S-0.1, r. 4 - Regulation respecting cases requiring consultation with a physician or transfer of clinical responsibility to a physician

Updated to 12 December 2023

This document has official status.

chapter S-0.1, r. 4

Regulation respecting cases requiring consultation with a physician or transfer of clinical responsibility to a physician

Midwives Act

(chapter S-0.1, s. 5, 1st par., subpar. 3).

DIVISION I CONSULTATION

1. The midwife shall initiate a consultation with a physician in the cases for mandatory consultation prescribed in a schedule to this Regulation and shall ensure that a consultation takes place within an appropriate time period, considering the severity of the woman’s or child’s condition and the harm that could result from that condition.

O.C. 455-2004, s. 1.

2. The midwife shall inform the woman of the reasons for the consultation.

O.C. 455-2004, s. 2.

3. The midwife shall provide the physician consulted with all the information and documents relevant to the consultation and specify the case for consultation referred to in a schedule to this Regulation.

O.C. 455-2004, s. 3.

4. After the consultation, the midwife shall inform the woman of the results of the consultation and, taking into account the medical recommendations,

(1)  continue with the follow-up;

(2)  continue with the follow-up during the period of simultaneous care;

(3)  transfer the clinical responsibility of the woman or child to a physician in accordance with sections 6 to 10.

O.C. 455-2004, s. 4.

DIVISION II TRANSFER

5. The midwife shall transfer the clinical responsibility of the woman or child to a physician where mandatory transfer of that responsibility is prescribed in a schedule to this Regulation.

O.C. 455-2004, s. 5.

6. The midwife shall inform the woman of the reasons for the transfer.

O.C. 455-2004, s. 6.

7. The midwife shall take the appropriate measures to facilitate the transfer according to the nature of the case of mandatory transfer.

O.C. 455-2004, s. 7.

8. The midwife who is with the woman or child at the time of transfer shall accompany the woman or child until she or he is under medical care, where the circumstances require it.

O.C. 455-2004, s. 8.

9. The midwife shall provide the physician with all the information and documents relevant to the transfer of care of the woman or child and specify the case for transfer referred to in a schedule to this Regulation.

O.C. 455-2004, s. 9.

10. In cases where the transfer is mandatory and where urgency, distance to travel or climatic conditions make the transfer impossible, the midwife must seek advice from a physician by telephone or by another appropriate means of communication.

O.C. 455-2004, s. 10.

DIVISION III FINAL

11. This Regulation replaces the Regulation respecting obstetrical and neonatal risks (O.C. 413-93, 93-04-07).

O.C. 455-2004, s. 11.

12. (Omitted).

O.C. 455-2004, s. 12.

SCHEDULE I

(ss. 1 and 5)

CLASSIFICATION: HISTORY

Cases for mandatory consultation

(1) genetic, hereditary or congenital disease that could affect the baby’s life

(2) repeated spontaneous abortions up to the 16th week without full term delivery

(3) cone biopsy of the cervix

(4) myomectomy

(5) more than 1 preterm birth

(6) more than 1 low-birth-weight infant

(7) perinatal mortality that could present a potential risk

Cases for mandatory transfer

(1) cervical amputation

(2) incompetent cervix with no history of a normal delivery

(3) repeated spontaneous abortions after the 16th week without full term delivery

(4) subarachnoid hemorrhage

(5) thromboembolic disease

(6) isoimmunization

O.C. 455-2004, sch. I.

SCHEDULE II

(ss. 1 and 5)

CLASSIFICATION: PRESENT PREGNANCY

Cases for mandatory consultation

(1) age less than 14 years

(2) thrombocytopenia

(3) Crohn’s disease

(4) ulcerative colitis

(5) mitral valve prolapse

(6) risks related to a pathology that could influence the course of the present pregnancy, for example: endocrine, hepatic, neurologic, psychiatric, heart, pulmonary or renal pathologies

(7) the mother’s use of medication, drugs or alcohol having a potential impact on the fetus or newborn

(8) active cancer

(9) severe vomiting of pregnancy

(10) suspected extrauterine pregnancy

(11) uterine malformation

(12) presence of fibroid

(13) abnormal cervical smear test

(14) sexually transmitted diseases: gonorrhea, syphilis, chlamydia

(15) seroconversion during pregnancy for herpes

(16) infectious contact of a non-immunized woman with hepatitis, measles or chickenpox

(17) anemia: less than 100 g/litre Hb unresponsive to treatment

(18) threatened preterm labour

(19) bleeding of unknown origin after 20 weeks

(20) polyhydramnios or oligohydramnios

(21) any diagnosed foetal anomaly

(22) presentation other than cephalic after 37 weeks

(23) pregnancy at 42 weeks

Cases for mandatory transfer

(1) insulin-dependent diabetes

(2) Addison’s and Cushing’s disease

(3) collagenosis

(4) hyperthyroidism

(5) multiple sclerosis

(6) hypertension

(7) active tuberculosis

(8) HIV seropositivity and AIDS

(9) seroconversion during pregnancy for the following infectious diseases: toxoplasmosis, rubella, cytomegalovirus, HIV and tuberculosis

(10) cardiac, renal or respiratory disease with failure

(11) presence of significant irregular antibodies

(12) thrombocytopenia, if severe

(13) coagulation abnormality

(14) incompetent cervix

(15) extrauterine pregnancy

(16) multiple gestation

(17) placental abruption

(18) placenta praevia

(19) intrauterine growth retardation

(20) uncontrolled glucose intolerance of pregnancy

(21) preeclampsia or eclampsia

(22) HELLP syndrome

(23) intrauterine death

O.C. 455-2004, sch. II.

