Oklahoma Administrative Code
Title 310 - Oklahoma State Department of Health
Chapter 395 - Licensed Midwives
Subchapter 5 - Midwife Practice
Section 310:395-5-8 - Required medical consultation or referral, antepartum and intrapartum periods

Universal Citation: OK Admin Code 310:395-5-8

Current through Vol. 42, No. 1, September 16, 2024

(a) The Licensed Midwife shall make an immediate Referral for any woman who during the antepartum period:

(1) Develops edema of the face and hands, severe, persistent headaches, epigastric pain, or visual disturbances concerning for preeclampsia;

(2) Develops eclampsia;

(3) Develops a systolic blood pressure of 140 or greater or diastolic blood pressure of 90 or greater on two separate occasions 4 hours apart, or develops a systolic blood pressure over 150 or greater or a diastolic blood pressure of 100 or greater on a single reading;

(4) Has persistent, frank vaginal bleeding before onset of labor;

(5) Has rupture of membranes prior to 37 weeks gestation;

(6) Has marked decrease in or cessation of fetal movement;

(7) Has polyhydramnios or oligohydramnios;

(8) Develops gestational diabetes by history or testing, unresponsive to dietary and exercise changes per American Diabetes Association (ADA) guidelines within two (2) weeks of implementing dietary and lifestyle changes;

(9) Has sexually transmitted infection including but not limited to, HIV, Syphilis, and HSV-1 or HSV-2 with an active infection or prodromal symptoms in the last trimester or at time of delivery; or

(10) Identifies twins other than di/di.

(b) The Licensed Midwife shall obtain Medical Consultation for a woman who during the antepartum period:

(1) Develops marked glucosuria or proteinuria on two consecutive separate visits;

(2) Has abnormal vaginal discharge with no signs of improvement with medication;

(3) Has symptoms of urinary tract infection that does not improve with treatment;

(4) Has inappropriate gestational size, through physical evaluation or diagnostic examination;

(5) Has demonstrated anemia by blood test (hematocrit less than 30 percent, hemoglobin under 10) that does not improve with treatment;

(6) Has demonstrated Thrombocytopenia by blood test (platelets under 150) that does not improve with treatment;

(7) Has an unexplained fever of equal or greater than 101°F or 38°C;

(8) Has hyperemesis;

(9) Has severe, protruding varicose veins of extremities or vulva with no signs of improvement after treatment;

(10) Has known structural abnormalities of the reproductive tract which are incompatible with vaginal birth;

(11) Has an abnormal Pap smear;

(12) Has sexually transmitted infection including but not limited to, Chlamydia, Gonorrhea, Trichomoniasis, Bacterial Vaginosis, HSV-1, HSV-2, HPV, Condylomata Acuminata;

(13) Reaches a gestation of 41 weeks, 3 days by dates and examination;

(14) Hepatitis C; and

(15) Any other infection requiring treatment or monitoring.

(c) The Licensed Midwife shall make an immediate Referral for any woman who during the intrapartum period:

(1) Goes into labor prior to 37 weeks 0/7 days gestation;

(2) Develops a systolic blood pressure of 140 or greater or diastolic blood pressure of 90 or greater on two separate occasions 4 hours apart, or develops a systolic blood pressure over 150 or greater or a diastolic blood pressure of 100 or greater on a single reading;

(3) Develops severe headache, epigastric pain, or visual disturbance concerning for eclampsia;

(4) Develops a fever over 100.4 0 F or 38 0 C;

(5) Develops respiratory distress;

(6) Has persistent baseline or recurrent fetal heart tones below 110 or above 160 beats per minute, or a fetal heart rate that is abnormal and does not improve with attempts to correct;

(7) Has ruptured membranes and birth has not reached active labor after 18 hours;

(8) Has unresolving, frank bleeding prior to delivery (other than bloody show);

(9) Has thick meconium or blood-stained amniotic fluid with non-reassuring fetal heart tones;

(10) Has a malpresentation incompatible with vaginal delivery;

(11) Does not progress in effacement, dilation, or station after 4 hours of adequate uterine activity in active labor;

(12) Does not show continued progress to deliver in second stage labor after adequate pushing effort for 4 hours;

(13) Does not deliver the placenta within one hour if there is no bleeding and the fundus is firm;

(14) Has a partially separated placenta during the third stage of labor with bleeding;

(15) Exhibits signs or symptoms of hypovolemia (low blood volume) and has a blood pressure below 100 systolic if the sustained pulse rate exceeds 100 beats per minute or who is symptomatic;

(16) Estimated blood loss greater than 500 ml with or after the delivery of the placenta and the mother is symptomatic;

(17) Has placental fragment or membranes (pieces of the placenta or amniotic sac) retained in the uterus; or

(18) Desires transfer.

Disclaimer: These regulations may not be the most recent version. Oklahoma may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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