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

(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