598 Guidelines for Perinatal Care Early Pregnancy Risk Identification for Consultation (continued) Risk Factor Recommended Consultation* Renal disease Chronic, creatinine 3 or greater with or MFM subspecialist without hypertension Chronic, other MFM subspecialist Requirement for prolonged anticoagulation MFM subspecialist Severe systemic disease MFM subspecialist Obstetric history and conditions Age 35 years or older at delivery Obstetrician–gynecologist Cesarean delivery, prior classical or Obstetrician–gynecologist vertical incision Cervical insufficiency Obstetrician–gynecologist Prior fetal structural or chromosomal MFM subspecialist abnormality Prior neonatal death Obstetrician–gynecologist Prior fetal death Obstetrician–gynecologist Prior preterm delivery or preterm PROM Obstetrician–gynecologist Prior low birth weight (less than 2,500 g) Obstetrician–gynecologist Second-trimester pregnancy loss Obstetrician–gynecologist Uterine leiomyomata or malformation Obstetrician–gynecologist Initial laboratory tests HIV Symptomatic or low CD4 count MFM subspecialist CDE (Rh) or other blood group MFM subspecialist isoimmunization (excluding ABO, Lewis) Initial examination—condylomata (extensive, Obstetrician–gynecologist covering vulva or vaginal opening) Abbreviations: AHA, American Heart Association HIV, human immunodeficiency virus MFM, maternal–fetal medicine MI, myocardial infarction PKU, phenylketonuria PROM, premature rupture of membranes. *At the time of consultation, continued patient care should be determined to be by col- laboration with the referring care provider or by transfer of care. Modified with permission from March of Dimes Birth Defects Foundation, Committee on Perinatal Health. Toward improving the outcome of pregnancy: the 90s and beyond. White Plains, New York: March of Dimes Birth Defects Foundation, 1993.
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