SCHEDULE III

(ss. 1 and 5)

CLASSIFICATION: LABOUR AND DELIVERY

Cases for mandatory consultation

(1) prolonged rupture of membranes

(2) failure to progress in active labour

(3) retained placenta

(4) third or fourth degree perineal laceration

(5) delivery will take place between 34 and 36 6/7 weeks

(6) labour begins after 42 weeks

(7) thick or particulate meconium-stained amniotic fluid

(8) unusual blood loss during labour

(9) suspected placental abruption

(10) suspected chorioamnionitis

Cases for mandatory transfer

(1) labour begins before 34 weeks

(2) any presentation other than vertex

(3) multiple gestation

(4) intrauterine death

(5) active genital herpes

(6) hypertension with diastolic pressure above 90 mm Hg for more than 2 hours

(7) signs or symptoms of preeclampsia or eclampsia

(8) vasa praevia palpated during a vaginal examination

(9) cord prolapse

(10) placenta praevia

(11) foetal distress

(12) arrest of descent of presenting part during the second stage

(13) obstetric shock

(14) hemorrhage unresponsive to treatment

(15) suspected uterine rupture

(16) uterine inversion

O.C. 455-2004, sch. III.

SCHEDULE IV

(ss. 1 and 5)

CLASSIFICATION: POSTPARTUM (MATERNAL)

Cases for mandatory consultation

(1) subinvolution of the uterus unresponsive to treatment

(2) persistent bleeding unresponsive to treatment

(3) suspected partially retained placenta

(4) vulval hematoma causing problems of micturition

(5) infection of the perineal wound

(6) uterine prolapse

(7) serious psychological problems

(8) suspected preeclampsia

Cases for mandatory transfer

(1) severe infection

(2) postpartum psychosis

(3) phlebitis and risk of thromboembolism

(4) suspected uterine rupture

(5) eclampsia

(6) persistent hypertension

O.C. 455-2004, sch. IV.

SCHEDULE V

(ss. 1 and 5)

CLASSIFICATION: NEWBORN

Cases for mandatory consultation

(1) abnormal pigmentation

(2) birth trauma

(3) enlarged fontanelles according to criteria in effect

(4) palpable thyroid gland

(5) 1 major malformation or 2 or more minor malformations suspected or apparent at birth

(6) suspected spina bifida

(7) abnormal crying

(8) absent or abnormal primitive reflexes after sequential evaluation

(9) abnormal neurological signs

(10) heart murmur

(11) hepatomegaly > 3 cm below costal margin

(12) palpable spleen

(13) single umbilical artery

(14) inguinal mass

(15) testicular mass at birth

(16) undescended or impalpable testes

(17) 36-36 6/7 weeks gestational age

(18) clinical examination suggesting gestational age less than 37 weeks

(19) persistant tachypnea at more than 60 respirations/minute

(20) weight below the 3rd percentile

(21) failure to regain birth weight after 14 days of life, unresponsive to treatment

(22) slow or poor infant weight gain according to the growth curve adapted to the sex and race

(23) inappropriate growth less than the 3rd percentile or greater than the 97th percentile according to the head circumference curve

(24) asymmetrical skull (absence of round shape) after 3 days

(25) irritability, hypertonia if more than 24 hours

(26) anuria beyond 24 hours of life

(27) absence of the passage of meconium after 24 hours of life

(28) abnormal laboratory results that may have a clinical impact

(29) jaundice requiring phototherapy

(30) persistent jaundice after 14 days of life

(31) suspected infections in the baby, or in the mother, having a potential impact on the baby

(32) periumbilical erythema compatible with an omphalitis

(33) skin eruption other than neonatal erythema or diaper rash

(34) purulent eye discharge with redness of the conjunctiva

(35) heart beat which is abnormal or irregular, less than 100 beats/min or more than 200 beats/min

(36) impalpable or asymmetrical femoral pulses

(37) absent red reflex of the eye

(38) abdominal mass

(39) hip instability or subluxation of the hips

(40) bulging anterior fontanelle

Cases for mandatory transfer

(1) hypothermia (36 °C rectal or 35.5 °C axillary) persisting beyond 2 hours of life or hyperthermia (38.5 °C rectal or 38 °C axillary) persisting beyond 12 hours of life

(2) respiratory distress or apnoea

(3) jaundice within the first 24 hours

(4) less than 36 weeks gestational age

(5) APGAR less than 7 at 5 minutes

less than 9 at 10 minutes

(6) central cyanosis

(7) newborn having required endotracheal intubation or positive pressure ventilation beyond the second minute of life

(8) any major anomaly requiring immediate intervention

(9) persistent pallor beyond 1 hour of life

(10) unilateral or bilateral choanal atresia

(11) jitteriness or convulsions

(12) lethargy or hypotonia

(13) generalized ecchymoses or petechiae

(14) signs of withdrawal

(15) distended abdomen with food intolerance

(16) gastrointestinal hemorrhage

(17) vomiting bile or diarrhea

O.C. 455-2004, sch. V.

REFERENCES

O.C. 455-2004, 2004 G.O. 2, 1633