Michigan Administrative Code › Department - Licensing and Regulatory Affairs › Bureau of Professional Licensing › Board of Midwifery › Board of Midwifery › Part 4 - PRACTICE, CONDUCT, AND CLASSIFICATION OF CONDITIONS › Section R. 338.17134 - Consultation and referral

Current through Vol. 24-12, July 15, 2024
Rule 134.
(1) A
					 licensed midwife shall consult with or refer a patient to a physician,
					 physician's assistant, or advanced practice registered nurse licensed under
					 article 15 of the code, MCL
					 333.16101 to
					 333.18838, document the
					 consultation or referral, and follow up with the patient regarding the
					 consultation or referral, if the patient presents with any of the following
					 conditions:
(a) Antepartum:
(i) Hypertension in pregnancy as defined as
					 systolic blood pressure greater than 140 mm Hg and diastolic blood pressure
					 greater than 90 mm Hg measured on 2 separate occasions more than 4 hours
					 apart.
(ii) Persistent, severe
					 headaches, epigastric pain, or visual disturbances.
(iii) Persistent symptoms of urinary tract
					 infection.
(iv) Significant vaginal
					 bleeding before the onset of labor not associated with uncomplicated
					 spontaneous abortion.
(v) Rupture
					 of membranes before the 36.6 weeks of gestation without active labor.
(vi) Noted abnormal decrease in or cessation
					 of fetal movement.
(vii) Hemoglobin
					 level less than 9 and resistant to supplemental therapy.
(viii) A temperature of 100.4 degrees
					 Fahrenheit or 38.0 degrees Celsius or greater for more than 24 hours.
(ix) Isoimmunization, Rh-negative
					 sensitization, or any other positive antibody titer, which would have a
					 detrimental effect on the mother or fetus.
(x) Abnormally elevated blood glucose levels
					 unresponsive to dietary management.
(xi) Positive HIV antibody test.
(xii) TORCH (Toxoplasmosis, other, rubella,
					 cytomegalovirus, and herpes simplex infections.)
(xiii) Symptoms of severe malnutrition,
					 severe persistent dehydration, or protracted weight loss.
(xiv) Symptoms of deep vein
					 thrombosis.
(xv) Documented
					 placenta previa.
(xvi) Documented
					 placenta overlying the site of a previous uterine scar.
(xvii) Active labor before 36.0 weeks of
					 gestation.
(xviii) Fetus with
					 diagnosed congenital abnormalities that will require immediate medical
					 intervention at birth.
(xix)
					 History of myomectomy.
(xx) Prior
					 history of early preterm birth, 32 weeks or less.
(xxi) Pelvic or uterine abnormalities
					 affecting normal vaginal births, including tumors and malformations.
(xxii) Marked abnormal fetal heart
					 tones.
(xxiii) Abnormal non'stress
					 test or abnormal biophysical profile.
(xxiv) Marked or severe hydramnios or
					 oligohydramnios.
(xxv) Suspected
					 intrauterine growth restriction.
(xxvi) Gestation beyond 42.0 weeks.
(xxvii) Suspected perinatal mood disorder or
					 uncontrolled current serious psychiatric illness.
(xxviii) Suspected active alcohol use
					 disorder.
(xxix) Suspected active
					 substance use disorder.
(xxx)
					 Receiving opioid replacement therapy.
(xxxi) Sexually transmitted
					 infection.
(xxxii) Symptoms of
					 ectopic pregnancy
(xxxiii) Second
					 or third trimester fetal demise.
(xxxiv) Symptoms or evidence of hydatidiform
					 mole.
(xxxv) Thrombocytopenia with
					 a count less than 100,000 platelets per microliter.
(xxxvi) Vaginal infection unresponsive to
					 treatment.
(xxxvii) Symptoms or
					 clinical evidence of hepatitis.
(xxxviii) Abnormal liver or metabolic
					 panel.
(xxxix) Significant
					 proteinuria.
(xl) Abnormal PAP test
					 results.
(xli) Significant
					 hematological disorders or coagulopathies, or pulmonary embolism.
(xlii) Hyperreflexia.
(xliii) Clonus.
(xliv) Rheumatoid arthritis.
(xlv) Chronic pulmonary disease.
(xlvi) Uncontrolled gestational
					 diabetes.
(xlvii) Hyperthyroidism
					 treated with medication.
(xlviii)
					 Suspected coagulation disorder.
(xlix) Inflammatory bowel disease.
(l) Addison's disease.
(li) Scleroderma.
(lii) Any other condition or symptom that
					 could threaten the health of the mother or fetus, as assessed by a licensed
					 midwife exercising reasonable skill and judgment.