64B24-7.004. Risk Assessment

(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	Prepregnant Minimum	Prepregnant Maximum
Without Shoes	Weight in Pounds	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. History–New 7-14-94, Formerly 61E8-7.004, 59DD-7.004, Amended 9-11-02, 2-2-06, 4-1-09.