Florida Administrative Code › 64 - DEPARTMENT OF HEALTH › 64B24 - Council of Licensed Midwifery › Chapter 64B24-7 - MIDWIFERY PRACTICE › Section 64B24-7.004 - Risk Assessment

Current through Reg. 50, No. 138; July 16, 2024
(1) For each
				patient, the licensed midwife shall assess risk status criteria for acceptance
				and continuation of care. The general health status and risk assessment shall
				be determined by the licensed midwife by obtaining a detailed medical history,
				performing a physical examination, and taking into account family circumstances
				along with social and psychological factors. The licensed midwife shall risk
				screen potential patients using the criteria in this section. If the risk
				factor score reaches 3 points the midwife shall consult with a physician who
				has obstetrical hospital privileges and if there is a joint determination that
				the patient can be expected to have a normal pregnancy, labor and delivery the
				midwife may provide services to the patient. When a client has a risk score of
				3 or higher and has previously had a physician consultation for the identical
				risk factors in a prior pregnancy with no current changes in health or risk
				factors another consultation is not required.
(2) The licensed midwife shall continue to
				evaluate a patient during the antepartum, intrapartum and postpartum. If the
				cumulative risk score reaches three points or higher and the patient is not
				expected to have a normal pregnancy, labor and delivery, the midwife shall
				transfer such patient out of his or her care. The midwife may provide
				collaborative care to the patient pursuant to Rule
				 64B24-7.010, F.A.C.
(3) The risk factors shall be scored as
							 follows:
Score
(a) Socio-Demographic Factors.
1. Chronological age under 16, or older than
							 40.
1
2. Residence of anticipated birth more than 30
							 minutes from emergency care.
3
(b) Documented Problems in Maternal Medical
							 History.
1. Cardiovascular System.
a. Chronic hypertension.
3
b. Heart disease.
3
c. Heart disease assessed by a cardiologist which
							 places the mother or fetus at no risk.
1
d. Pulmonary embolus.
3
e. Congenital heart defects.
3
(i) Congenital heart defects assessed by a
							 cardiologist which places the mother or fetus at no risk.
1
2. Urinary System.
a. Renal disease.
3
b. History of pyelonephritis.
1
3. Psycho-Neurological.
a. History of psychotic episode adjudged by
							 psychiatric evaluation and which required use of drugs related to its
							 management, but not currently on medication.
1
b. Current mental health problems.
Requiring drug therapy.
3
c. Epilepsy or seizures in the last two years.
3
d. Required use of anticonvulsant drugs.
3
e. During the current pregnancy, drug or alcohol
							 addiction, use of addicting drugs.
3
f. Severe undiagnosed headache.
3
4. Endocrine System.
a. Diabetes mellitus.
3
b. History of gestational diabetes.
1
c. Current thyroid disease.
(I) Euthyroid.
1
(II) Non-Euthyroid.
3
5. Respiratory System.
a. Chronic bronchitis.
1
(I) Current or chronic or with medication.
3
(II) Without medication or current problems.
1
b. Smoking.
(I) 10 or less cigarettes per day.
1
(II) More than 10 cigarettes per day.
3
6. Other Systems.
a. Bleeding disorder or hemolytic disease.
3
b. Cancer of the breast in the past five
							 years.
3
7. Documented Problems in Obstetrical History
a. Expected Date of Delivery (EDD) less than 12
							 months from date of previous delivery.
1
b. Previous Rh sensitization.
3
c. 5 or more term pregnancies.
3
d. Previous abortions.
(I) 3 or more consecutive spontaneous
							 abortions.
3
(II) Two consecutive spontaneous abortions or more
							 than three spontaneous abortions.
1
(III) 1 septic abortion.
3
e. Uterus.
(I) Incompetent cervix, with related medical
							 treatment.
3
(II) Prior uterine surgery.
3
(III) Prior uterine surgery followed by an
							 uncomplicated vaginal birth.
2
f. Previous placenta abruptio.
3
g. Previous placenta previa.
1
h. Severe pregnancy induced hypertension during last
							 pregnancy.
2
i. Postpartum hemorrhage apparently unrelated to
							 management.
3
8. Physical Findings of Previous Births
a. Stillbirth occurring at more than 20 weeks
							 gestation or neonatal loss (other than cord accident).
3
b. Birthweight.
(I) Less than 2500 grams or two or more previous
							 premature labors without a subsequent low risk pregnancy and full term
							 appropriate for gestational age (AGA) infant.
3
(II) Less than 2500 grams or two or more previous
							 premature labors with one or more full term AGA infant(s) subsequently
							 delivered, after a low risk pregnancy.
1
(III) More than 4000 grams.
1
c. Major congenital malformations, genetic, or
							 metabolic disorder.
3
9. Maternal Physical Findings.
a. Gestation.
(I) Of more than 22 weeks in the patient's first
							 pregnancy (nullipara), unless the patient provides a copy of a medical record
							 documenting a prenatal physical examination and prenatal care by a licensed
							 physician, advanced registered nurse practitioner, or licensed midwife trained
							 in obstetrics and gynecology who regularly provides maternity care.
3
(II) Of more than 28 weeks if the patient has had at
							 least one previous viable birth (multipara), unless the patient provides a copy
							 of a medical record documenting a prenatal physical examination and prenatal
							 care by a licensed physician, advanced registered nurse practitioner, or
							 licensed midwife trained in obstetrics and gynecology who regularly provides
							 maternity care.
3
b. Prepregnant weight is not within the range of the
							 following weights by height:
2
Height in Inches Without Shoes
Prepregnant Minimum Weight in Pounds
Prepregnant Maximum Weight in Pounds
56
83
143
57
85
146
58
86
150
59
89
153
60
92
157
61
95
161
62
97
166
63
100
170
64
103
175
65
106
180
66
110
185
67
113
190
68
117
196
69
121
202
70
124
208
71
128
212
72
131
217
73
135
222
c. Evidence of clinically diagnosed pathological
							 uterine myoma or malformations, abdominal or adnexal masses.
3
d. Polyhydramnios or oligohydramnios.
(I) Prior pregnancy.
2
(II) Current pregnancy.
3
e. Cardiac diastolic murmur, systolic murmur grade
							 III or above, or cardiac enlargement.
3
10. Current Laboratory Findings.
a. Hematocrit/Hemoglobin.
(I) Less than 31% or 10.3 gm/100 ml.
1
(II) Less than 28% or 9.3 gm/100 ml.
3
b. Sickle cell anemia.
3
c. Pap smear suggestive of dysplasia.
3
d. Evidence of active tuberculosis.
3
e. Positive serologic test for syphilis confirmed
							 active.
3
f. HIV positive.
3
Rulemaking Authority
					 456.004(5),
					 467.005 FS. Law Implemented
					 467.015
					 FS.
New 7-14-94, Formerly 61E8-7.004, 59DD-7.004, Amended
					 9-11-02, 2-2-06, 4-1-09.