressure above baseline, more than 30/15 points or greater than 140/90.

SPS 182.03(4)(b)2.b. b. Persistent, severe headaches, epigastric pain or visual disturbances.

SPS 182.03(4)(b)2.c. c. Significant proteinuria or ketonuria.

SPS 182.03(4)(b)2.d. d. Fever over 100.6° F or 38° C in absence of environmental factors.

SPS 182.03(4)(b)2.e. e. Ruptured membranes without onset of established labor after 18 hours.

SPS 182.03(4)(b)2.f. f. Significant bleeding prior to delivery or any abnormal bleeding, with or without abdominal pain; or evidence of placental abruption.

SPS 182.03(4)(b)2.g. g. Lie not compatible with spontaneous vaginal delivery or unstable fetal lie.

SPS 182.03(4)(b)2.h. h. Failure to progress after 5 hours of active labor or following 2 hours of active second stage labor.

SPS 182.03(4)(b)2.i. i. Signs or symptoms of maternal infection.

SPS 182.03(4)(b)2.j. j. Active genital herpes at onset of labor.

SPS 182.03(4)(b)2.k. k. Fetal heart tones with non-reassuring patterns.

SPS 182.03(4)(b)2.L. L. Signs or symptoms of fetal distress.

SPS 182.03(4)(b)2.m. m. Thick meconium or frank bleeding with birth not imminent.

SPS 182.03(4)(b)2.n. n. Client or licensed midwife desires physician consultation or transfer.

SPS 182.03(4)(b)3. 3. Postpartum.

SPS 182.03(4)(b)3.a. a. Failure to void within 6 hours of birth.

SPS 182.03(4)(b)3.b. b. Signs or symptoms of maternal shock.

SPS 182.03(4)(b)3.c. c. Febrile: 102° F or 39° C and unresponsive to therapy for 12 hours.

SPS 182.03(4)(b)3.d. d. Abnormal lochia or signs or symptoms of uterine sepsis.

SPS 182.03(4)(b)3.e. e. Suspected deep vein thrombosis.

SPS 182.03(4)(b)3.f. f. Signs of clinically significant depression.

SPS 182.03(4)(c) (c) A licensed midwife shall consult with a licensed physician or licensed certified nurse-midwife with regard to any neonate who is born with or develops the following risk factors:

SPS 182.03(4)(c)1. 1. Apgar score of 6 or less at 5 minutes without significant improvement by 10 minutes.

SPS 182.03(4)(c)2. 2. Persistent grunting respirations or retractions.

SPS 182.03(4)(c)3. 3. Persistent cardiac irregularities.

SPS 182.03(4)(c)4. 4. Persistent central cyanosis or pallor.

SPS 182.03(4)(c)5. 5. Persistent lethargy or poor muscle tone.

SPS 182.03(4)(c)6. 6. Abnormal cry.

SPS 182.03(4)(c)7. 7. Birth weight less than 2300 grams.

SPS 182.03(4)(c)8. 8. Jitteriness or seizures.

SPS 182.03(4)(c)9. 9. Jaundice occurring before 24 hours or outside of normal range.

SPS 182.03(4)(c)10. 10. Failure to urinate within 24 hours of birth.

SPS 182.03(4)(c)11. 11. Failure to pass meconium within 48 hours of birth.

SPS 182.03(4)(c)12. 12. Edema.

SPS 182.03(4)(c)13. 13. Prolonged temperature instability.

SPS 182.03(4)(c)14. 14. Significant signs or symptoms of infection.

SPS 182.03(4)(c)15. 15. Significant clinical evidence of glycemic instability.

SPS 182.03(4)(c)16. 16. Abnormal, bulging, or depressed fontanel.

SPS 182.03(4)(c)17. 17. Significant clinical evidence of prematurity.

SPS 182.03(4)(c)18. 18. Medically significant congenital anomalies.

SPS 182.03(4)(c)19. 19. Significant or suspected birth injury.

SPS 182.03(4)(c)20. 20. Persistent inability to suck.

SPS 182.03(4)(c)21. 21. Diminished consciousness.

SPS 182.03(4)(c)22. 22. Clinically significant abnormalities in vital signs, muscle tone or behavior.

SPS 182.03(4)(c)23. 23. Clinically significant color abnormality, cyanotic, or pale or abnormal perfusion.

SPS 182.03(4)(c)24. 24. Abdominal distension or projectile vomiting.

SPS 182.03(4)(c)25. 25. Signs of clinically significant dehydration or failure to thrive.

SPS 182.03(5) (5) Transfer.

SPS 182.03(5)(a) (a) Transport via private vehicle is an acceptable method of transport if it is the most expedient and safest method for accessing medical services. The licensed midwife shall initiate immediate transport according to the licensed midwife's emergency plan; provide emergency stabilization until emergency medical services arrive or transfer is completed; accompany the client or follow the client to a hospital in a timely fashion; provide pertinent information to the receiving facility and complete an emergency transport record. The following conditions shall require immediate physician notification and emergency transfer to a hospital:

SPS 182.03(5)(a)1. 1. Seizures or unconsciousness.

SPS 182.03(5)(a)2. 2. Respiratory distress or arrest.

SPS 182.03(5)(a)3. 3. Evidence of shock.

SPS 182.03(5)(a)4. 4. Psychosis.

SPS 182.03(5)(a)5. 5. Symptomatic chest pain or cardiac arrhythmias.

SPS 182.03(5)(a)6. 6. Prolapsed umbilical cord.

SPS 182.03(5)(a)7. 7. Shoulder dystocia not resolved by Advanced Life Support in Obstetrics (ALSO) protocol.

SPS 182.03(5)(a)8. 8. Symptoms of uterine rupture.

SPS 182.03(5)(a)9. 9. Preeclampsia or eclampsia.

SPS 182.03(5)(a)10. 10. Severe abdominal pain inconsistent with normal labor.

SPS 182.03(5)(a)11. 11. Chorioamnionitis.

SPS 182.03(5)(a)12. 12. Clinically significant fetal heart rate patterns or other manifestation of fetal distress.

SPS 182.03(5)(a)13. 13. Presentation not compatible with spontaneous vaginal delivery.

SPS 182.03(5)(a)14. 14. Laceration greater than second degree perineal or any cervical.

SPS 182.03(5)(a)15. 15. Hemorrhage non-responsive to therapy.

SPS 182.03(5)(a)16. 16. Uterine prolapse or inversion.

SPS 182.03(5)(a)17. 17. Persistent uterine atony.

SPS 182.03(5)(a)18. 18. Anaphylaxis.

SPS 182.03(5)(a)19. 19. Failure to deliver placenta after one hour if there is no bleeding and fundus is firm.

SPS 182.03(5)(a)20. 20. Sustained instability or persistent abnormal vital signs.