The UAMS High-Risk Pregnancy Program within the UAMS Institute for Digital Health & Innovation is a network of obstetricians, family practice physicians, maternal-fetal medicine specialists, pediatricians and neonatologists in Arkansas who collaborate to ensure high-risk pregnancy cases receive appropriate clinical care.
This innovative initiative is a joint program of UAMS and the Arkansas Department of Human Services.
The supplied table serves as a reference to identify:
- high-risk situations in which primary care is appropriate and
- high-risk situations in which the UAMS High-Risk Pregnancy Program can provide consultation, co-management, or assumption of care.
As part of our many services, the UAMS High-Risk Pregnancy Program provides guidelines for best practices in obstetrical and neonatal care, weekly educational teleconferences, facilitation of maternal transport, coordination of subspecialty care for fetal anomalies, and complete reporting and follow-up for referring physicians.
To access the guidelines, visit the Angels Guidelines website to view, download or bookmark for easy access.
The UAMS High-Risk Pregnancy Program thrives on the input and participation of providers around the state of Arkansas. We appreciate your questions and suggestions. Please contact us at 866-273-3835 if we may further assist you.
Levels of Care
The suggested levels of clinical care were developed to aid health care providers in making decisions about appropriate care for high-risk pregnancy cases. The guidelines and suggested levels of care are not intended to dictate an exclusive course of treatment. The needs of the individual patient, resources available, and limitations unique to the institution or type of practice may warrant variations.
Past Medical History / Conditions
| History or Condition | Level of Care |
|---|---|
| Asthma — Asymptomatic | *Primary Provider |
| Asthma — Symptomatic on medication | *Primary Provider *MFM consultation recommended. (After consultation, select patients may be co-managed.) |
| Asthma — Severe (multiple hospitalizations) | * MFM specialists should assume care *MFM consultation recommended. (After consultation, select patients may be co-managed.) |
| Maternal cardiac disease — Cyanotic, prior MI, prosthetic valve | *MFM specialists should assume care *MFM consultation recommended. (After consultation, select patients may be co-managed.) |
| Maternal cardiac disease — NAHA Class > II, history of cardiac surgery | MFM specialists should assume care |
| Maternal cardiac disease — Congenital heart disease | Primary Provider |
| Maternal cardiac disease — Pulmonary hypertension | MFM specialists should assume care |
| Maternal cardiac disease — Other valvular disease | Primary Provider |
| Diabetes — Gestational Diabetes, managed by diet | Primary Provider |
| Diabetes — Gestational Diabetes, managed by medication | Primary Provider |
| Diabetes — Type II | Primary Provider |
| Diabetes — Type I | Primary Provider |
| Drug/alcohol use* | Primary Provider |
| Epilepsy (on medication) | Primary Provider |
| Family history of genetic problems (e.g., Down Syndrome, Tay Sachs) | Primary Provider |
| Hemoglobinopathy (SS, SC, S-thal disease) | MFM specialists should assume care |
| Hypertension — Chronic, with renal or heart disease | MFM specialists should assume care |
| Hypertension — Chronic, on medication or diastolic < 90 | Primary Provider; Consider MFM consultation |
| Obesity | Primary Provider |
| Psychiatric disease (significant)* (e.g., psychoses, schizophrenia, manic-depressive, multiple prescriptions) | Consider MFM consultation; MFM consultation recommended (After consultation, select patients may be co-managed); |
| Psychiatric disease (mild)* (anxiety, depression) | Primary Provider |
| Pulmonary disease — Severe obstructive pulmonary disease, ARDS | MFM specialists should assume care |
| Renal disease — Chronic, creatinine > 1.5 with or without hypertension | MFM specialists should assume care |
| Renal disease — Chronic, other | Primary Provider |
| Autoimmune Disorders — SLE | MFM specialists should assume care |
| Autoimmune Disorders — Controlled thyroid disease | Primary Provider; Consider MFM consultation |
| Autoimmune Disorders — Uncontrolled thyroid disease | Primary Provider |
| Marfan’s syndrome or other major connective tissue disease | MFM specialists should assume care |
| Hx of intracranial injury (e.g., stroke, A.V. malformation, aneurysm) | MFM specialists should assume care |
| Maternal spina bifida | Primary Provider |
| Gastric bypass | Primary Provider |
| Thrombophilias — Prior pulmonary embolus/deep vein thrombosis | Primary Provider |
| Thrombophilias — Hypercoagulable State (e.g. protein S/C def, ATIII deficiency) | Primary Provider |
| Thrombophilias — Prolonged anticoagulation (therapeutic levels) | MFM specialists should assume care |
Other History / Conditions
| History or Condition | Level of Care |
|---|---|
| Age > 35 at delivery | Primary Provider; MFM consultation recommended (After consultation, select patients may be co-managed) |
| Cesarean delivery, prior classical or vertical | Primary Provider; Consider MFM consultation |
| Cervical Insufficiency | Primary Provider; MFM consultation recommended (After consultation, select patients may be co-managed) |
| Prior history of Preterm Delivery <34 weeks | Primary Provider; MFM consultation recommended (After consultation, select patients may be co-managed) |
| Prior fetal structural or chromosomal abnormality | Primary Provider; MFM consultation recommended (After consultation, select patients may be co-managed) |
| Prior neonatal death | Primary Provider; MFM consultation recommended (After consultation, select patients may be co-managed) |
