1. (1) A low risk of adverse birth outcomes indicates a clinical scenario for which there is not clear demonstratable benefit for a medical intervention or transfer to a physician's care.
2. (2) Consultation with a physician does not preclude a low risk of adverse birth outcomes.
3. (3) Preexisting arrangements for emergency transportation to a nearby hospital if needed do not preclude a low risk of adverse birth outcomes.

4. (4) The following conditions preclude a low risk of adverse birth outcomes.

   1. (a) Pre-existing conditions (not gynecological):

      1. (i) subarachnoid hemorrhage, aneurysm;
      2. (ii) recent or acute herniated nucleus pulposus;
      3. (iii) active tuberculosis or ongoing treatment;
      4. (iv) human immunodeficiency virus, acquired immunodeficiency syndrome, hepatitis B or hepatitis C;
      5. (v) heart defect with hemodynamic consequences;
      6. (vi) clotting disorders;
      7. (vii) kidney dysfunction;
      8. (viii) hypertension;
      9. (ix) diabetes mellitus;
      10. (x) unmedicated thyroid disorders with present TSH receptor antibodies;
      11. (xi) inflammatory bowel disease, including ulcerative colitis and Crohn's disease;
      12. (xii) systemic and rare disorders, including Addison's disease, Cushing's syndrome, systemic lupus erythematosus, antiphospholipid syndrome, scleroderma, rheumatoid arthritis, polyarteritis nodosa, Raynaud's disease, and Marfan syndrome;
      13. (xiii) illegal drug use; or
      14. (xiv) alcoholism.

   2. (b) Pre-existing gynecological conditions:

      1. (i) pelvic floor reconstruction;
      2. (ii) conization;
      3. (iii) myomectomy or other uterine surgery; or
      4. (iv) uterine distortion, including bicornuate, septate, unicornuate, or didelphic conditions.

   3. (c) Obstetric history:

      1. (i) blood group antagonism, including Rhesus, Kell, Duffy, and Kidd glycoproteins;
      2. (ii) previous pre-term (before 34 weeks) birth. If a normal pregnancy occurred after the premature birth, the current birth may be considered to be low risk;
      3. (iii) cervical insufficiency or cerclage;
      4. (iv) placental abruption;
      5. (v) caesarean section - must transfer current pregnancy at 37 weeks if no reason for transfer prior;
      6. (vi) dysmaturity;
      7. (vii) uncontrolled post-partum hemorrhage;
      8. (viii) manual placental removal;
      9. (ix) placenta accreta; and
      10. (x) total uterine rupture with no functional recovery; or
      11. (xi) history of intrauterine fetal demise.

   4. (d) Occurring or diagnosed during pregnancy:

      1. (i) rubella;
      2. (ii) cytomegalovirus;
      3. (iii) genital herpes (primo infection);
      4. (iv) parvovirus;
      5. (v) tuberculosis;
      6. (vi) human immunodeficiency virus or acquired immunodeficiency syndrome;
      7. (vii) syphilis;
      8. (viii) illegal drug use;
      9. (ix) alcoholism;
      10. (x) maternal anemia;
      11. (xi) extrauterine pregnancy;
      12. (xii) amniotic fluid loss or preterm labor before 37 weeks;
      13. (xiii) uncontrolled diabetes mellitus;
      14. (xiv) gestational diabetes mellitus;
      15. (xv) gestational hypertension with diastolic blood pressure above 100 or systolic blood pressure above 160;
      16. (xvi) preeclampsia, superimposed preeclampsia, hemolysis, or elevated liver enzymes and low platelets (HELLP) syndrome;
      17. (xvii) blood group antagonism;
      18. (xviii) deep vein thrombosis;
      19. (xix) clotting disorders;
      20. (xx) vasa previa;
      21. (xxi) velamentous cord insertion;
      22. (xxii) placenta previa;
      23. (xxiii) placental abruption;
      24. (xxiv) serotonin syndrome;
      25. (xxv) cervical insufficiency prior to 37 weeks of gestation;
      26. (xxvi) multiple pregnancy;
      27. (xxvii) breech or abnormal position at term; or
      28. (xxviii) fetal mortality; or
      29. (xxix) prolonged gestation > 42 weeks.

Authorizing statute(s): 37-1-131, MCA

Implementing statute(s): 37-8-202, MCA

History: NEW, 2023 MAR p. 1561, Eff. 11/4/23.