59855 Induced abortion, by 1 or more vaginal suppositories (eg, prostaglandin) with or without cervical dilation (eg, laminaria), including hospital admission and visits, delivery of fetus and secundines

Name of the Procedure:

Induced Abortion by Vaginal Suppositories (Prostaglandin) with or without Cervical Dilation

Summary

This procedure involves the medical termination of a pregnancy using vaginal suppositories that contain prostaglandin. It may include the dilation of the cervix using materials like laminaria. The procedure is generally performed in a hospital setting and includes hospital admission, visits, and the delivery of the fetus and secundines (placenta and other tissues).

Purpose

The procedure is used to terminate an unwanted or non-viable pregnancy. The goal is to safely and effectively complete the abortion process in a controlled medical environment.

Indications

• Unwanted pregnancy
• Non-viable pregnancy (e.g., severe fetal anomalies)

• Health risks to the mother (e.g., preeclampsia)

  Patient criteria:

• Confirmed intrauterine pregnancy
• Desire for termination within a legal gestational limit
• Informed consent

Preparation

• Fasting may be required a few hours prior.
• Discontinuation of certain medications as advised by the doctor.
• Initial health assessment and ultrasound to confirm gestational age and rule out ectopic pregnancy.
• Blood tests may be conducted to ensure no underlying health concerns.

Procedure Description

1. The patient is admitted to the hospital.
2. Pre-procedure checks and vital signs monitoring are conducted.
3. Vaginal suppositories containing prostaglandin are inserted into the vagina.
4. Cervical dilation may be initiated using laminaria (seaweed sticks that absorb moisture and expand the cervix).
5. The patient is monitored for the onset of uterine contractions and progression of the abortion.
6. The delivery of the fetus and secundines is assisted as needed.
7. Post-abortion care includes ensuring all tissues have been expelled and monitoring for any complications.

Duration

The procedure can take several hours to a day, depending on the patient's response to the medication.

Setting

This is typically performed in a hospital setting.

Personnel

• Obstetricians/Gynecologists
• Nurses
• Anesthesiologists (if sedation is required)
• Support staff

Risks and Complications

• Common: Pain, bleeding, cramping, nausea.
• Rare: Infection, heavy bleeding, injury to the uterus, incomplete abortion requiring further intervention.
• Emergency complications: Hemorrhage, severe infection.

Benefits

• Safe termination of pregnancy.
• High success rate.
• Control over reproductive health.

Recovery

• Monitoring in the hospital for a few hours to ensure there are no immediate complications.
• Discharge with pain relief medication and antibiotics if necessary.
• Follow-up visit after a week to ensure complete recovery and absence of complications.
• Avoid heavy lifting and strenuous activity for a few days.

Alternatives

• Medical abortion using oral medications (e.g., mifepristone followed by misoprostol).

• Surgical abortion (e.g., vacuum aspiration or dilation and curettage).

  Each alternative has its own set of pros and cons which should be discussed with the healthcare provider.

Patient Experience

• The patient may experience cramping and bleeding similar to a heavy menstrual period.
• Pain can be managed with prescribed medications.
• Emotional support from healthcare providers, family, or counseling services is advised.