| Prior stillbirth | Primary Provider; MFM consultation recommended (After consultation, select patients may be co-managed) |
| Prior preterm delivery or preterm PROM | Primary Provider; MFM consultation recommended (After consultation, select patients may be co-managed) |
| Prior low birthweight (< 2500 gm) | Primary Provider; MFM consultation recommended (After consultation, select patients may be co-managed) |
| Second trimester pregnancy loss | Primary Provider; MFM consultation recommended (After consultation, select patients may be co-managed) |
| Uterine leiomyomata or malformation | Primary Provider; Consider MFM consultation |
Examination / Laboratory Findings
| Examination or Laboratory Finding | Level of Care |
|---|---|
| Abnormal Quad Screen (low or high) | Primary Provider; MFM consultation recommended (After consultation, select patients may be co-managed) |
| Abnormal First Trimester Screening | Primary Provider; MFM consultation recommended (After consultation, select patients may be co-managed) |
| Abnormal NIPT/cffDNA | Primary Provider; MFM consultation recommended (After consultation, select patients may be co-managed) |
| Abnormal Pap smear | Primary Provider |
| Anemia (HCT < 28% unresponsive to iron therapy) | Primary Provider; MFM consultation recommended (After consultation, select patients may be co-managed) |
| Condylomata (extensive, covering labia/vagina) | Primary Provider; Consider MFM consultation |
| HIV | MFM consultation recommended (After consultation, select patients may be co-managed) |
| Rh/other blood group isoimmunizations (excluding ABO, Lewis) | Primary Provider; MFM consultation recommended (After consultation, select patients may be co-managed) |
Medical Conditions During Pregnancy
| Condition | Level of Care |
|---|---|
| Drug/alcohol use* | Primary Provider; Consider MFM consultation |
| Pyelonephritis | Primary Provider; Consider MFM consultation |
| DVT/pulmonary embolus | Primary Provider; MFM consultation recommended (After consultation, select patients may be co-managed) |
| Breast cancer | MFM consultation recommended (After consultation, select patients may be co-managed) |
| Cancer, other | MFM consultation recommended (After consultation, select patients may be co-managed) |
* Consider referral to Women’s Mental Health Provider
Current Obstetrical History / Conditions
| History or Condition | Level of Care |
|---|---|
| Proteinuria (>4gms by 24º urine collection) | Primary Provider; MFM specialists should assume care |
| Blood pressure elevation (diastolic > 90), no proteinuria | MFM consultation recommended (After consultation, select patients may be co-managed); |
| Preeclampsia (mild) | Consider MFM consultation |
| Preeclampsia (severe) | MFM consultation recommended (After consultation, select patients may be co-managed); |
| IUGR diagnosis | MFM consultation recommended (After consultation, select patients may be co-managed); |
| Fetal abnormality suspected by ultrasound | MFM consultation recommended (After consultation, select patients may be co-managed); |
| Fetal demise | Consider MFM consultation |
| Gestational age 41 weeks (to be seen by 42 weeks) | Primary Provider |
| Diabetes — Gestational Diabetes | MFM consultation recommended (After consultation, select patients may be co-managed); |
| Diabetes — Type II | MFM consultation recommended (After consultation, select patients may be co-managed); |
| Diabetes — Type I | Primary Provider; MFM consultation recommended (After consultation, select patients may be co-managed); MFM specialists should assume care |
| Herpes, active lesions 36 weeks | Consider MFM consultation |
| Polyhydramnios by ultrasound — Severe, < 34 weeks | Primary Provider; MFM consultation recommended (After consultation, select patients may be co-managed); MFM specialists should assume care |
| Polyhydramnios by ultrasound — Severe, > 34 weeks | Consider MFM consultation |
| Hyperemesis, persisting beyond first trimester | MFM consultation recommended (After consultation, select patients may be co-managed); |
| Multiple gestation — >3 | Primary Provider; MFM consultation recommended (After consultation, select patients may be co-managed); MFM specialists should assume care |
| Multiple gestation — Twins — Monoamniotic | Primary Provider; MFM specialists should assume care |
| Multiple gestation — Twins — Conjoined | Primary Provider; MFM specialists should assume care |
| Multiple gestation — Twins — Monochorionic | MFM consultation recommended (After consultation, select patients may be co-managed); |
| Multiple gestation — Twins — Dichorionic, normal growth | Primary Provider |
| Multiple gestation — Twins — Discordant | MFM consultation recommended (After consultation, select patients may be co-managed); |
| Obesity | MFM consultation recommended (After consultation, select patients may be co-managed); |
| Oligohydramnios by ultrasound — <34 weeks | MFM consultation recommended (After consultation, select patients may be co-managed); |
| Oligohydramnios by ultrasound — >34 weeks | Consider MFM consultation |
| Preterm labor, threatened, < 34 weeks | Consider MFM consultation |
| Preterm labor, threatened, < 34 weeks — Documented cervical change | MFM consultation recommended (After consultation, select patients may be co-managed); |
| Prelabor Rupture of Membranes (PROM) — <34 weeks | MFM consultation recommended (After consultation, select patients may be co-managed); |
| Prelabor Rupture of Membranes (PROM) — >34 weeks | Primary Provider |
| Placenta accreta (diagnosed antepartum) | Primary Provider; MFM consultation recommended (After consultation, select patients may be co-managed); MFM specialists should assume care |
| Placenta previa | Consider MFM consultation |