Section 340.1550 Obstetrical and Gynecological Care

Section 340

Section 340.1550  Obstetrical

and Gynecological Care

Every woman resident of

child-bearing age shall receive routine obstetrical and gynecological

evaluations as well as necessary prenatal care.

(Section 2-104(b) of the

Act)  In addition, women residents shall be referred immediately for diagnosis

whenever pregnancy is suspected.

a)         "Routine obstetrical evaluations" and

"necessary prenatal care" shall include ata minimum, the following:

1)         Early diagnosis of pregnancy;

2)         A comprehensive health history, including menstrual history, methods

of family planning that the patient has used, a detailed record of past

pregnancies, and data on the current pregnancy that allow the physician to

estimate the date of delivery;

3)         Identification of factors in the current pregnancy that help

to identify the patient at high risk, such as maternal age, vaginal bleeding,

edema, urinary infection, exposure to radiation and chemicals, ingestion of

drugs and alcohol, and use of tobacco;

4)         A comprehensive physical examination, including an evaluation

of nutritional status; determination of height, weight and blood pressure;

examination of the head, breasts, heart, lungs, abdomen, pelvis, rectum, and

extremities;

5)         The following laboratory tests, as early in pregnancy as

possible. Findings obtained from the history and physical examination may

determine the need for additional laboratory evaluations:

A)        Hemoglobin or hematocrit measurement;

B)        Urinalysis, including microscopic examination or culture;

C)        Blood group and Rh type determination;

D)        Antibody screen;

E)        Rubella antibody titer measurement;

F)         Syphilis screen;

G)        Cervical cytology; and

H)        Viral hepatitis (HBsAg) testing;

6)         A risk assessment that, based on the findings of the history

and physical examination, should indicate any risk factors that may require

special management, such as cardiovascular disease, maternal age more than 3

Antibody screen;

E)        Rubella antibody titer measurement;

F)         Syphilis screen;

G)        Cervical cytology; and

H)        Viral hepatitis (HBsAg) testing;

6)         A risk assessment that, based on the findings of the history

and physical examination, should indicate any risk factors that may require

special management, such as cardiovascular disease, maternal age more than 35

years, neurologic disorder, or congenital abnormalities;

7)         Return visits, the frequency of which will be determined by

the resident's needs and risk factors.  A woman with an uncomplicated pregnancy

shall be seen every four weeks for the first 28 weeks of pregnancy, every two

to three weeks until 36 weeks of gestation, and weekly thereafter;

8)         Determinations of blood pressure, measured fundal height,

fetal heart rate, and, in later months, fetal presentation, and urinalysis for

albumin and glucose.  Hemoglobin or hematocrit level shall be measured again

early in the third trimester.  Glucose screening is recommended for women who

are 30 years of age or older;

9)         Evaluation and monitoring of nutritional status and habits;

10)         Education for health promotion and maintenance;

11)         Counseling concerning exercise and childbirth education

programs; and

12)         Postpartum review and evaluation four to eight weeks after

delivery, including determination of weight and blood pressure and assessment

of status of breasts, abdomen, and external and internal genitalia

oring of nutritional status and habits;

10)         Education for health promotion and maintenance;

11)         Counseling concerning exercise and childbirth education

programs; and

12)         Postpartum review and evaluation four to eight weeks after

delivery, including determination of weight and blood pressure and assessment

of status of breasts, abdomen, and external and internal genitalia.

b)         "Routine gynecological evaluations" shall include, at

a minimum, the following:

1)         An initial examination, the basic components of which are:

A)        History; any present illnesses; menstrual, reproductive,

medical, surgical, emotional, social, family, and sexual history; medications;

allergies; family planning; and systems review;

B)        Physical examination, including height, weight, nutritional

status, and blood pressure; head and neck, including thyroid gland; heart;

lungs; breasts; abdomen; pelvis, including external and internal genitalia;

rectum; extremities, including signs of abuse; lymph nodes; and

C)        Laboratory tests, including urine screen; hemoglobin or

hematocrit determination and, if indicated, complete blood cell count; cervical

cytology; rubella titer.

2)         Annual updates, including, but not limited to:

A)        History, including the purpose of the visit; menstrual history;

interval history, including systems review; emotional history;

B)        Physical examination, including weight, nutritional status and

blood pressure; thyroid gland; breasts; abdomen; pelvis, including external and

internal genitalia; rectum; other areas as indicated by the interval history;

C)        Laboratory, including urine screen; cervical cytology, unless

not indicated; hemoglobin or hematocrit determinations; and

D)        Additional laboratory tests, such as screening for sexually

transmitted disease, shall be performed as warranted by the history, physical

findings, and risk factors

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internal genitalia; rectum; other areas as indicated by the interval history;

C)        Laboratory, including urine screen; cervical cytology, unless

not indicated; hemoglobin or hematocrit determinations; and

D)        Additional laboratory tests, such as screening for sexually

transmitted disease, shall be performed as warranted by the history, physical

findings, and risk factors.

c)         When a resident is referred for a diagnosis of pregnancy

and/or for prenatal care, the facility shall send the health care provider a

copy of the resident's medical record, including a list of prescription

medications taken by the resident; if known, the resident's use of alcohol,

tobacco and illicit drugs; and any exposure of the resident to radiation or

chemicals during the preceding three months.

d)         Cancer screening shall

include the following:

1)         A

periodic Pap test.  The frequency and administration of Pap tests shall be

according to the guidelines set forth in the "Guidelines for Women's

Health Care", published by the American College of Obstetricians and

Gynecologists; and

2)         Mammography.

The frequency and administration of mammograms shall be according to the

guidelines set forth in the "Guidelines for Women's Health Care".