Appalachian District Health Department

Policy and Procedure Policy Name Clinical Protocols and Procedures Policy Topic High Risk Maternity Clinic

Section 500

Approved Date: 3-30-00

Chapter 541

Revised Date: 3-01-07

Purpose: ADHD will keep an updated list of high risk maternity conditions which they are able to provide care for. Policy: The OB/GYN in charge of high risk maternity will determine whether a patient’s condition is determined high risk and whether they are appropriate for care in the high risk maternity clinic Procedure: Patients with the following High Risk conditions may be seen at the Watauga County High Risk Maternity Clinic for consultation and evaluation. If appropriate the patient will continue to come to Watauga County High Risk Maternity Clinic for care. The chard will be flagged High Risk. The Communication Sheet for High Risk Referral Patients will be sent to the referring county after each visit. High Risk Medical Conditions include: I.

Early Pregnancy Risk Identification Risk Factor A. Medical history/conditions Asthma Symptomatic on medication Severe (multiple hospitalizations) Cardiac disease Diabetes mellitus Class A-C Class D or greater Drug/alcohol use Epilespy (on medication) Family history of genetic problems (Down syndrome, Tay-Sachs disease) Hemoglobinopathy (SS, SC, S-thal) Hypertension Chronic, with renal or heart disease Prior pulmonary embolus/deep vein thrombosis Psychiatric illness Pulmonary disease Severe obstructive or restrictive Moderate Renal disease

1|Clinical Protocols and Procedures – High Risk Maternity Clinic

Appalachian District Health Department

Policy and Procedure Policy Name Clinical Protocols and Procedures Policy Topic High Risk Maternity Clinic

Section 500

Approved Date: 3-30-00

Chapter 541

Revised Date: 3-01-07

Chronic, creatinine with or with out hypertension Chronic, other Hypo or Hyperthyroidism requiring medication Requirement for prolonged anticoagulation Severe systemic disease Other conditions as determined by OB/GYN B. Obstetric history/conditions Age ≥ 35 at delivery or ≤ 15 Cesarean delivery, prior classical or vertical incision Incompetent cervix Prior fetal structural or chromosomal abnormality Prior neonatal death Prior fetal death Prior preterm delivery or preterm PROM Prior low birth weight (2,500 g) Second-trimester pregnancy loss Uterine leiomyomata or malformation Other conditions as determined by OB/GYN C. Initial laboratory tests HIV Positive Symptomatic or low CD4 count CDE (Rh) or other blood group Isoimmunization (excluding ABO, Lewis) Positive Hepatitis B II.

Ongoing Pregnancy Risk Identification Risk Factor A. Medical history/ conditions Drug/alcohol use Proteinuria (2+ by catheter sample, unexplained by urinary tract infection) Pyelonephritis systemic disease that adversely affects pregnancy

2|Clinical Protocols and Procedures – High Risk Maternity Clinic

Appalachian District Health Department

Policy and Procedure Policy Name Clinical Protocols and Procedures Policy Topic High Risk Maternity Clinic

Section 500

Approved Date: 3-30-00

Chapter 541

Revised Date: 3-01-07

B. Obstetric history/conditions Blood pressure elevation (diastolic 90 mm Hg), no proteinuria Fetal growth restriction suspected Fetal abnormality suspected by ultrasound Anencephaly Other Fetal demise Gestational age 41 weeks (to be seen by 42 weeks) Gestational diabetes mellitus Herpes, active lesions 36 weeks Hydramnios by ultrasound Hyperemesis, persisting beyond first trimester Multiple gestation Oligohydramnios by ultrasound Preterm labor, threatened, 37 weeks Premature rupture of membranes Vaginal bleeding 14 weeks C. Examination/laboratory findings Abnormal MSAFP (low or high) Abnormal Pap test Dysplasia, mild or severe Anemia (Hct 28%, unresponsive to iron therapy) Condylomata (extensive, covering labia/vaginal opening_ HIV Symptomatic or low CD4 count CDE (Rh) or other blood group isoimmunization (excluding ABO, Lewis)

3|Clinical Protocols and Procedures – High Risk Maternity Clinic